Counting hard-to-count populations: the network scale-up method for public health

Estimating sizes of hidden or hard-to-reach populations is an important problem in public health. For example, estimates of the sizes of populations at highest risk for HIV and AIDS are needed for designing, evaluating and allocating funding for treatment and prevention programmes. A promising approach to size estimation, relatively new to public health, is the network scale-up method (NSUM), involving two steps: estimating the personal network size of the members of a random sample of a total population and, with this information, estimating the number of members of a hidden subpopulation of the total population. We describe the method, including two approaches to estimating personal network sizes (summation and known population). We discuss the strengths and weaknesses of each approach and provide examples of international applications of the NSUM in public health. We conclude with recommendations for future research and evaluation

Lives saved by Global Fund-supported HIV/AIDS, tuberculosis and malaria programs: estimation approach and results between 2003 and end-2007

<p>Abstract</p> <p>Background</p> <p>Since 2003, the Global Fund has supported the scale-up of HIV/AIDS, tuberculosis and malaria control in low- and middle-income countries. This paper presents and discusses a methodology for estimating the lives saved through selected service deliveries reported to the Global Fund.</p> <p>Methods</p> <p>Global Fund-supported programs reported, by end-2007, 1.4 million HIV-infected persons on antiretroviral treatment (ARV), 3.3 million new smear-positive tuberculosis cases detected in DOTS (directly observed TB treatment, short course) programs, and 46 million insecticide-treated mosquito nets (ITNs) delivered. We estimated the corresponding lives saved using adaptations of existing epidemiological estimation models.</p> <p>Results</p> <p>By end-2007, an estimated 681,000 lives (95% uncertainty range 619,000-774,000) were saved and 1,097,000 (993,000-1,249,000) life-years gained by ARV. DOTS treatment would have saved 1.63 million lives (1.09 - 2.17 million) when compared against no treatment, or 408,000 lives (265,000-551,000) when compared against non-DOTS treatment. ITN distributions in countries with stable endemic <it>falciparum </it>malaria were estimated to have achieved protection from malaria for 26 million of child-years at risk cumulatively, resulting in 130,000 (27,000-232,000) under-5 deaths prevented.</p> <p>Conclusions</p> <p>These results illustrate the scale of mortality effects that supported programs may have achieved in recent years, despite margins of uncertainty and covering only selected intervention components. Evidence-based evaluation of disease impact of the programs supported by the Global Fund with international and in-country partners must be strengthened using population-level data on intervention coverage and demographic outcomes, information on quality of services, and trends in disease burdens recorded in national health information systems.</p

“I JUST FEEL LIKE MY BRAIN IS NOT THE SAME”: A PRELIMINARY MIXED METHODS EXAMINATION OF HELP-SEEKING BEHAVIORS AMONG ADULTS WITH CANCER-RELATED COGNITIVE IMPAIRMENT

Purpose This study aimed to investigate help-seeking behaviors and interventions among cancer survivors with self-reported Cancer-Related Cognitive Impairment (CRCI), focusing on understanding the differences between help-seekers and non-help-seekers regarding demographics and cognitive- communication scores. Method A cross-sectional survey was administered to adult cancer survivors to collect data on self-reported cognitive-communication deficits, social participation, social satisfaction, and help-seeking behaviors. Linear regression analysis was used to assess the relationship between self-reported cognitive-communication scores and help-seeking behaviors, and logistic regression analysis was used to determine the predictors of seeking help for CRCI. Results Approximately 27.38% of the participants sought help for their CRCI, with healthcare providers, independent searching, and personal connections being the most common sources of assistance. The interventions utilized included medication, physical activity, and counseling. However, 75% of participants did not engage in specific help-seeking behaviors. Age was identified as a significant predictor of seeking help in individuals with self-reported CRCI. Conclusion Qualitative thematic analysis revealed barriers to help-seeking, including lack of awareness, reluctance, perception of CRCI as insignificant, and lack of validation by healthcare professionals. This study underscores the importance of improved collaboration between oncology and rehabilitation teams, better dissemination of information, and increased support for CRCI survivors. Understanding the characteristics of help-seekers and non-help- seekers is crucial for targeted education efforts and for enhancing survivors' quality of life

The Young Men’s Survey Phase II: Hepatitis B Immunization and Infection Among Young Men Who Have Sex With Men

Objectives. We measured the prevalence of hepatitis B virus (HBV) immunization and HBV infection among men aged 23 to 29 years who have sex with men

Estimating the level of HIV prevention coverage, knowledge and protective behavior among injecting drug users: what does the 2008 UNGASS reporting round tell us?

Objectives: The 2001 Declaration of Commitment from the United Nations General Assembly Special Session on HIV/AIDS (UNGASS) set the prevention of HIV infection among injecting drug users (IDUs) as an important priority in the global fight against HIV/AIDS. This article examines data gathered to monitor the fulfillment of this commitment in low-income and middle-income countries (LMICs) where resources to develop an effective response to HIV are limited and where injecting drug use is reported to occur in 99 (of 147) countries, home to 75% of the estimated 15.9 million global IDU population.Methods: Data relating to injecting drug use submitted by LMICs to the Joint United Nations Programme on HIV/AIDS (UNAIDS) in the 2008 reporting round for monitoring the Declaration of Commitment on HIV/AIDS were reviewed. The quality of the data reported was assessed and country data were aggregated and compared to determine progress in HIV prevention efforts. For each indicator, the mean value weighted for the size of each country's IDU population was determined; regional estimates were also made.Results: Reporting was inconsistent between countries. Forty percent of LMIC (40/99), where injecting occurs, reported data for 1 or more of the 5 indicators pertinent to HIV prevention among IDUs. Many of the data reported were excluded from this analysis because the indicators used by countries were not consistent with those defined by UNAIDS Monitoring and Evaluation Reference Group and could not be compared. Data from 32 of 99 countries met our inclusion criteria. These 32 countries account for approximately two-thirds (68%) of the total estimated IDU population in all LMICs.The IDU population weighted means are as follows: 36% of IDUs tested for HIV in the last year; 26% of IDUs reached with HIV prevention programs in the last year; 45% of IDUs with correct HIV prevention knowledge; 37% of IDUs used a condom at last sexual intercourse; and 63% of IDUs used a clean syringe at last injection. Marked variance was observed in the data reported between different regions.Conclusions: Data from the 2008 United Nations General Assembly Special Session reporting round provide a baseline against which future progress might be measured. The data indicate a wide variation in HIV service coverage for IDUs and a wide divergence in HIV knowledge and risk behaviors among IDUs in different countries. Countries should be encouraged and assisted in monitoring and reporting on HIV prevention for IDUs