Oliver Stevens, Keith Sabin, Rebecca L Anderson, Sonia Arias Garcia, Kalai Willis, Amrita Rao, Anne F McIntyre, Elizabeth Fearon, Emilie Grard, Alice Stuart-Brown, Frances Cowan, Louisa Degenhardt, James Stannah, Jinkou Zhao, Avi J Hakim, Katherine Rucinski, Isabel Sathane, Makini Boothe, Lydia Atuhaire, Peter S Nyasulu, Mathieu Maheu-Giroux, Lucy Platt, Brian Rice, Wolfgang Hladik, Stefan Baral, Mary Mahy, Jeffrey W Imai-Eaton
{"title":"撒哈拉以南非洲主要人群的人口规模、艾滋病毒感染率和抗逆转录病毒疗法覆盖率：2010-23 年调查数据的整理与综合。","authors":"Oliver Stevens, Keith Sabin, Rebecca L Anderson, Sonia Arias Garcia, Kalai Willis, Amrita Rao, Anne F McIntyre, Elizabeth Fearon, Emilie Grard, Alice Stuart-Brown, Frances Cowan, Louisa Degenhardt, James Stannah, Jinkou Zhao, Avi J Hakim, Katherine Rucinski, Isabel Sathane, Makini Boothe, Lydia Atuhaire, Peter S Nyasulu, Mathieu Maheu-Giroux, Lucy Platt, Brian Rice, Wolfgang Hladik, Stefan Baral, Mary Mahy, Jeffrey W Imai-Eaton","doi":"10.1016/S2214-109X(24)00236-5","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Key population HIV programmes in sub-Saharan Africa require epidemiological information to ensure equitable and universal access to effective services. We aimed to consolidate and harmonise survey data among female sex workers, men who have sex with men, people who inject drugs, and transgender people to estimate key population size, HIV prevalence, and antiretroviral therapy (ART) coverage for countries in mainland sub-Saharan Africa.</p><p><strong>Methods: </strong>Key population size estimates, HIV prevalence, and ART coverage data from 39 sub-Saharan Africa countries between 2010 and 2023 were collated from existing databases and verified against source documents. We used Bayesian mixed-effects spatial regression to model urban key population size estimates as a proportion of the gender-matched, year-matched, and area-matched population aged 15-49 years. We modelled subnational key population HIV prevalence and ART coverage with age-matched, gender-matched, year-matched, and province-matched total population estimates as predictors.</p><p><strong>Findings: </strong>We extracted 2065 key population size data points, 1183 HIV prevalence data points, and 259 ART coverage data points. Across national urban populations, a median of 1·65% (IQR 1·35-1·91) of adult cisgender women were female sex workers, 0·89% (0·77-0·95) were men who have sex with men, 0·32% (0·31-0·34) were men who injected drugs, and 0·10% (0·06-0·12) were women who were transgender. HIV prevalence among key populations was, on average, four to six times higher than matched total population prevalence, and ART coverage was correlated with, but lower than, the total population ART coverage with wide heterogeneity in relative ART coverage across studies. Across sub-Saharan Africa, key populations were estimated as comprising 1·2% (95% credible interval 0·9-1·6) of the total population aged 15-49 years but 6·1% (4·5-8·2) of people living with HIV.</p><p><strong>Interpretation: </strong>Key populations in sub-Saharan Africa experience higher HIV prevalence and lower ART coverage, underscoring the need for focused prevention and treatment services. In 2024, limited data availability and heterogeneity constrain precise estimates for programming and monitoring trends. Strengthening key population surveys and routine data within national HIV strategic information systems would support more precise estimates.</p><p><strong>Funding: </strong>UNAIDS, Bill & Melinda Gates Foundation, and US National Institutes of Health.</p>","PeriodicalId":48783,"journal":{"name":"Lancet Global Health","volume":"12 9","pages":"e1400-e1412"},"PeriodicalIF":19.9000,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11345451/pdf/","citationCount":"0","resultStr":"{\"title\":\"Population size, HIV prevalence, and antiretroviral therapy coverage among key populations in sub-Saharan Africa: collation and synthesis of survey data, 2010-23.\",\"authors\":\"Oliver Stevens, Keith Sabin, Rebecca L Anderson, Sonia Arias Garcia, Kalai Willis, Amrita Rao, Anne F McIntyre, Elizabeth Fearon, Emilie Grard, Alice Stuart-Brown, Frances Cowan, Louisa Degenhardt, James Stannah, Jinkou Zhao, Avi J Hakim, Katherine Rucinski, Isabel Sathane, Makini Boothe, Lydia Atuhaire, Peter S Nyasulu, Mathieu Maheu-Giroux, Lucy Platt, Brian Rice, Wolfgang Hladik, Stefan Baral, Mary Mahy, Jeffrey W Imai-Eaton\",\"doi\":\"10.1016/S2214-109X(24)00236-5\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Key population HIV programmes in sub-Saharan Africa require epidemiological information to ensure equitable and universal access to effective services. We aimed to consolidate and harmonise survey data among female sex workers, men who have sex with men, people who inject drugs, and transgender people to estimate key population size, HIV prevalence, and antiretroviral therapy (ART) coverage for countries in mainland sub-Saharan Africa.</p><p><strong>Methods: </strong>Key population size estimates, HIV prevalence, and ART coverage data from 39 sub-Saharan Africa countries between 2010 and 2023 were collated from existing databases and verified against source documents. We used Bayesian mixed-effects spatial regression to model urban key population size estimates as a proportion of the gender-matched, year-matched, and area-matched population aged 15-49 years. We modelled subnational key population HIV prevalence and ART coverage with age-matched, gender-matched, year-matched, and province-matched total population estimates as predictors.