Mapping and Size Estimation of Key Populations on HIV Surveillance in Nepal

Introduction: The HIV epidemic in Nepal is mainly concentrated among key populations, including people who inject drugs, gay men and other men who have sex with men, transgender people, female sex workers, and male labor migrants and their spouses. In countries with this type of concentrated HIV epidemic, the size of the key population estimation is important to address the national epidemic. Objectives: The study has been designed to estimate the district and national level size of key populations at risk of HIV infection and providing a foundation for policy and programing and to guide the national response to address HIV epidemic. Methods: This is a prospective mapping exercise study done in 44 districts of Nepal. Semi-structured interview were carried out among key populations members as well as non-key population key informants who were familiar with the local situation in and around the high prevalence areas. The study was conducted from August until November 2016. The collected data has been complied on Census and Survey Processing System and analyzed using Statistical Package for the Social Science software package 16 version. Results: The national estimates of key populations were FSW around 54,207, MSM/MSW/TG around 112,150 of which men having sex with men were 67,292. The PWID individuals range around 34,487. Conclusion: To fast track the response to achieve global 90-90-90 targets for the continuum of prevention to care, the country is updating its understanding of key population sizes and risk behaviors in different geographical area.

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Mapping and size estimation of hidden key populations in low-income setting experiencing concentrated HIV epidemic: the case of Nepal (Preprint)

10.2196/preprints.11269 ◽

2018 ◽

Author(s):

Keshab Deuba ◽

Upendra Shrestha ◽

Bir Bahadur Rawal ◽

Rajan Bhattarai ◽

Bishnu Prasad Shrestha ◽

...

Keyword(s):

Low Income ◽

Sex Workers ◽

National Level ◽

Relevant Information ◽

District Level ◽

Key Populations ◽

Size Estimation ◽

Hiv Epidemic ◽

Adjustment Factors ◽

Mapping Exercise

BACKGROUND Most low-income settings experiencing concentrated HIV epidemic lack information about key populations (KPs), including people who inject drugs (PWID), men who have sex with men (MSM), male sex workers (MSW), transgender (TG) and female sex workers (FSW) because they are hidden and marginalised in society and frequently undocumented. Out of several approaches to size estimation, mapping and size estimation is particularly useful when local estimates are needed for planning and monitoring of prevention programmes. OBJECTIVE To locate hot spots related to sex work, cruising spots, and injecting drug use, and to estimate the number of sex workers, PWID, MSM, MSW and TG at the district level (adjusting for double-counting, frequency of visiting spots, and low visibility), and at the national level using extrapolation algorithms . METHODS The mapping exercise among MSM, MSW, TG, PWID and FSW was carried out in 44 districts of Nepal between July and November 2016 by collecting relevant information directly from hotspots where KPs members congregate. Districts to be mapped were selected purposively, to both provide data to local programmes in areas with high concentrations of KPs, and inform extrapolation to unmapped districts as part of national estimation procedures. RESULTS Altogether 11056 KPs and 10977 non- KPs informants were interviewed from across the 44 mapped districts to identify the hotspots. District level adjustment factors (mobility adjustment, frequency adjustment and invisibility adjustment) were sequentially applied. The final estimates used all three adjustment factors. We found that the national estimate of FSW in Nepal ranges between 43,829 to 54,207. The national estimate of MSM/TG lies between 88,009 and 112,150, of which a minimum of 18,704 and maximum 24,216 are TG, and a minimum 53,373 and maximum 67,292 are MSM. And finally the national estimate of PWID ranges between 27,248 to 34,487. Among them, a minimum 24,572 and a maximum 30,561 are men, and minimum 2,676 and maximum 3,926 are women. CONCLUSIONS The size of KPs provided through mapping exercise can be utilised for setting benchmarks and measuring program coverage. The major limitation is that mapping may count the majority of KPs who visit hotspots on a very regular basis, while missing the subset who are not “hotspot based” or who visit hotspots less frequently. However, the strength of mapping is that it reflects hands-on knowledge and experience of people who have access to communities that outside researchers may not have, thereby accounting for people who might otherwise be invisible.

