RESUMO
BACKGROUND: Improving viral suppression among people with HIV reduces morbidity, mortality, and transmission. Accordingly, monitoring the proportion of patients with a suppressed viral load is important to optimizing HIV care and treatment programs. But viral load data are often incomplete in clinical records. We illustrate a two-stage approach to estimate the proportion of treated people with HIV who have a suppressed viral load in the Dominican Republic. METHODS: Routinely collected data on viral load and patient characteristics were recorded in a national database, but 74% of patients on treatment at the time of the study did not have a recent viral load measurement. We recruited a subset of these patients for a rapid assessment that obtained additional viral load measurements. We combined results from the rapid assessment and main database using a two-stage weighting approach and compared results to estimates obtained using standard approaches to account for missing data. RESULTS: Of patients with recent routinely collected viral load data, 60% had a suppressed viral load. Results were similar after applying standard approaches to account for missing data. Using the two-stage approach, we estimated that 77% (95% confidence interval [CI] = 74, 80) of those on treatment had a suppressed viral load. CONCLUSIONS: When assessing the proportion of people on treatment with a suppressed viral load using routinely collected data, applying standard approaches to handle missing data may be inadequate. In these settings, augmenting routinely collected data with data collected through sampling-based approaches could allow more accurate and efficient monitoring of HIV treatment program effectiveness.
Assuntos
Fármacos Anti-HIV , Infecções por HIV , Fármacos Anti-HIV/uso terapêutico , República Dominicana , Infecções por HIV/tratamento farmacológico , Infecções por HIV/epidemiologia , Humanos , Carga ViralRESUMO
The risk of HIV infection is higher among transgender women and cisgender men who have sex with men (MSM) compared to the general population due in part to social and contextual factors. This study aimed to determine the prevalence and association of alcohol and drug abuse, discrimination and violence among transgender sex workers compared to cisgender male sex workers and cisgender men who had not received money for sex in Guatemala City. In 2010, transgender women and cisgender men who had had sex with men or transgender women were recruited into a cross-sectional behavioural survey. Among transgender women, 86% received money for sex in the past year. Transgender sex workers were more likely to use drugs and binge drink, three times as likely to be discriminated against and eight times as likely to be forced to have sex compared to non-sex worker men. Male sex workers were twice as likely to use illicit drugs or experience physical violence and six times as likely to experience forced sex compared to non-sex worker men. Transgender and male sex workers would benefit from harm reduction for substance use, violence prevention, response and strategies to mitigate discrimination.
Assuntos
Infecções por HIV/epidemiologia , Profissionais do Sexo , Minorias Sexuais e de Gênero , Pessoas Transgênero , Adolescente , Adulto , Estudos Transversais , Identidade de Gênero , Guatemala , Humanos , Masculino , Trabalho Sexual , Sexismo , Transtornos Relacionados ao Uso de Substâncias , Violência , Adulto JovemRESUMO
INTRODUCTION: Despite the higher risk of HIV among female sex workers (FSWs), men who have sex with men (MSM) and transgender women (TGW), these populations are under-represented in the literature on HIV in Haiti. Here, we present the first nationally representative estimates of HIV prevalence and the first care and treatment cascade for FSWs, MSM and TGW in Haiti. We also examine the social determinants of HIV prevalence in these groups and estimate FSW and MSM population size in Haiti. METHODS: Data were collected between April 2016 and February 2017 throughout the 10 geographical departments of Haiti. The Priorities for Local AIDS Control Efforts (PLACE) method was used to: (1) recruit participants for a behavioural survey; (2) provide rapid testing, counselling and linkage to care for syphilis and HIV; and (3) measure viral load using dried blood spots for participants testing HIV positive. RESULTS: Study participants included 990 FSWs, 520 MSM and 109 TGW. HIV prevalence was estimated at 7.7% (95% CI 6.2%, 9.6%) among FSWs, 2.2% (0.9%, 5.3%) among MSM and 27.6% (5.0%, 73.5%) among TGW. Of participants who tested positive for syphilis, 17% of FSWs, 19% of MSM and 74% of TGW were co-infected with HIV. Economic instability and intimate partner violence (IPV) were significantly associated with HIV among MSM; food insecurity, economic instability and history of rape were significantly associated with HIV among TGW. Fewer than one-third of participants living with HIV knew their status, and more than a quarter of those who knew their status were not on treatment. While approximately four in five FSW and MSM participants on treatment for HIV were virally suppressed, viral suppression was less common among TGW participants at only 46%. CONCLUSIONS: This study demonstrates a need for targeted interventions to prevent and treat HIV among key populations in Haiti. Potential high-impact interventions may include venue-based, peer navigator-led outreach and testing for HIV and syphilis and improving screening and case management for structural violence and IPV. TGW are in urgent need of such interventions due to our observations of alarmingly high HIV prevalence and low frequency of HIV viral suppression among TGW.