</p><p><strong>Findings: </strong>We extracted 2065 key population size data points, 1183 HIV prevalence data points, and 259 ART coverage data points. Across national urban populations, a median of 1·65% (IQR 1·35-1·91) of adult cisgender women were female sex workers, 0·89% (0·77-0·95) were men who have sex with men, 0·32% (0·31-0·34) were men who injected drugs, and 0·10% (0·06-0·12) were women who were transgender. HIV prevalence among key populations was, on average, four to six times higher than matched total population prevalence, and ART coverage was correlated with, but lower than, the total population ART coverage with wide heterogeneity in relative ART coverage across studies. Across sub-Saharan Africa, key populations were estimated as comprising 1·2% (95% credible interval 0·9-1·6) of the total population aged 15-49 years but 6·1% (4·5-8·2) of people living with HIV.</p><p><strong>Interpretation: </strong>Key populations in sub-Saharan Africa experience higher HIV prevalence and lower ART coverage, underscoring the need for focused prevention and treatment services. In 2024, limited data availability and heterogeneity constrain precise estimates for programming and monitoring trends. Strengthening key population surveys and routine data within national HIV strategic information systems would support more precise estimates.</p><p><strong>Funding: </strong>UNAIDS, Bill & Melinda Gates Foundation, and US National Institutes of Health.</p>\",\"PeriodicalId\":48783,\"journal\":{\"name\":\"Lancet Global Health\",\"volume\":\"12 9\",\"pages\":\"e1400-e1412\"},\"PeriodicalIF\":19.9000,\"publicationDate\":\"2024-09-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11345451/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Lancet Global Health\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1016/S2214-109X(24)00236-5\",\"RegionNum\":1,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Lancet Global Health","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1016/S2214-109X(24)00236-5","RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH","Score":null,"Total":0}
Population size, HIV prevalence, and antiretroviral therapy coverage among key populations in sub-Saharan Africa: collation and synthesis of survey data, 2010-23.
Background: Key population HIV programmes in sub-Saharan Africa require epidemiological information to ensure equitable and universal access to effective services. We aimed to consolidate and harmonise survey data among female sex workers, men who have sex with men, people who inject drugs, and transgender people to estimate key population size, HIV prevalence, and antiretroviral therapy (ART) coverage for countries in mainland sub-Saharan Africa.
Methods: Key population size estimates, HIV prevalence, and ART coverage data from 39 sub-Saharan Africa countries between 2010 and 2023 were collated from existing databases and verified against source documents. We used Bayesian mixed-effects spatial regression to model urban key population size estimates as a proportion of the gender-matched, year-matched, and area-matched population aged 15-49 years. We modelled subnational key population HIV prevalence and ART coverage with age-matched, gender-matched, year-matched, and province-matched total population estimates as predictors.
Findings: We extracted 2065 key population size data points, 1183 HIV prevalence data points, and 259 ART coverage data points. Across national urban populations, a median of 1·65% (IQR 1·35-1·91) of adult cisgender women were female sex workers, 0·89% (0·77-0·95) were men who have sex with men, 0·32% (0·31-0·34) were men who injected drugs, and 0·10% (0·06-0·12) were women who were transgender. HIV prevalence among key populations was, on average, four to six times higher than matched total population prevalence, and ART coverage was correlated with, but lower than, the total population ART coverage with wide heterogeneity in relative ART coverage across studies. Across sub-Saharan Africa, key populations were estimated as comprising 1·2% (95% credible interval 0·9-1·6) of the total population aged 15-49 years but 6·1% (4·5-8·2) of people living with HIV.
Interpretation: Key populations in sub-Saharan Africa experience higher HIV prevalence and lower ART coverage, underscoring the need for focused prevention and treatment services. In 2024, limited data availability and heterogeneity constrain precise estimates for programming and monitoring trends. Strengthening key population surveys and routine data within national HIV strategic information systems would support more precise estimates.
Funding: UNAIDS, Bill & Melinda Gates Foundation, and US National Institutes of Health.
期刊介绍：
The Lancet Global Health is an online publication that releases monthly open access (subscription-free) issues.Each issue includes original research, commentary, and correspondence.In addition to this, the publication also provides regular blog posts.
The main focus of The Lancet Global Health is on disadvantaged populations, which can include both entire economic regions and marginalized groups within prosperous nations.The publication prefers to cover topics related to reproductive, maternal, neonatal, child, and adolescent health; infectious diseases (including neglected tropical diseases); non-communicable diseases; mental health; the global health workforce; health systems; surgery; and health policy.
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