Building Key Populations HIV Cascades in Data-Scarce Environments: Towards a participatory stakeholder methodology for cascades construction, adoption, and utilization

Abstract

Introduction 27Recent HIV key populations (KP) surveillance studies in South Africa, including female sex 28 workers (FSW) and men who have sex with men (MSM), demonstrate the disproportionate burden of 29HIV they bear compared to the general population. The national response for KP has lagged due to 30 relatively scarce KP data focused narrowly on urban areas. We adopted a participatory data triangulation 31 approach with stakeholders to overcome the challenges of KP program planning in KP data-scarce 32districts. Here we describe our methodology for achieving consensus on population size estimates (PSE) 33and treatment cascade indicator estimates derived from FSW and MSM surveillance data and applied 34 across the country.35 Methods 36The South African National AIDS Council (SANAC) convened the group; technical advisors 37 from the University of California San Francisco (UCSF) facilitated; and stakeholders from government, 38non-government, academic, and KP-led advocacy organizations involved in program implementation and 39research provided input through three in-person meetings covering four phases of work: surveillance data 40 analysis; cascades data extraction; presentation for feedback; and data extrapolation. Results 42Technical advisors presented eight cascades (three FSW, five MSM) to stakeholders, 43recommending data-informed extrapolation factors for each population. Stakeholders adopted 44 recommendations by consensus with few adjustments. FSW cascades displayed high awareness of HIV 45 status and steep breakpoints towards ART uptake; MSM cascades displayed less HIV status awareness, 46but relatively good ART uptake, with metropolitan areas displaying better uptake than rural districts. Conclusion 48The participatory process enabled KP stakeholders to vet disparate data sources against 49 programmatic experience and recommend consistency in cascades data; participatory triangulation of 50 additional surveillance and program data will follow. The considerable time and resource investments in 51 this process had downstream benefits, including consistency in sub-national HIV implementation plans. 52We recommend this consensus-based approach as a transparent, consistent, and sound methodology for 53 cascades construction in KP data-scarce environments. 54 55