Estimating the contribution of key populations towards the spread of<scp>HIV</scp>in Dakar, Senegal

Mukandavire, Christinah; Walker, Josephine G.; Schwartz, Sheree; Boily, Marie Claude; Danon, León; Lyons, Carrie; Diouf, Daouda; Liestman, Benjamin; Diouf, Nafissatou Leye; Dramé, Fatou Maria; Coly, Karleen; Muhire, Remy Serge Manzi; Thiam, Sylla; Diallo, Papa Amadou Niang; Kane, Coumba Touré; Ndour, Cheikh Tidiane; Volz, Erik; Mishra, Sharmistha; Baral, Stefan; Vickerman, Peter

doi:10.1002/jia2.25126

Cited by 40 publications

(53 citation statements)

References 53 publications

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“…Finally, the model does not currently disaggregate indicators by members of key populations (e.g., men who have sex with men, female sex workers, clients) or produce estimates of HIV diagnosis among children. Key populations are important to overall transmission dynamics in several countries [56][57][58][59] and the sustainable control of HIV epidemics also hinges on also achieving the 90-90-90 targets in these groups [60] . The general framework outlined above could in theory be used to monitor awareness status for key populations, but additional challenges related to representativeness of key population surveys, among others, are expected [13] .…”

Section: Model Limitationsmentioning

confidence: 99%

National HIV testing and diagnosis coverage in sub-Saharan Africa: a new modeling tool for estimating the “first 90” from program and survey data

Maheu‐Giroux

Marsh

Doyle

et al. 2019

Preprint

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Objective: HIV testing services (HTS) are a crucial component of national HIV responses. Learning one's HIV diagnosis is the entry point to accessing life-saving antiretroviral treatment and care. Recognizing the critical role of HTS, the Joint United Nations Programme on HIV/AIDS (UNAIDS) launched the 90-90-90 targets stipulating that by 2020, 90% of people living with HIV know their status, 90% of those who know their status receive antiretroviral therapy, and 90% of those on treatment have a suppressed viral load. Countries will need to regularly monitor progress on these three indicators. Estimating the proportion of people living with HIV who know their status (i.e., the "first 90"), however, is difficult. Methods:We developed a mathematical model (henceforth referred to as "F90") that formally synthesizes population-based survey and HTS program data to estimate HIV status awareness over time. The proposed model uses country-specific HIV epidemic parameters from the standard UNAIDS Spectrum model to produce outputs that are consistent with other national HIV estimates. The F90 model provides estimates of HIV testing history, diagnosis rates, and knowledge of HIV status by age and sex. We validate the F90 model using both in-sample comparisons and out-of-sample predictions using data from three countries: Côte d'Ivoire, Malawi, and Mozambique. Results: In-sample comparisons suggest that the F90 model can accurately reproduce longitudinal sex-specific trends in HIV testing. Out-of-sample predictions of the fraction of PLHIV ever tested over a 4-to-6-year time horizon are also in good agreement with empirical survey estimates. Importantly, out-of-sample predictions of HIV knowledge are consistent (i.e., within 4% points) with those of the fully calibrated model in the three countries, when HTS program data are included. The F90 model's predictions of knowledge of status are higher than available selfreported HIV awareness estimates, however, suggesting -in line with previous studies-that these self-reports could be affected by non-disclosure of HIV status awareness. Conclusion: Knowledge of HIV status is a key indicator to monitor progress, identify bottlenecks, and target HIV responses. The F90 model can help countries track progress towards their "first 90" by leveraging surveys of HIV testing behaviors and annual HTS program data.