Assuntos
Fármacos Anti-HIV/uso terapêutico , Infecções por HIV/epidemiologia , Infecções por HIV/transmissão , Homossexualidade Masculina , Profissionais do Sexo , Pessoas Transgênero , Adulto , Feminino , Infecções por HIV/prevenção & controle , HIV-1 , Haiti/epidemiologia , Humanos , Masculino , Programas de Rastreamento , Pessoa de Meia-Idade , Prevalência , Fatores de Risco , Inquéritos e Questionários , Sífilis , Carga Viral , Adulto JovemRESUMO
BACKGROUND: Researchers use a variety of population size estimation methods to determine the sizes of key populations at elevated risk of human immunodeficiency virus (HIV)/acquired immune deficiency syndrome (AIDS), an important step in quantifying epidemic impact, advocating for high-risk groups, and planning, implementing, and monitoring prevention, care, and treatment programs. Conventional procedures often use information about sample respondents' social network contacts to estimate the sizes of key populations of interest. A recent study proposes a generalized network scale-up method that combines two samples-a traditional sample of the general population and a link-tracing sample of the hidden population-and produces more accurate results with fewer assumptions than conventional approaches. METHODS: We extended the generalized network scale-up method from link-tracing samples to samples collected with venue-based sampling designs popular in sampling key populations at risk of HIV. Our method obviates the need for a traditional sample of the general population, as long as the size of the venue-attending population is approximately known. We tested the venue-based generalized network scale-up method in a comprehensive simulation evaluation framework. RESULTS: The venue-based generalized network scale-up method provided accurate and efficient estimates of key population sizes, even when few members of the key population were sampled, yielding average biases below ±6% except when false-positive reporting error is high. It relies on limited assumptions and, in our tests, was robust to numerous threats to inference. CONCLUSIONS: Key population size estimation is vital to the successful implementation of efforts to combat HIV/AIDS. Venue-based network scale-up approaches offer another tool that researchers and policymakers can apply to these problems.
