Availability and Quality of Size Estimations of Female Sex Workers, Men Who Have Sex with Men, People Who Inject Drugs and Transgender Women in Low- and Middle-Income Countries

<div><p>Objective</p><p>To assess the availability and quality of population size estimations of female sex workers (FSW), men who have sex with men (MSM), people who inject drug (PWID) and transgender women.</p><p>Methods</p><p>Size estimation data since 2010 were retrieved from global reporting databases, Global Fund grant application documents, and the peer-reviewed and grey literature. Overall quality and availability were assessed against a defined set of criteria, including estimation methods, geographic coverage, and extrapolation approaches. Estimates were compositely categorized into ‘nationally adequate’, ‘nationally inadequate but locally adequate’, ‘documented but inadequate methods’, ‘undocumented or untimely’ and ‘no data.’</p><p>Findings</p><p>Of 140 countries assessed, 41 did not report any estimates since 2010. Among 99 countries with at least one estimate, 38 were categorized as having nationally adequate estimates and 30 as having nationally inadequate but locally adequate estimates. Multiplier, capture-recapture, census and enumeration, and programmatic mapping were the most commonly used methods. Most countries relied on only one estimate for a given population while about half of all reports included national estimates. A variety of approaches were applied to extrapolate from sites-level numbers to national estimates in two-thirds of countries.</p><p>Conclusions</p><p>Size estimates for FSW, MSM, PWID and transgender women are increasingly available but quality varies widely. The different approaches present challenges for data use in design, implementation and evaluation of programs for these populations in half of the countries assessed. Guidance should be further developed to recommend: a) applying multiple estimation methods; b) estimating size for a minimum number of sites; and, c) documenting extrapolation approaches.</p></div

Number of estimates used in countries with known estimation methods for female sex workers (FSW), men who have sex with men (MSM), people who inject drug (PWID)and transgender women in low- and middle-income countries, 2010–2014.

<p>Number of estimates used in countries with known estimation methods for female sex workers (FSW), men who have sex with men (MSM), people who inject drug (PWID)and transgender women in low- and middle-income countries, 2010–2014.</p

Categorization of population size estimates of female sex workers, men who have sex with men, people who inject drugs, and transgender women in low- and middle-income countries, 2010–2014.

<p>Categorization of population size estimates of female sex workers, men who have sex with men, people who inject drugs, and transgender women in low- and middle-income countries, 2010–2014.</p

Approaches used for extrapolations to national population size estimates in countries with known estimation methods for female sex workers (FSW), men who have sex with men (MSM), people who inject drug (PWID) and transgender women in low- and middle-income countries, 2010–2014.

<p>Approaches used for extrapolations to national population size estimates in countries with known estimation methods for female sex workers (FSW), men who have sex with men (MSM), people who inject drug (PWID) and transgender women in low- and middle-income countries, 2010–2014.</p

Geographic coverage of estimation in countries with known estimation methods for female sex workers (FSW), men who have sex with men (MSM), people who inject drug (PWID) and transgender women in low- and middle-income countries, 2010–2014.

<p>Geographic coverage of estimation in countries with known estimation methods for female sex workers (FSW), men who have sex with men (MSM), people who inject drug (PWID) and transgender women in low- and middle-income countries, 2010–2014.</p

Number of countries with available estimates for female sex workers (FSW), men who have sex with men (MSM), people who inject drug (PWID) and transgender women by groups over the year 2010–2014 in low- and middle-income countries.

<p>Number of countries with available estimates for female sex workers (FSW), men who have sex with men (MSM), people who inject drug (PWID) and transgender women by groups over the year 2010–2014 in low- and middle-income countries.</p

Application of methods in estimating population size estimates for female sex workers (FSW), men who have sex with men (MSM), people who inject drug (PWID) and transgender women in low- and middle-income countries, 2010–2014.

<p>Application of methods in estimating population size estimates for female sex workers (FSW), men who have sex with men (MSM), people who inject drug (PWID) and transgender women in low- and middle-income countries, 2010–2014.</p

TB and HIV co-infection rates, coverage of TB/HIV interventions, according to NTCP registry (A) and TB notifications (B).

<p>TB and HIV co-infection rates, coverage of TB/HIV interventions, according to NTCP registry (A) and TB notifications (B).</p

Uptake of HIV testing and counseling (A) and (B) estimated numbers of PLWH [32], according to ART eligibility/need of actual enrolment on ART, at the end of every year.

<p>Uptake of HIV testing and counseling (A) and (B) estimated numbers of PLWH [<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0069437#B32" target="_blank">32</a>], according to ART eligibility/need of actual enrolment on ART, at the end of every year.</p

Population standardized number of hospital admissions for (A) females and (B) males aged 15-49 and population standardized number of hospital deaths for (C) females and (D) males aged 15-49.

<p>Population standardized number of hospital admissions for (A) females and (B) males aged 15-49 and population standardized number of hospital deaths for (C) females and (D) males aged 15-49.</p