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Developing HIV assisted partner notification services tailored to Mexican key populations: a qualitative approach

BMC Public Health ◽

10.1186/s12889-021-10612-3 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Heleen Vermandere ◽

Santiago Aguilera-Mijares ◽

Liliane Martínez-Vargas ◽

M. Arantxa Colchero ◽

Sergio Bautista-Arredondo

Keyword(s):

Partner Notification ◽

Key Populations ◽

Structured Interviews ◽

Hiv Diagnosis ◽

Serostatus Disclosure ◽

Hiv Epidemic ◽

Contact Information ◽

Hiv Awareness ◽

Sex With Men ◽

The Individual

Abstract Background Assisted partner notification services (APNS) may increase HIV testing, early diagnosis, and treatment, but they are not formally implemented in Mexico, where the HIV epidemic is concentrated in men who have sex with men (MSM) and transwomen (TW). This study aimed to explore the awareness of and need for HIV partner notification, as well as to outline potential strategies for APNS based on identified barriers and facilitators. Methods We conducted semi-structured interviews to explore partner notification with MSM, TW, and counselors. Afterwards, brainstorm sessions were carried out to produce strategies for implementing APNS. Results Most participants reported experiences with informal partner notification and serostatus disclosure, but not with APNS. Only one counselor indicated assisting notification systematically. The main barriers for notifying or disclosing mentioned by both MSM and TW included fear of (violent) reactions, discrimination and lacking contact information of casual partners. Participants thought it was easier to inform a formal partner, conditional of being well informed about HIV. Given current stigma and lack of awareness, it was suggested that APNS should be preceded by HIV awareness efforts, and be provided by counselors or peers to mitigate potential rejection or violent reactions. Conclusions While APNS are not formally implemented in Mexico, all participants supported the service, indicating that APNS could potentially enhance early HIV diagnosis in Mexico. Strategies to implement such services need to be flexible addressing the individual needs of participants, guaranteeing the safety of more vulnerable participants.

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Mapping key population hotspots in Nigeria for targeted HIV program planning (Preprint)

10.2196/preprints.25623 ◽

2020 ◽

Author(s):

Julia Lo ◽

Samuel U. Nwafor ◽

Amee M. Schwitters ◽

Andrew Mitchell ◽

Victor Sebastian ◽

...

Keyword(s):

Sex Workers ◽

Program Planning ◽

The United States ◽

Size Estimation ◽

Emergency Plan ◽

Targeted Interventions ◽

Key Population ◽

The Social ◽

Capture Recapture ◽

Sex With Men

BACKGROUND With the fourth highest HIV burden globally, Nigeria is characterized as having a mixed HIV epidemic with high HIV prevalence among key populations (KP), including female sex workers (FSW), men who have sex with men (MSM), and people who inject drugs (PWID). Reliable and accurate mapping of KP hotspots is necessary for strategic placement of services and allocation of limited resources for targeted interventions. OBJECTIVE We aimed to map and develop a profile for FSW, MSM, and PWID hotspots in seven states of Nigeria to inform HIV prevention and service programming and in preparation for a multiple-source capture-recapture population size estimation effort. METHODS In August 2018, 261 trained data collectors from 36 KP-led community-based organizations (CBOs) in seven priority states in Nigeria mapped, validated, and profiled hotspots identified during the formative assessment and designated by the United States President’s Emergency Plan for AIDS Relief (PEPFAR). Hotspots were defined as physical venues where KP members frequent to socialize, seek clients and/or engage in KP-defining behaviors. Hotspots were visited by data collectors and each hotspot’s name, local government area (LGA), address, type, geographic coordinates, peak times of activity, and estimated number of KP members were recorded. The number of KP hotspots per LGA were tabulated from the final list of hotspots. RESULTS A total of 13,899 KP hotspots were identified and mapped in the seven states, including 1,297 in Akwa Ibom, 1,714 in Benue, 2,666 in Cross River, 2,974 in Lagos, 1,550 in Nasarawa, 2,494 in Rivers and 1,204 in the Federal Capital Territory. The most common hotspots were those frequented by FSW (69.0%), followed by PWID (19.6%), and MSM (11.3%). More hotspots were found in metropolitan LGAs and state capitals, although hotspots were identified in all LGAs visited. CONCLUSIONS A total of 13,899 KP hotspots in the seven states were identified; more than previously reported in similar studies in Nigeria. Close collaboration with KP-led CBOs facilitated identification of many new and previously undocumented KP hotspots in the seven states. The small number of MSM hotspots (n=1,577) relative to FSW (n=9,593) and PWID (n=2,729) hotspots may reflect the social pressure and stigma faced by this population since the 2014 Same Sex Marriage (Prohibition) Act (SSMPA), which makes it illegal to engage in intimate relationships, organize meetings of gays or patronize gay businesses. CLINICALTRIAL