Assuntos
Infecções por HIV/epidemiologia , Densidade Demográfica , Estatística como Assunto , Usuários de Drogas/estatística & dados numéricos , Infecções por HIV/diagnóstico , Infecções por HIV/tratamento farmacológico , Política de Saúde , Humanos , Formulação de Políticas , Fatores de Risco , Profissionais do Sexo/estatística & dados numéricos , Minorias Sexuais e de Gênero/estatística & dados numéricos , Abuso de Substâncias por Via Intravenosa/epidemiologiaRESUMO
INTRODUCTION: HIV prevention strategies often include outreach to female sex workers at social venues identified as places where people meet new sexual partners. Patrons and staff at these venues may include female sex workers, their clients, as well as others who have high rates of new sexual partnerships. Few studies have compared HIV/STI among venue-based and general populations, across types of venues, or by sub-group of the venue population. Program planners often assume that the prevalence of infection is highest among female sex workers and considerably lower among other people at these venues, but there are few empiric studies assessing the prevalence of infection by sex worker status and type of venue. METHODS: In 2011, we used the PLACE method to identify public venues where people meet new sexual partners across Jamaica. The study team visited all venues with reported sex work as well as a 10% random sample of other venues and subsequently interviewed and tested a probability sample of 991 venue patrons and workers for HIV and other STI. RESULTS: Community informants identified 1207 venues. All venues where sex work was reported (735 venues) and a random sample of the remainder (134 of 472) were selected for onsite visits. Of these, 585 were found and operational. At a stratified random sample of venues, survey teams interviewed and tested 717 women and 274 men. 394 women reported recent sex work and 211 of these women reported soliciting clients on the street. Women exchanging sex for money were more likely to be infected with HIV (5.4% vs 1.0%; OR = 5.6, 95% CI = 1.8,17.3) or syphilis (11.7% vs. 5.8%, OR = 2.2, 95% CI = 1.7,4,0) than other women, but not significantly more likely to be infected with gonorrhea (8.4% vs 7.8%; OR = 1.1,95% CI = 0.6,1.9), chlamydia (16.2% vs 21.6%;OR = 0.7,95% CI = 0.5,1.0) or trichomoniasis (23.0% vs 17.0%, OR = 1.5,95% CI = 0.9,2.2). Women at venues were more likely to report sex work and multiple partners than women interviewed in a 2008 national population-based household survey commissioned by the Ministry of Health. CONCLUSIONS: In Jamaica, although the highest HIV prevalence was among street-based sex workers, the risk of HIV and STI extends to men and women at high risk venues, even those who do not self-identify as sex workers. Findings confirm the appropriateness of outreach to all men and women at these venues.
Assuntos
Infecções por HIV/epidemiologia , Infecções por HIV/prevenção & controle , Síndrome da Imunodeficiência Adquirida/epidemiologia , Síndrome da Imunodeficiência Adquirida/prevenção & controle , Adolescente , Adulto , Comorbidade , Feminino , Infecções por HIV/virologia , Humanos , Jamaica/epidemiologia , Masculino , Pessoa de Meia-Idade , Programas Nacionais de Saúde , Vigilância da População , Profissionais do Sexo , Adulto JovemRESUMO
BACKGROUND: National estimates of the sizes of key populations, including female sex workers, men who have sex with men, and transgender women are critical to inform national and international responses to the HIV pandemic. However, epidemiologic studies typically provide size estimates for only limited high priority geographic areas. This article illustrates a two-stage approach to obtain a national key population size estimate in the Dominican Republic using available estimates and publicly available contextual information. METHODS: Available estimates of key population size in priority areas were augmented with targeted additional data collection in other areas. To combine information from data collected at each stage, we used statistical methods for handling missing data, including inverse probability weights, multiple imputation, and augmented inverse probability weights. RESULTS: Using the augmented inverse probability weighting approach, which provides some protection against parametric model misspecification, we estimated that 3.7% (95% CI = 2.9, 4.7) of the total population of women in the Dominican Republic between the ages of 15 and 49 years were engaged in sex work, 1.2% (95% CI = 1.1, 1.3) of men aged 15-49 had sex with other men, and 0.19% (95% CI = 0.17, 0.21) of people assigned the male sex at birth were transgender. CONCLUSIONS: Viewing the size estimation of key populations as a missing data problem provides a framework for articulating and evaluating the assumptions necessary to obtain a national size estimate. In addition, this paradigm allows use of methods for missing data familiar to epidemiologists.
Assuntos
Demografia/métodos , Densidade Demográfica , Adolescente , Adulto , Interpretação Estatística de Dados , República Dominicana/epidemiologia , Medidas em Epidemiologia , Feminino , Homossexualidade Masculina/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Projetos de Pesquisa , Trabalho Sexual/estatística & dados numéricos , Pessoas Transgênero/estatística & dados numéricos , Adulto JovemRESUMO
This study aims to describe the transgender women and men who have sex with men (MSM) missed through venue-based sampling and illustrate how data on venues can be used to prioritize service delivery. Respondent-driven sampling (RDS) and time-location sampling (TLS) were used concurrently in 2010 for behavioral surveillance among MSM and transgender women in Guatemala City. RDS recruits who did not frequent venues (n = 106) were compared to TLS recruits (n = 609). TLS participants recruited at different types of venues were compared. RDS recruits who did not frequent venues were less educated, less likely to identify as gay, more likely to have concurrent partners and female sexual partners. Participants recruited at NGOs, saunas, hotels, streets and parks had more partners, were more likely to receive money for sex or have concurrent partners. Prevention programs for MSM and transgender women should characterize social venues and people that frequent them and improve service coverage through venues and social networks.
