Comparison of Empirically Derived and Model-Based Estimates of Key Population HIV Incidence and the Distribution of New Infections by Population Group in Sub-Saharan Africa

Oliver Stevens*, Rebecca K Barnes, John Stover, Yu Teng, James Stannah, Romain Silhol, Harriet Jones, Ross D Booton, Rowan Martin-Hughes, Leigh Johnson, Mathieu Maheu-Giroux, Sharmistha Mishra, Jack Stone, Anna Bershteyn, Hae-Young Kim, Keith Sabin, Kate M Mitchell, Dobromir Dimitrov, Stefan D. Baral, Deborah DonnellEline Korenromp, Brian Rice, James Hargreaves, Peter T Vickerman, Marie Claude Boily, Jeffrey Imai-Eaton

*Corresponding author for this work

Research output: Contribution to journalArticle (Academic Journal)peer-review

1 Citation (Scopus)

Abstract

Abstract
Background:
The distribution of new HIV infections among key populations, including female sex workers (FSWs), gay men and other men who have sex with men (MSM), and people who inject drugs (PWID) are essential information to guide an HIV response, but data are limited in sub-Saharan Africa (SSA). We analyzed empirically derived and mathematical model-based estimates of HIV incidence among key populations and compared with the Joint United Nations Programme on HIV/AIDS (UNAIDS) estimates.

Methods:
We estimated HIV incidence among FSW and MSM in SSA by combining meta-analyses of empirical key population HIV incidence relative to the total population incidence with key population size estimates (KPSE) and HIV prevalence. Dynamic HIV transmission model estimates of HIV incidence and percentage of new infections among key populations were extracted from 94 country applications of 9 mathematical models. We compared these with UNAIDS-reported distribution of new infections, implied key population HIV incidence and incidence-to-prevalence ratios.

Results:
Across SSA, empirical FSW HIV incidence was 8.6-fold (95% confidence interval: 5.7 to 12.9) higher than total population female 15–39 year incidence, and MSM HIV incidence was 41.8-fold (95% confidence interval: 21.9 to 79.6) male 15–29 year incidence. Combined with KPSE, these implied 12% of new HIV infections in 2021 were among FSW and MSM (5% and 7% respectively). In sensitivity analysis varying KPSE proportions within 95% uncertainty range, the proportion of new infections among FSW and MSM was between 9% and 19%. Insufficient data were available to estimate PWID incidence rate ratios. Across 94 models, median proportion of new infections among FSW, MSM, and PWID was 6.4% (interquartile range 3.2%–11.7%), both much lower than the 25% reported by UNAIDS.

Conclusion:
Empirically derived and model-based estimates of HIV incidence confirm dramatically higher HIV risk among key populations in SSA. Estimated proportions of new infections among key populations in 2021 were sensitive to population size assumptions and were substantially lower than estimates reported by UNAIDS.
Original languageEnglish
Pages (from-to)e46-e58
Number of pages6
JournalJournal of Acquired Immune Deficiency Syndromes
Volume95
Issue number1S
DOIs
Publication statusPublished - 1 Jan 2024

Bibliographical note

Publisher Copyright:
Copyright © 2023 The Author(s). Published by Wolters Kluwer Health, Inc.

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