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Knowledge and Use of PEP and PrEP Among Key Populations Tested in Community Centers in Portugal

Frontiers in Public Health ◽

10.3389/fpubh.2021.673959 ◽

2021 ◽

Vol 9 ◽

Author(s):

Daniel Simões ◽

Paula Meireles ◽

Miguel Rocha ◽

Rosa Freitas ◽

Ana Aguiar ◽

...

Keyword(s):

Sex Workers ◽

Post Exposure Prophylaxis ◽

Key Populations ◽

Community Centers ◽

Counseling And Testing ◽

Key Population ◽

Hiv Test ◽

Sex With Men ◽

Exposure Prophylaxis ◽

Male To Female

Background: Pre-exposure prophylaxis (PrEP) and post-exposure prophylaxis (PEP) have been increasingly available in Europe. Due to the high burden of HIV in key populations, these could benefit from their use. In 2016, in Portugal, an open, non-interval, prospective cohort study was established in a network of 26 community-based voluntary HIV/STI counseling and testing centers. Data collected included questions on PEP and PrEP knowledge and use. We aimed to estimate the proportion of PEP and PrEP knowledge and its use among key populations, visiting the centers between 2016 and 2019.Method and results: Individuals who self-identify as being among at least one key population for HIV, men who have sex with men (MSM), people who inject drugs (PWID), sex workers (SW), migrants, and male-to-female transgender individuals (MTF), responded to questions on PEP and PrEP knowledge and use while waiting for their test results between 2016 and 2019 (n = 12,893 for PEP; n = 10,973 for PrEP). Reported knowledge was low in all key populations for both tools: 15.7% of respondents reported knowing about PEP and 10.9% about PrEP over the course of 4 years. PEP was used by 1.8% and PrEP by 0.4% of the respondents, MSM being 88.9% of PrEP users, and 52.8% of PEP users. Multivariate logistic regression showed multiple factors associated with knowing the tools, including age, education, country of birth, gender, year of test, having a reactive HIV test in the same visit, reporting an STI or condomless sex in the last 12 months, and identifying with being MSM or SW.Conclusions: Knowledge and use of PEP and PrEP remain low among key populations in Portugal. The need remains to increase knowledge and use among those at risk for HIV infection.

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Estimating the Size of Key Populations in Kampala, Uganda: 3-Source Capture-Recapture Study (Preprint)

10.2196/preprints.12118 ◽

2018 ◽

Author(s):

Reena H Doshi ◽

Kevin Apodaca ◽

Moses Ogwal ◽

Rommel Bain ◽

Ermias Amene ◽

...