Assuntos
Infecções por HIV/prevenção & controle , Comportamento Sexual , Parceiros Sexuais , Rede Social , Pessoas Transgênero , Transexualidade , Síndrome da Imunodeficiência Adquirida , Adulto , Feminino , Guatemala/epidemiologia , Infecções por HIV/epidemiologia , Humanos , Masculino , Assunção de Riscos , Inquéritos e QuestionáriosRESUMO
The prevalence of human immunodeficiency virus type 1 (HIV-1) is highest among men who have sex with men (MSM) in Jamaica but no genotypic data are available on the virus strains that are responsible for the epidemic among this key population. HIV-1 polymerase (pol) genes from 65 MSM were sequenced and used to predict drug resistance mutations. An HIV drug resistance prevalence of 28% (minimum 13%) was observed among this cohort, with the most frequent mutations conferring resistance to efavirenz, nevirapine, and lamivudine. Phylogenetic analysis of the sequences revealed 10 times the number of linked HIV infections among this cohort than respondent reporting. HIV treatment and prevention efforts in Jamaica could benefit significantly from Pol genotyping of the HIV strains infecting socially vulnerable MSM prior to initiating antiretroviral therapy (ART), as this would guide suppressive ART and unearth HIV transmission clusters to enable more effective delivery of treatment and prevention programs.
Assuntos
Farmacorresistência Viral , Infecções por HIV/virologia , HIV-1/efeitos dos fármacos , HIV-1/genética , Fármacos Anti-HIV/farmacologia , Monitoramento Epidemiológico , Genótipo , Infecções por HIV/epidemiologia , HIV-1/isolamento & purificação , Homossexualidade Masculina , Humanos , Jamaica/epidemiologia , Masculino , Dados de Sequência Molecular , Oxirredução , Filogenia , Prevalência , RNA Viral/genética , Análise de Sequência de DNA , Produtos do Gene pol do Vírus da Imunodeficiência Humana/genéticaRESUMO
OBJECTIVES: This study estimates HIV prevalence among men who have sex with men (MSM) in Jamaica and explores social determinants of HIV infection among MSM. DESIGN: An island-wide cross-sectional survey of MSM recruited by peer referral and outreach was conducted in 2011. A structured questionnaire was administered and HIV/STI tests done. We compared three groups: MSM who accepted cash for sex within the past 3 months (MSM SW), MSM who did not accept cash for sex (MSM non-SW), and MSM with adverse life events (ever raped, jailed, homeless, victim of violence or low literacy). RESULTS: HIV prevalence among 449 MSM was 31.4%, MSM SW 41.1%, MSM with adverse life events 38.5%, 17 transgender MSM (52.9%), and MSM non-SW without adverse events 21.0%. HIV prevalence increased with age and number of adverse life events (test for trend P < 0.001), as did STI prevalence (P = 0.03). HIV incidence was 6.7 cases/100 person-years (95% CI: 3.74, 12.19). HIV prevalence was highest among MSM reporting high-risk sex; MSM SW who had been raped (65.0%), had a STI (61.2%) and who self identified as female (55.6%). Significant risk factors for HIV infection common to all 3 subgroups were participation in both receptive and insertive anal intercourse, high-risk sex, and history of a STI. Perception of no or little risk, always using a condom, and being bisexual were protective. CONCLUSION: HIV prevalence was high among MSM SW and MSM with adverse life events. Given the characteristics of the sample, HIV prevalence among MSM in Jamaica is probably in the range of 20%. The study illustrates the importance of social vulnerability in driving the HIV epidemic. Programs to empower young MSM, reduce social vulnerability and other structural barriers including stigma and discrimination against MSM are critical to reduce HIV transmission.
