A Comprehensive Review of Available Epidemiologic and HIV Service Data for Female Sex Workers, Men Who Have Sex With Men, and People Who Inject Drugs in Select West and Central African Countries

MacAllister, Jack; Sherwood, Jennifer; Galjour, Joshua; Scott, Sarah Robbins; Zhao, Jinkou; Dam, Kim H; Grosso, Ashley; Baral, Stefan

doi:10.1097/qai.0000000000000457

Cited by 27 publications

(16 citation statements)

References 18 publications

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“…In Nigeria, ART coverage in KP is unknown [6–8]. KP are understudied and likely underserved resulting in a limited characterization of their HIV prevention, treatment, and care needs [7]. On the other hand, stigma, discrimination, poor nutrition, food insecurity and substance use are known predictors of poor linkage to care, retention in care, and viral suppression [9–10].…”

Section: Introductionmentioning

confidence: 99%

Characteristics and early clinical outcomes of key populations attending comprehensive community-based HIV care: Experiences from Nasarawa State, Nigeria

et al. 2018

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BackgroundDespite a call for differentiated care, there are limited data from sub-Saharan Africa on comprehensive community-based HIV care for key populations (KP), including commercial sex workers (CSW), men who have sex with men (MSM), and people who inject drugs (PWID). In Nigeria, a programme was implemented that liaised with community-based organizations and offered HIV testing, same-day ART initiation, and ART follow-up to KP. Here we characterize KP and their partners enrolled on ART. Our objective is to assess the early treatment outcomes and to estimate predictors of attrition among KP.MethodThis is a retrospective cohort study of routinely collected data in a community-based HIV program for KP in Nasarawa state, Nigeria from August 2016 to November 2017. Variables of interest were socio-demographic, KP types, treatment outcomes, ART adherence, WHO stage, TB status and viral load. Summary statistics, logistic and Cox proportional hazard regression were used to describe the characteristics of KP and estimate predictors of attrition (patients either lost to follow-up (LTFU) or dead).ResultSeven hundred and ten (710) KP and their partners were enrolled into this study, 77.3% (549) of study participants were female and the median age was 30 years (IQR: 24–35). Respectively, 74.2%, 4.5%, 1.1% and 20% were FSW, MSM, PWID and their partners. Of 710 KP who started ART, 13.9% (99/710) discontinued after the first visit. After a median follow-up time of 7 months on ART 73.2% of patients were retained, 23.4% were LTFU, and 3.4% were dead. Lack of formal education (aHR 1.8; 95% CI 1.3–2.6) and unemployment (aHR 1.8; 95% CI 1.2–2.6) were significantly associated with attrition.ConclusionComprehensive community-based HIV care, including HIV testing and same-day ART is feasible. However, ART initiation on the same day of confirmatory HIV testing resulted in a high uptake of ART, but possibly inflated early attrition on ART. To mitigate early attrition among KP after same-day ART initiation, the psychosocial readiness of clients should be assessed better. We strongly recommend further studies to understand factors contributing to high attrition among the KP.

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Section: Introductionmentioning

confidence: 99%

Characteristics and early clinical outcomes of key populations attending comprehensive community-based HIV care: Experiences from Nasarawa State, Nigeria

et al. 2018

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“…Although there has recently been a substantial focus on geospatial variability in prevalence and incidence in targeting responses [92], these studies highlight that it is also important to focus on sub-national risk heterogeneity, including risk among key populations, to optimize prevention investments in each location. However, the knowledge base at present is insufficient to most efficiently allocate prevention resources [10]. This increases the importance of recent efforts to systematize this data and make it more readily available for program planning, analysis and modeling [13 ▪▪ ].…”

Section: The Challenges Of Estimating Key Population Effects In Genermentioning

confidence: 99%

Evolving HIV epidemics

Brown

Peerapatanapokin

2019

Current Opinion in HIV and AIDS

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Purpose of review To explore the comparative importance of HIV infections among key populations and their intimate partners as HIV epidemics evolve, and to review implications for guiding responses. Recent findings Even as concentrated epidemics evolve, new infections among current and former key population members and their intimate partners dominate new infections. Prevalent infections in the general population grow primarily because of key population turnover and infections among their intimate partners. In generalized epidemic settings, data and analysis on key populations are often inadequate to assess the impact of key population-focused responses, so they remain limited in coverage and under resourced. Models must incorporate downstream infections in comparing impacts of alternative responses. Summary Recognize that every epidemic is unique, moving beyond the overly simplistic concentrated/generalized epidemic paradigm that can misdirect resources. Guide HIV responses by gathering and using locally relevant data, understanding risk heterogeneity, and applying modeling at both national and sub-national levels to optimize resource allocations among different populations for greatest impact. Translate this improved understanding into clear, unequivocal advice for policymakers on where to focus for impact, breaking them free of the generalized/concentrated paradigm limiting their thinking and affecting their decisions.

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“…Among both concentrated and generalized epidemics around the world, key populations including female sex workers (FSW), cisgender men who have sex with men (MSM), people who use drugs (PWUD), and transgender women bear a disproportionate burden of HIV when compared to other reproductive-aged adults [1][2][3][4][5][6][7]. Specifically, the Joint United Nations Programme on HIV and AIDS (UNAIDS) estimated that between 40% and 95% of new HIV infections in various global regions in 2017 were among key populations and their immediate sexual partners [8].…”

Section: Introductionmentioning

confidence: 99%

The uptake of population size estimation studies for key populations in guiding HIV responses on the African continent

Viswasam

Lyons

MacAllister³

et al. 2020

PLoS ONE

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BackgroundThere has been a heightened emphasis on prioritizing data to inform evidence-based HIV responses, including data focused on both defining the content and scale of HIV programs in response to evidence-based need. Consequently, population size estimation (PSE) studies for key populations have become increasingly common to define the necessary scale of specific programs for key populations. This study aims to assess the research utilization of these size estimates in informing HIV policy and program documents across the African continent. MethodsThis study included two phases; Phase 1 was a review of all PSE for key populations, including men who have sex with men (MSM), female sex workers (FSW), people who use drugs (PWUD), and transgender persons in the 54 countries across Africa published

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A Comprehensive Review of Available Epidemiologic and HIV Service Data for Female Sex Workers, Men Who Have Sex With Men, and People Who Inject Drugs in Select West and Central African Countries

Cited by 27 publications

References 18 publications

Characteristics and early clinical outcomes of key populations attending comprehensive community-based HIV care: Experiences from Nasarawa State, Nigeria

Characteristics and early clinical outcomes of key populations attending comprehensive community-based HIV care: Experiences from Nasarawa State, Nigeria

Evolving HIV epidemics

The uptake of population size estimation studies for key populations in guiding HIV responses on the African continent

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