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Front. Public Health, 16 May 2023 Sec. Infectious Diseases: Epidemiology and Prevention Vol.11
2nd Generation HIV Surveillance in Pakistan, Round 5
The Overall objective of this mapping study was to update population size estimates of selected key populations (PWID, FSWs, MSM & TGs) to c ... reate evidence for developing action plans for HIV prevention interventions in Pakistan. A total number of 23 cities/towns were selected for Mapping. This included 13 cities in Punjab province, 6 in Sindh Province and 2 cities each in KPK and Baluchistan provinces.
large file: 70,5 MB The preview/download includes only the pages 1 to 23. more
The Overall objective of this mapping study was to update population size estimates of selected key populations (PWID, FSWs, MSM & TGs) to c ... reate evidence for developing action plans for HIV prevention interventions in Pakistan. A total number of 23 cities/towns were selected for Mapping. This included 13 cities in Punjab province, 6 in Sindh Province and 2 cities each in KPK and Baluchistan provinces.
large file: 70,5 MB The preview/download includes only the pages 1 to 23. more
Serving the needs of Key Populations: Case examples of innovation and good practice in HIV Prevention, Diagnosis, Treatment and Care
A. Armstrong; C. Irvine; C. Figueroa; A. Verster; R. Baggaley et al.
World Health Organization WHO
(2017)
C_WHO
This WHO guidelines highlight innovative, community-led, and peer-driven approaches to reduce HIV risks among key populations—sex workers, trans people, MSM, people who inject drugs, and prisoners
...
. Effective practices integrate services, utilize trained peers for testing (HTS), and provide stigma-free, targeted care to increase engagement
more
Training Manual and Reference Guide
Estimating the size of key affected populations (KAP) provides important data for planning and implementing an effective response to the HIV epidemic. In the Philippines, these KAP include males who
...
have sex with males (MSM), female sex workers (FSW), and injecting drug users (IDU). Given the difficulty in reaching these populations, as well as their high mobility, the process consequently entailed a specific methodology to directly estimate the size of KAP.
The national estimate of MSM was 531,500 or 2.2% (1.8%-3.2%) of males aged 15-49. Within this MSM estimate, figures for transgender women (TGW) and male transactional sex workers (MSW) were determined. The national estimate for TGW was 122,800 or about 0.50% (0.40%-0.75%) of males aged 15-49, and 23% of the MSM population. Meanwhile, MSW comprised 0.35% (0.29%-0.53%) of the male population aged 15-49 and 16% of the MSM population, giving a best estimate of 86,600.
The estimate of combined RFSW and FFSW was 66,100 or 0.28% (0.19%-0.40%) of females aged 15-49. Meanwhile, there are approximately 10,000 to 21,700 IDU or 0.04%-0.09% of males aged 15-49. more
The national estimate of MSM was 531,500 or 2.2% (1.8%-3.2%) of males aged 15-49. Within this MSM estimate, figures for transgender women (TGW) and male transactional sex workers (MSW) were determined. The national estimate for TGW was 122,800 or about 0.50% (0.40%-0.75%) of males aged 15-49, and 23% of the MSM population. Meanwhile, MSW comprised 0.35% (0.29%-0.53%) of the male population aged 15-49 and 16% of the MSM population, giving a best estimate of 86,600.
The estimate of combined RFSW and FFSW was 66,100 or 0.28% (0.19%-0.40%) of females aged 15-49. Meanwhile, there are approximately 10,000 to 21,700 IDU or 0.04%-0.09% of males aged 15-49. more
Program Considerations
Countries experiencing concentrated epidemics of HIV need the size of key populations (KPs) to guide the national response on HIV and AIDS. Conducting a robust method to estimate the size of KPs is
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quite challenging as most of them are hidden and do not want to disclose theiridentity due to stigma and discrimination associated with their behaviour. KPs in Bangladesh include female sex workers (FSW), people who inject drugs (PWID), men who have sex with men (MSM) including transgender (TG)/Hijra and sex workers, and clients of sex workers in the country or abroad.
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The Kenya Strategic AIDS Framework IV prioritises key populations for interventions
Policy Brief. Good practice statement: When planning and implementing a response for HIV, viral hepatitis and sexually transmitted diseases (STIs), policy-makers and providers should be aware that
counselling behavioural interventions aimed to change behaviours to reduce risks associated
with th
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ese infections for key populations have not been shown to have an effect on HIV, viral
hepatitis and STIs’ incidence nor on risk behaviour such as condom use and needle/syringe
sharing. Counselling and information sharing, not aimed at changing behaviours, can be a key
component of engagement with key populations and, when provided, it should be in a nonjudgemental manner, alongside other prevention interventions and with involvement of peers
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Social network-based HIV testing is an approach for engaging sexual and drug injecting partners and social contacts of key population members with HIV and of those who are HIV-negative and at ongoing risk in voluntary HTS.
By addressing people’
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s confidentiality concerns and broadening the reach to social contacts, social network-based HIV testing approaches can improve the acceptability of partner services among key populations and so reach more people who may not otherwise test for HIV. WHO now recommends that social network-based HIV testing approaches can be offered for key populations
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Despite progress in improving antiretroviral therapy (ART) for people with HIV in Malawi, the burden of HIV infections and HIV treatment outcomes among key populations is suboptimal. Client-centered
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differentiated service delivery approaches may facilitate addressing HIV prevention and treatment needs of key populations in Malawi.
Methods
De-identified program data routinely collected as part of the LINKAGES project–Malawi were assembled from October 2017 to September 2019. HIV case finding was compared across different testing modalities for each population. Poisson regression was used to estimate the association between testing modalities and ART initiation.
Results
Of the 18 397 people included in analyses, 10 627 (58%) were female sex workers (FSWs), 2219 (12%) were men who have sex with men (MSM), and 4970 (27%) were clients of FSWs. HIV case finding varied by modality and population, with index testing and enhanced peer outreach demonstrating high yield despite reaching relatively few individuals. FSWs who tested positive through risk network referral testing were more likely to initiate ART within 30 days compared with those who tested positive through clinic-based testing (adjusted risk ratio [aRR], 1.50; 95% CI, 1.23–1.82). For MSM, index testing (aRR, 1.45; 95% CI, 1.06–2.00) and testing through a drop-in center (aRR, 1.82; 95% CI, 1.19–2.78) were associated with 30-day ART initiation.
Conclusions
These data suggest that differentiated HIV testing and outreach approaches tailored to the needs of different key populations may facilitate improved ART initiation in Malawi. Achieving 0 new infections by 2030 suggests the need to adapt treatment strategies given individual and structural barriers to treatment for key populations with HIV in high-prevalence settings.
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The Consolidated guidelines on HIV, viral hepatitis and STI prevention, diagnosis, treatment and care for key populations outline a public health response for 5
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key populations (men who have sex with men, trans and gender diverse people, sex workers, people who inject drugs and people in prisons and other closed settings). They present and discuss new recommendations and consolidate a range of recommendations and guidance from current WHO guidelines.
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