Assuntos
Infecções por HIV/epidemiologia , HIV-1 , Homossexualidade Masculina , Assunção de Riscos , Adolescente , Adulto , Feminino , Humanos , Jamaica/epidemiologia , Masculino , Pessoa de Meia-Idade , Prevalência , Fatores de Risco , Fatores SocioeconômicosRESUMO
To estimate the association between a simple measure of sexual partner concurrency and sexually transmitted infection (STI) we conducted a cross-sectional population-based household survey (n = 1795) and targeted surveys of people at venues where people meet sexual partners (n = 1580) to ask about sexual behaviour. Persons interviewed at venues were tested for HIV, gonorrhoea, chlamydia, and trichomoniasis. We compared the association between STI and reporting a partner had other partners. More women than men reported their main partner had other partners. Thirteen percent of all women in the population-based survey and 14.4% in the targeted survey reported having one partner in the past 12 months and that partner had additional partners. STI prevalence was significantly associated with reporting a partner had other partners (36.8% vs. 30.2%; prevalence ratio [PR] 1.2; 95% confidence interval [CI] 1.1, 1.4). Construction of complete sexual networks is costly and not routinely feasible. We recommend adding a question to cross-sectional surveys used to monitor sexual behaviour about whether the respondent believes his or her partner has other sexual partners. Although subject to bias, the question was useful in Jamaica to identify a group of women with only one sexual partner at increased risk of infection.
Assuntos
Infecções por HIV/epidemiologia , Comportamento Sexual/estatística & dados numéricos , Parceiros Sexuais , Infecções Sexualmente Transmissíveis/epidemiologia , Estudos Transversais , Feminino , Inquéritos Epidemiológicos , Humanos , Jamaica/epidemiologia , Masculino , Prevalência , Fatores de Risco , Assunção de Riscos , Inquéritos e QuestionáriosRESUMO
OBJECTIVE: To determine whether a site-based Priorities for Local AIDS Control Efforts (PLACE) HIV prevention intervention in Kingston, Jamaica increased condom use among persons with new or multiple sex partners. METHODS: A total of 147 sites where persons go to meet new sex partners were grouped into 50 geographic clusters and randomized to receive or not receive a multilevel PLACE prevention intervention. Baseline cross-sectional surveys of sites and patrons at sites were conducted in 2005 to determine the nature of social activities at sites to better plan the intervention and to ensure that the two arms of the trial were similar. The intervention was delivered by 50 trained outreach workers between January and June 2006. After the intervention two cross-sectional surveys were conducted to assess the extent of intervention implementation and to estimate the proportion of patrons at sites with recent new or concurrent partnerships and inconsistent condom use. RESULTS: Characteristics of sites and patrons were similar for most variables at intervention and control sites at both baseline and post-intervention. A total of 1535 patrons (723 men, 812 women) were interviewed at intervention sites and 1324 patrons (661 men, 663 women) at control sites 6-9 months after the intervention. There were no significant differences between intervention and control groups in the proportions of men (37.8% and 31.6%) and women (24.6% and 22.6%) who reported new or multiple relationships in the past year and inconsistent condom use. There was no significant difference in the proportion of men or women showing a condom at interview, having a HIV test in the past 12 months or being exposed to the intervention. CONCLUSIONS: An intent-to-treat analysis did not show any intervention effect. This was probably because of difficulty in implementing the intervention, the extent of patron mixing among sites, the intensity of national education campaigns, delay in conducting the post-intervention survey and evidence of other interventions at some control sites.
