背景:撒哈拉以南非洲的主要人群艾滋病毒规划需要流行病学信息,以确保公平和普遍获得有效服务。我们旨在巩固和协调女性性工作者的调查数据,和男人发生性关系的男人,注射毒品的人,和变性人来估计关键的人口规模,艾滋病毒流行率,以及撒哈拉以南非洲大陆国家的抗逆转录病毒疗法(ART)覆盖率。
方法:主要人口规模估计,艾滋病毒流行率,2010年至2023年期间来自撒哈拉以南非洲39个国家的ART覆盖率数据从现有数据库中进行了整理,并对照源文件进行了验证.我们使用贝叶斯混合效应空间回归对城市关键人口规模估计值作为性别匹配的比例进行建模,年份匹配,和15-49岁的地区匹配人口。我们以年龄匹配的方式模拟了国家以下主要人群的艾滋病毒流行率和ART覆盖率,性别匹配,年份匹配,和省匹配的总人口估计值作为预测因子。
结果:我们提取了2065个关键人口规模数据点,1183个艾滋病毒流行率数据点,和259个ART覆盖数据点。在全国城市人口中,成年顺性女性的中位数为1·65%(IQR1·35-1·91)是女性性工作者,0·89%(0·77-0·95)是男男性行为者,0·32%(0·31-0·34)是注射毒品的男性,0·10%(0·06-0·12)是变性女性。关键人群中的艾滋病毒流行率是,平均而言,比匹配的总人口患病率高出四到六倍,ART覆盖率与,但低于,总ART覆盖率在研究中相对ART覆盖率具有广泛异质性。在撒哈拉以南非洲,估计关键人群占15-49岁总人口的1·2%(95%可信区间0·9-1·6),但占HIV感染者的6·1%(4·5-8·2).
结论:撒哈拉以南非洲的主要人群艾滋病毒感染率较高,ART覆盖率较低,强调需要有重点的预防和治疗服务。2024年,有限的数据可用性和异质性限制了对规划和监测趋势的精确估计。在国家艾滋病毒战略信息系统中加强关键人口调查和常规数据将有助于更精确的估计。
背景:联合国艾滋病规划署,比尔和梅林达·盖茨基金会,和美国国立卫生研究院。
BACKGROUND: Key population HIV programmes in sub-Saharan Africa require epidemiological information to ensure equitable and universal access to effective services. We aimed to consolidate and harmonise survey data among female sex workers, men who have sex with men, people who inject drugs, and transgender people to estimate key population size, HIV prevalence, and antiretroviral therapy (ART) coverage for countries in mainland sub-Saharan Africa.
METHODS: Key population size estimates, HIV prevalence, and ART coverage data from 39 sub-Saharan Africa countries between 2010 and 2023 were collated from existing databases and verified against source documents. We used Bayesian mixed-effects spatial regression to model urban key population size estimates as a proportion of the gender-matched, year-matched, and area-matched population aged 15-49 years. We modelled subnational key population HIV prevalence and ART coverage with age-matched, gender-matched, year-matched, and province-matched total population estimates as predictors.
RESULTS: We extracted 2065 key population size data points, 1183 HIV prevalence data points, and 259 ART coverage data points. Across national urban populations, a median of 1·65% (IQR 1·35-1·91) of adult cisgender women were female sex workers, 0·89% (0·77-0·95) were men who have sex with men, 0·32% (0·31-0·34) were men who injected drugs, and 0·10% (0·06-0·12) were women who were transgender. HIV prevalence among key populations was, on average, four to six times higher than matched total population prevalence, and ART coverage was correlated with, but lower than, the total population ART coverage with wide heterogeneity in relative ART coverage across studies. Across sub-Saharan Africa, key populations were estimated as comprising 1·2% (95% credible interval 0·9-1·6) of the total population aged 15-49 years but 6·1% (4·5-8·2) of people living with HIV.
CONCLUSIONS: Key populations in sub-Saharan Africa experience higher HIV prevalence and lower ART coverage, underscoring the need for focused prevention and treatment services. In 2024, limited data availability and heterogeneity constrain precise estimates for programming and monitoring trends. Strengthening key population surveys and routine data within national HIV strategic information systems would support more precise estimates.
BACKGROUND: UNAIDS, Bill & Melinda Gates Foundation, and US National Institutes of Health.