Keyword(s):

Population Size ◽

Latent Class ◽

Latent Class Model ◽

Key Populations ◽

Size Estimation ◽

Public Health Response ◽

Hiv Epidemic ◽

Population Size Estimates ◽

Capture Recapture ◽

Size Estimates

BACKGROUND Key populations, including people who inject drugs (PWID), men who have sex with men (MSM), and female sex workers (FSW), are disproportionately affected by the HIV epidemic. Understanding the magnitude of, and informing the public health response to, the HIV epidemic among these populations requires accurate size estimates. However, low social visibility poses challenges to these efforts. OBJECTIVE The objective of this study was to derive population size estimates of PWID, MSM, and FSW in Kampala using capture-recapture. METHODS Between June and October 2017, unique objects were distributed to the PWID, MSM, and FSW populations in Kampala. PWID, MSM, and FSW were each sampled during 3 independent captures; unique objects were offered in captures 1 and 2. PWID, MSM, and FSW sampled during captures 2 and 3 were asked if they had received either or both of the distributed objects. All captures were completed 1 week apart. The numbers of PWID, MSM, and FSW receiving one or both objects were determined. Population size estimates were derived using the Lincoln-Petersen method for 2-source capture-recapture (PWID) and Bayesian nonparametric latent-class model for 3-source capture-recapture (MSM and FSW). RESULTS We sampled 467 PWID in capture 1 and 450 in capture 2; a total of 54 PWID were captured in both. We sampled 542, 574, and 598 MSM in captures 1, 2, and 3, respectively. There were 70 recaptures between captures 1 and 2, 103 recaptures between captures 2 and 3, and 155 recaptures between captures 1 and 3. There were 57 MSM captured in all 3 captures. We sampled 962, 965, and 1417 FSW in captures 1, 2, and 3, respectively. There were 316 recaptures between captures 1 and 2, 214 recaptures between captures 2 and 3, and 235 recaptures between captures 1 and 3. There were 109 FSW captured in all 3 rounds. The estimated number of PWID was 3892 (3090-5126), the estimated number of MSM was 14,019 (95% credible interval (CI) 4995-40,949), and the estimated number of FSW was 8848 (95% CI 6337-17,470). CONCLUSIONS Our population size estimates for PWID, MSM, and FSW in Kampala provide critical population denominator data to inform HIV prevention and treatment programs. The 3-source capture-recapture is a feasible method to advance key population size estimation.

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Estimates of the size of key populations at risk for HIV infection: men who have sex with men, female sex workers and injecting drug users in Nairobi, Kenya

Sexually Transmitted Infections ◽

10.1136/sextrans-2013-051071 ◽

2013 ◽

Vol 89 (5) ◽

pp. 366-371 ◽

Cited By ~ 44

Author(s):

Jerry Okal ◽

Scott Geibel ◽

Nicolas Muraguri ◽

Helgar Musyoki ◽

Waimar Tun ◽

...

Keyword(s):

At Risk ◽

Hiv Infection ◽

Sex Workers ◽

Drug Users ◽

Female Sex Workers ◽

Injecting Drug Users ◽

Key Populations ◽

Female Sex ◽

Populations At Risk ◽

Sex With Men

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Estimating the Size of Key Populations in Kampala, Uganda: 3-Source Capture-Recapture Study

JMIR Public Health and Surveillance ◽

10.2196/12118 ◽

2019 ◽

Vol 5 (3) ◽

pp. e12118 ◽

Cited By ~ 5

Author(s):

Reena H Doshi ◽

Kevin Apodaca ◽

Moses Ogwal ◽

Rommel Bain ◽

Ermias Amene ◽

...

Keyword(s):