Assuntos
Infecções por HIV/prevenção & controle , HIV-1 , Promoção da Saúde/métodos , Sexo Seguro/estatística & dados numéricos , Adolescente , Adulto , Preservativos/estatística & dados numéricos , Estudos Transversais , Feminino , Infecções por HIV/transmissão , Humanos , Masculino , Avaliação de Resultados em Cuidados de Saúde , Fatores Sexuais , Comportamento Sexual/estatística & dados numéricos , Parceiros Sexuais , Adulto JovemRESUMO
OBJECTIVE: The objective of this study was to assess sexual behavior of persons at risk of HIV infection. GOAL: The goal of this study was to identify sites where HIV prevention is needed. STUDY DESIGN: Customers at sites where persons meet new sex partners in St. James, Jamaica, were surveyed. RESULTS: Of 421 sites, 282 men and 200 women (random sample, 23 sites) and 320 men and 265 women (special sample, 26 sites) were interviewed. Over one fourth of men and 14% (special) and 4% (random) of women had one or more new sex partners in the last 4 weeks. Seventy-eight percent of men reported condom use at last sex with a new partner compared with 66% of women. Approximately 50% of respondents reported condom use at last sex with a regular partner. CONCLUSION: Sites at which people meet new sex partners were diverse with significant opportunities for prevention. Commercial and transactional sex are features at many sites.
Assuntos
Infecções por HIV/epidemiologia , Infecções por HIV/prevenção & controle , Promoção da Saúde/organização & administração , Recreação , Comportamento Sexual , Parceiros Sexuais , Infecções Sexualmente Transmissíveis/epidemiologia , Infecções Sexualmente Transmissíveis/prevenção & controle , Adulto , Preservativos/estatística & dados numéricos , Feminino , Infecções por HIV/etiologia , Humanos , Jamaica/epidemiologia , Masculino , Fatores de Risco , Infecções Sexualmente Transmissíveis/etiologiaRESUMO
OBJECTIVE: To identify the meeting sites of new sexual partners in two Southern border cities in Mexico. MATERIAL AND METHODS: A descriptive epidemiologic study was carried out in May 2001, by surveying key informants in two border cities. Each reported site was visited to interview a resident subject. Subjects socializing in a subsample of sites were also interviewed. RESULTS: The key informants of the community reported 134 meeting sites in Chetumal and 111 in Ciudad Hidalgo. Both sites had scarce HIV/AIDS prevention activities. Characteristics were obtained for 89 sites in Chetumal and 42 in Ciudad Hidalgo. Almost 21% of interviewees reportedly met a new sexual partner in these sites in the past four weeks. CONCLUSIONS: Preventive actions are needed in meeting sites of new sexual partners. This method may provide information to plan for future interventions. The English version of this paper is available too at:http://www.insp.mx/salud/index.html.
Assuntos
Emigração e Imigração , Comportamento Sexual , Parceiros Sexuais , Adulto , América Central , Feminino , Infecções por HIV/prevenção & controle , Infecções por HIV/transmissão , Humanos , Masculino , México , Infecções Sexualmente Transmissíveis/prevenção & controle , Infecções Sexualmente Transmissíveis/transmissão , População UrbanaRESUMO
OBJETIVO: Identificar sitios de encuentro de nuevas parejas sexuales en dos ciudades de la frontera sur de México. MATERIAL Y MÉTODOS: En un estudio epidemiológico descriptivo se encuestó, en mayo de 2001, a informantes clave de la comunidad en dos ciudades fronterizas del sur de México para identificar sitios de encuentro de nuevas parejas. Se visitó cada sitio reportado y se encuestó a una persona del lugar. De una submuestra de sitios, se encuestó a personas que socializaban en los mismos. RESULTADOS: Los informantes clave de la comunidad reportaron 134 sitios en Chetumal y 111 en Ciudad Hidalgo. Se obtuvo información de las características de 89 sitios en Chetumal y 42 en Ciudad Hidalgo, ambos con escasas actividades preventivas del VIH/SIDA. Cerca de 21 por ciento de usuarios encuestados reportaron haber conocido una nueva pareja en los sitios en las últimas cuatro semanas. CONCLUSIONES: Son necesarias acciones de prevención en los sitios de encuentro de nuevas parejas sexuales. Este método puede proveer información para planificar futuras intervenciones.