背景:在所有流行病环境中,重点人群中的HIV监测是一个优先事项。全球以及卢旺达的女性性工作者(FSW)受到艾滋病毒流行的影响尤其严重;因此,卢旺达艾滋病毒和艾滋病国家战略计划(2018-2024)采用了每2-3年定期监测FSWs的人口规模估计(PSE).
目标:我们旨在估计,第四次,卢旺达基于街道和场所的FSW和年龄≥15岁的性剥削未成年人的人口规模。
方法:2022年8月,采用3源捕获-再捕获方法估算了卢旺达FSW和性剥削未成年人的人口规模。现场工作花了3周时间完成,每次捕获都持续一周。每次捕获的样本大小是使用shinyrecap计算的,输入来自先前进行的估计练习。在每一轮捕获中,采用了分层多阶段抽样过程,以行政省份为分层,以FSW热点地区为主要抽样单位。在每个捕获轮次中将不同的独特对象分配给FSW;对独特对象的接受被标记为成功捕获。询问用于后续捕获场合的采样FSW是否已接收到先前分布的唯一对象以便确定重新捕获。在R(版本4.0.5)中进行统计分析,进行贝叶斯模型平均以产生具有95%可信度集(CS)的最终PSE。
结果:我们在每个捕获回合中对1766、1848和1865个FSW和性剥削未成年人进行了采样。在捕获1和2之间严格进行了169次重新捕获,在捕获2和3之间仅进行了210次重新捕获,在捕获1和3之间仅进行了65次重新捕获。在所有3次捕获中,捕获了61个FSW。卢旺达街头和场地FSW和性剥削未成年人的平均PSE为37,647(95%CS31,873-43,354),相当于普通人群中成年女性总数的1.1%(95%CI0.9%-1.3%)。相对于普通人群中的成年女性,西部和北部省份以更高的FSW集中度排名第一和第二,分别。基加利和东部省份的城市排名第三和第四,分别。南部省份被确定为FSW浓度较低。
结论:我们提供,第一次,卢旺达基于街道和地点的FSW的国家和省级人口规模估计。与前两轮FSW国家层面的PSE相比,我们观察到卢旺达基于街道和地点的FSW人口规模的差异.我们的研究可能没有考虑FSW,他们不想让任何人知道他们是FSW,原因有几个,导致可能低估了真实的PSE。
BACKGROUND: HIV surveillance among key populations is a priority in all epidemic settings. Female sex workers (FSWs) globally as well as in Rwanda are disproportionately affected by the HIV epidemic; hence, the Rwanda HIV and AIDS National Strategic Plan (2018-2024) has adopted regular surveillance of population size estimation (PSE) of FSWs every 2-3 years.
OBJECTIVE: We aimed at estimating, for the fourth time, the population size of street- and venue-based FSWs and sexually exploited minors aged ≥15 years in Rwanda.
METHODS: In August 2022, the 3-source capture-recapture method was used to estimate the population size of FSWs and sexually exploited minors in Rwanda. The field work took 3 weeks to complete, with each capture occasion lasting for a week. The sample size for each capture was calculated using shinyrecap with inputs drawn from previously conducted estimation exercises. In each capture round, a stratified multistage sampling process was used, with administrative provinces as strata and FSW hotspots as the primary sampling unit. Different unique objects were distributed to FSWs in each capture round; acceptance of the unique object was marked as successful capture. Sampled FSWs for the subsequent capture occasions were asked if they had received the previously distributed unique object in order to determine recaptures. Statistical analysis was performed in R (version 4.0.5), and Bayesian Model Averaging was performed to produce the final PSE with a 95% credibility set (CS).
RESULTS: We sampled 1766, 1848, and 1865 FSWs and sexually exploited minors in each capture round. There were 169 recaptures strictly between captures 1 and 2, 210 recaptures exclusively between captures 2 and 3, and 65 recaptures between captures 1 and 3 only. In all 3 captures, 61 FSWs were captured. The median PSE of street- and venue-based FSWs and sexually exploited minors in Rwanda was 37,647 (95% CS 31,873-43,354), corresponding to 1.1% (95% CI 0.9%-1.3%) of the total adult females in the general population. Relative to the adult females in the general population, the western and northern provinces ranked first and second with a higher concentration of FSWs, respectively. The cities of Kigali and eastern province ranked third and fourth, respectively. The southern province was identified as having a low concentration of FSWs.
CONCLUSIONS: We provide, for the first time, both the national and provincial level population size estimate of street- and venue-based FSWs in Rwanda. Compared with the previous 2 rounds of FSW PSEs at the national level, we observed differences in the street- and venue-based FSW population size in Rwanda. Our study might not have considered FSWs who do not want anyone to know they are FSWs due to several reasons, leading to a possible underestimation of the true PSE.