Availability and Quality of Surveillance and Survey Data on HIV Prevalence Among Sex Workers, Men Who Have Sex With Men, People Who Inject Drugs, and Transgender Women in Low- and Middle-Income Countries: Review of Available Data (2001-2017).

BACKGROUND: In 2019, 62% of new HIV infections occurred among key populations (KPs) and their sexual partners. The World Health Organization (WHO) recommends implementation of bio-behavioral surveys every 2-3 years to obtain HIV prevalence data for all KPs. However, the collection of these data is often less frequent and geographically limited. OBJECTIVE: This study intended to assess the availability and quality of HIV prevalence data among sex workers (SWs), men who have sex with men (MSM), people who inject drugs, and transgender women (transwomen) in low- and middle-income countries. METHODS: Data were obtained from survey reports, national reports, journal articles, and other grey literature available to the Global Fund, Joint United Nations Programme on HIV/AIDS, and WHO or from other open sources. Elements reviewed included names of subnational units, HIV prevalence, sampling method, and size. Based on geographical coverage, availability of trends over time, and recency of estimates, data were categorized by country and grouped as follows: nationally adequate, locally adequate but nationally inadequate, no recent data, no trends available, and no data. RESULTS: Among the 123 countries assessed, 91.9% (113/123) presented at least 1 HIV prevalence data point for any KP; 78.0% (96/123) presented data for at least 2 groups; and 51.2% (63/123), for at least 3 groups. Data on all 4 groups were available for only 14.6% (18/123) of the countries. HIV prevalence data for SWs, MSM, people who inject drugs, and transwomen were available in 86.2% (106/123), 80.5% (99/123), 45.5% (56/123), and 23.6% (29/123) of the countries, respectively. Only 10.6% (13/123) of the countries presented nationally adequate data for any KP between 2001 and 2017; 6 for SWs; 2 for MSM; and 5 for people who inject drugs. Moreover, 26.8% (33/123) of the countries were categorized as locally adequate but nationally inadequate, mostly for SWs and MSM. No trend data on SWs and MSM were available for 38.2% (47/123) and 43.9% (54/123) of the countries, respectively, while no data on people who inject drugs and transwomen were available for 76.4% (94/123) and 54.5% (67/123) of the countries, respectively. An increase in the number of data points was observed for MSM and transwomen. Overall increases were noted in the number and proportions of data points, especially for MSM, people who inject drugs, and transwomen, with sample sizes exceeding 100. CONCLUSIONS: Despite general improvements in health data availability and quality, the availability of HIV prevalence data among the most vulnerable populations in low- and middle-income countries remains insufficient. Data collection should be expanded to include behavioral, clinical, and epidemiologic data through context-specific differentiated survey approaches while emphasizing data use for program improvements. Ending the HIV epidemic by 2030 is possible only if the epidemic is controlled among KPs.

Transmission of HIV-1 infection in sub-Saharan Africa and effect of elimination of unsafe injections.

During the past year, a group has argued that unsafe injections are a major if not the main mode of HIV-1 transmission in sub-Saharan Africa. We review the main arguments used to question the epidemiological interpretations on the lead role of unsafe sex in HIV-1 transmission, and conclude there is no compelling evidence that unsafe injections are a predominant mode of HIV-1 transmission in sub-Saharan Africa. Conversely, though there is a clear need to eliminate all unsafe injections, epidemiological evidence indicates that sexual transmission continues to be by far the major mode of spread of HIV-1 in the region. Increased efforts are needed to reduce sexual transmission of HIV-1.

How are countries in the Western Pacific Region tracking the HIV epidemic? Results from a 2011 survey of ministries of health.