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Section: Model Limitationsmentioning

confidence: 99%

National HIV testing and diagnosis coverage in sub-Saharan Africa: a new modeling tool for estimating the “first 90” from program and survey data

Maheu‐Giroux

Marsh

Doyle

et al. 2019

Preprint

View full text Add to dashboard Cite

show abstract

“…An article by Mukandavire et al . presents a new methodology to estimate the contribution of onward HIV transmission among key populations to the overall HIV dynamic in Dakar, Senegal . They report that the contribution of commercial sex to HIV transmission is diminishing; however, unprotected sex between men contributed to 42% of transmissions between 1995 and 2005, and increases to an estimated 64% in the 2015 to 2025 period.…”

Section: Data Approaches To Improve Cascade Monitoringmentioning

confidence: 99%

Building the evidence base to optimize the impact of key population programming across the HIV cascade

et al. 2018

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“…FSW and MSM together accounted for 9.3% of Yunnan's estimated prevalent cases in 2017. This is lower than the share of these key groups in past Spectrum-STI estimates 35,36,40 , and in HIV incidence estimates [41][42][43][44] , which reflects that both the estimated prevalence of syphilis in FSW and Yunnan's key population size estimates are lower than in other countries 7,9,45,46 . The size estimate of FSW was based on self-identified sex workers; and almost certainly is an under-estimate of the total number of women who engage in transactional sex work.…”

Section: Discussionmentioning

confidence: 83%

The Spectrum-STI Groups model: syphilis prevalence trends across high-risk and lower-risk populations in Yunnan, China

Korenromp¹,

Zhang

et al. 2020

Sci Rep

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Spectrum-Sti model, structured by subgroups within a population, was used in a workshop in Yunnan, China, to estimate provincial trends in active syphilis in 15 to 49-year-old adults. Syphilis prevalence data from female sex workers (fSW), men who have sex with men (MSM), and lower-risk women and men in Yunnan were identified through literature searches and local experts. Sources included antenatal care clinic screening, blood donor screening, HiV/Sti bio-behavioural surveys, sentinel surveillance, and epidemiology studies. The 2017 provincial syphilis prevalence estimates were 0.26% (95% confidence interval 0.17-0.34%) in women and 0.28% (0.20-0.36%) in men. Estimated prevalence was 6.8-fold higher in FSW (1.69% (0.68-3.97%) than in lower-risk women (0.25% (0.18-0.35%)), and 22.7-fold higher in MSM (5.35% (2.74-12.47%) than in lower-risk men (0.24% (0.17-0.31%). For all populations, the 2017 estimates were below the 2005 estimates, but differences were not significant. In 2017 FSW and MSM together accounted for 9.3% of prevalent cases. These estimates suggest Yunnan's Sti programs have kept the overall prevalence of syphilis low, but prevalence remains high in FSW and MSM. Strengthening efforts targeting FSW and MSM, and identification of other risk populations e.g. among heterosexual men, are critical to reduce syphilis. Spectrum-STI is a statistical trend-fitting model designed for countries to estimate trends over time in the prevalence and incidence of three sexually transmitted infections (STIs): syphilis (etiologic agent: Treponema pallidum subspecies pallidum); gonorrhea (Neisseria gonorrhoeae); and chlamydia (Chlamydia trachomatis) from available prevalence data after standardizing for diagnostic test, location and age and weighted to reflect representativeness. The model builds on the Spectrum suite of health policy planning and surveillance models developed by Avenir Health 1. The latest version of Spectrum-STI, the Spectrum-STI Groups model, allows for estimates to be generated for different higher-risk and lower-risk groups in a population and for these to be combined to form an overall population estimate. In November 2018, Spectrum-STI Groups was piloted in a 3-day workshop held in Kunming, Yunnan's capital, organized by the Yunnan provincial Center for Disease Control and Prevention (CDC) and the World Health Organization (WHO). Yunnan province is located in the southwest of China and in 2017 had a population of just under 46 million (3.4% of China's population). It is one of three provinces chosen by China's National Health and Family Commission and UNICEF to pilot validating elimination of mother-to-child transmission of HIV, syphilis and

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Estimating the contribution of key populations towards the spread ofHIVin Dakar, Senegal

Cited by 40 publications

References 53 publications

National HIV testing and diagnosis coverage in sub-Saharan Africa: a new modeling tool for estimating the “first 90” from program and survey data

National HIV testing and diagnosis coverage in sub-Saharan Africa: a new modeling tool for estimating the “first 90” from program and survey data

Building the evidence base to optimize the impact of key population programming across the HIV cascade

The Spectrum-STI Groups model: syphilis prevalence trends across high-risk and lower-risk populations in Yunnan, China

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