Population Size ◽

Latent Class ◽

Latent Class Model ◽

Key Populations ◽

Size Estimation ◽

Public Health Response ◽

Hiv Epidemic ◽

Population Size Estimates ◽

Capture Recapture ◽

Size Estimates

Background Key populations, including people who inject drugs (PWID), men who have sex with men (MSM), and female sex workers (FSW), are disproportionately affected by the HIV epidemic. Understanding the magnitude of, and informing the public health response to, the HIV epidemic among these populations requires accurate size estimates. However, low social visibility poses challenges to these efforts. Objective The objective of this study was to derive population size estimates of PWID, MSM, and FSW in Kampala using capture-recapture. Methods Between June and October 2017, unique objects were distributed to the PWID, MSM, and FSW populations in Kampala. PWID, MSM, and FSW were each sampled during 3 independent captures; unique objects were offered in captures 1 and 2. PWID, MSM, and FSW sampled during captures 2 and 3 were asked if they had received either or both of the distributed objects. All captures were completed 1 week apart. The numbers of PWID, MSM, and FSW receiving one or both objects were determined. Population size estimates were derived using the Lincoln-Petersen method for 2-source capture-recapture (PWID) and Bayesian nonparametric latent-class model for 3-source capture-recapture (MSM and FSW). Results We sampled 467 PWID in capture 1 and 450 in capture 2; a total of 54 PWID were captured in both. We sampled 542, 574, and 598 MSM in captures 1, 2, and 3, respectively. There were 70 recaptures between captures 1 and 2, 103 recaptures between captures 2 and 3, and 155 recaptures between captures 1 and 3. There were 57 MSM captured in all 3 captures. We sampled 962, 965, and 1417 FSW in captures 1, 2, and 3, respectively. There were 316 recaptures between captures 1 and 2, 214 recaptures between captures 2 and 3, and 235 recaptures between captures 1 and 3. There were 109 FSW captured in all 3 rounds. The estimated number of PWID was 3892 (3090-5126), the estimated number of MSM was 14,019 (95% credible interval (CI) 4995-40,949), and the estimated number of FSW was 8848 (95% CI 6337-17,470). Conclusions Our population size estimates for PWID, MSM, and FSW in Kampala provide critical population denominator data to inform HIV prevention and treatment programs. The 3-source capture-recapture is a feasible method to advance key population size estimation.

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Prevalence of HIV among Men who Have Sex with Men (MSM) and Its Associated Factors in Sabah

Borneo Journal of Medical Sciences (BJMS) ◽

10.51200/bjms.vi.1804 ◽

2019 ◽

pp. 27

Author(s):

Valentine J. G. ◽

Diane C. ◽

Chua Y. W.

Keyword(s):

Hiv Prevention ◽

Support Services ◽

Associated Factors ◽

Sexual Practices ◽

Key Populations ◽

Legal Environment ◽

Infection Rates ◽

Hiv Epidemic ◽

Care And Support ◽

Sex With Men

Men who have sex with men (MSM) is one of the key populations affected by HIV epidemic with infection rates exceeding five percentages. Due to a strict and prohibitive socio-cultural and legal environment, male-to-male sexual practices are often misunderstood and highly stigmatised, thus creating barriers for MSM to access HIV prevention, treatment, care and support services.

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Population Size Estimate of Men Who Have Sex with Men in Essex, New Jersey, To Inform Policy and Programming

Annals of LGBTQ Public and Population Health ◽

10.1891/lgbtq-2020-0003 ◽

2021 ◽

pp. LGBTQ-2020-0003

Author(s):

Henry F. Raymond ◽

Perry N. Halkitis ◽

Christopher Menscher

Keyword(s):

New Jersey ◽

Hiv Prevention ◽

Population Size ◽

Unmet Need ◽

Size Estimation ◽

Essex County ◽

Populations At Risk ◽

Population Size Estimates ◽

Sex With Men ◽

Hiv Negative

BackgroundPopulation size estimates for key populations at risk for and living with HIV infection are key to understanding the need for and impact of HIV prevention and care. In this brief report we demonstrate approaches to estimating population size and unmet need for prevention and care among gay, bisexual, and other men who have sex with men (MSM) in Essex County, New Jersey.MethodsWe employed literature/census denominator and component methods of size estimation. We applied additional data points available electronically or in the published literature to estimate the number of undiagnosed MSM, the number of HIV negative men MSM in need of prevention programming.ResultsWe estimate a total of 11,362 MSM living in Essex County, New Jersey, of which 2,550 are HIV infected and of those 408 are not diagnosed. We estimate 8,812 HIV negative MSM in need of HIV prevention programs.ConclusionsThese estimates will allow future resources to be deployed in a more targeted and strategic manner, thereby bringing Essex County and New Jersey closer to achieving the 90-90-90 goals.

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