In 2011, as part of the World Health Organization global reporting tool to collect data on the progress of improving the health sector response to HIV/AIDS towards universal access, a questionnaire was sent to ministries of health of Western Pacific Region Member States on the scope and functioning of their HIV surveillance systems. Of the 17 countries that responded, 13 were low- to middle-income countries and four were high-income countries. Regular serosurveillance surveys are conducted with female sex workers in all lower- and middle-income countries that responded to the survey but less so with people who inject drugs and men who have sex with men. Furthermore, there are no surveillance activities of the key populations in most of the Pacific island countries. It is recommended that estimations of high-risk populations be conducted in priority Pacific island countries and tailored surveillance systems be designed. Efforts should also be made to gather and accumulate data from sufficient geographic coverage to allow the HIV epidemic to continue to be monitored.

Is the HIV sentinel surveillance system adequate in China? Findings from an evaluation of the national HIV sentinel surveillance system.

BACKGROUND: An external evaluation was conducted to assess the performance of the national HIV sentinel surveillance system (HSS), identify operational challenges at national and local levels and provide recommendations for improvement. METHODS: The United States Centers for Disease Control and Prevention's (CDC) Updated Guidelines for Evaluating Public Health Surveillance Systems were followed to assess the key attributes of HSS. Comprehensive assessment activities were conducted, including: using a detailed checklist to review surveillance guidelines, protocols and relevant documents; conducting self-administered, anonymous surveys with 286 local China CDC staff; and carrying out field observations in 32 sentinel sites in four provinces. RESULTS: China has built an extensive HSS with 1888 sentinel sites to monitor HIV epidemic trends by population groups over time. The strengths of HSS lie in its flexibility, simplicity, usefulness and increase in coverage in locations and populations. With its rapid expansion in 2010, HSS faces challenges in maintaining acceptability, timeliness, data quality, representativeness and sustainability. RECOMMENDATIONS: Implementation of the national guidelines should be standardized by strengthening training, monitoring and supervision of all staff involved, including community-based organizations. National surveillance guidelines need to be revised to strengthen data quality and representativeness, particularly to include specific instructions on HIV testing result provision, collection of identifying information, sample size and sampling methods particularly for men who have sex with men (MSM), collection of refusal information, and data interpretation. Sustainability of China's HSS could be strengthened by applying locally tailored surveillance strategies, strengthening coordination and cooperation among government agencies and ensuring financial and human resources.

How are countries in the Western Pacific Region tracking the HIV epidemic? Results from a 2011 survey of ministries of health

In 2011, as part of the World Health Organization global reporting tool to collect data on the progress of improving the health sector response to HIV/AIDS towards universal access, a questionnaire was sent to ministries of health of Western Pacific Region Member States on the scope and functioning of their HIV surveillance systems. Of the 17 countries that responded, 13 were low- to middle-income countries and four were high-income countries. Regular serosurveillance surveys are conducted with female sex workers in all lower- and middle-income countries that responded to the survey but less so with people who inject drugs and men who have sex with men. Furthermore, there are no surveillance activities of the key populations in most of the Pacific island countries. It is recommended that estimations of high-risk populations be conducted in priority Pacific island countries and tailored surveillance systems be designed. Efforts should also be made to gather and accumulate data from sufficient geographic coverage to allow the HIV epidemic to continue to be monitored.

Monitoring the scale-up of antiretroviral therapy programmes: methods to estimate coverage.

This paper reviews the data sources and methods used to estimate the number of people on, and coverage of, antiretroviral therapy (ART) programmes in low- and middle-income countries and to monitor the progress towards the "3 by 5" target set by WHO and UNAIDS. We include a review of the data sources used to estimate the coverage of ART programmes as well as the efforts made to avoid double counting and over-reporting. The methods used to estimate the number of people in need of ART are described and expanded with estimates of treatment needs for children, both for ART and for cotrimoxazole prophylaxis. An estimated 6.5 million people were in need of treatment in low- and middle-income countries by the end of 2004, including 660,000 children under age 15 years. The mid-2005 estimate of 970,000 people receiving ART in low- and middle-income countries (with an uncertainty range 840,000-1,100,000) corresponds to a coverage of 15% of people in need of treatment.