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Background Sampling frames rarely exist for key populations at highest risk for HIV, such as sex workers, men who have sex with men, people who use drugs, and transgender populations. Without reliable sampling frames, most data collection relies on non-probability sampling approaches including network-based methods (e.g. respondent driven sampling) and venue-based methods (e.g. time-location sampling). Quality of implementation and reporting of these studies is highly variable, making wide-ranging estimates often difficult to compare. Here, a modified quality assessment tool, Global.HIV Quality Assessment Tool for Data Generated through Non-Probability Sampling (GHQAT), was developed to evaluate the quality of HIV epidemiologic evidence generated using non-probability methods. Methods The GHQAT assesses three main domains: study design, study implementation, and indicator-specific criteria(prevalence, incidence, HIV continuum of care, and population size estimates). The study design domain focuses primarily on the specification of the target and study populations. The study implementation domain is concerned with sampling implementation. Each indicator-specific section contains items relevant to that specific indicator. A random subset of 50 studies from a larger systematic review on epidemiologic data related to HIV and key populations was generated and reviewed using the GHQAT by two independent reviewers. Inter-rater reliability was assessed by calculating intraclass correlation coefficients for the scores assigned to study design, study implementation and each of the indicator-specific criteria. Agreement was categorized as poor(0.00-0.50), fair(0.51-0.70), and good(0.71-1.00). The distribution of good, fair, and poor scores for each section was described. Results Overall, agreement between the two independent reviewers was good(ICC >0.7). Agreement was best for the section evaluating the HIV continuum of care(ICC = 0.96). For HIV incidence, perfect agreement was observed, but this is likely due to the small number of studies reviewed that assessed incidence(n = 3). Of the studies reviewed, 2% (n = 1) received a score of "poor" for study design, while 50% (n = 25) received a score of "poor" for study implementation. Conclusions Addressing HIV prevention and treatment needs of key populations is increasingly understood to be central to HIV responses across HIV epidemic settings, though data characterizing specific needs remains highly variable with the least amount of information in the most stigmatizing settings. Here, we present an efficient tool to guide HIV prevention and treatment programs as well as epidemiological data collection by reliably synthesizing the quality of available non-probability based epidemiologic information for key populations. This tool may help shed light on how researchers may improve not only the implementation of, but also the reporting on their studies.

Female sex workers (FSW) are affected by individual, network, and structural risks, making them vulnerable to poor health and well-being. HIV prevention strategies and local community-based programs can rely on estimates of the number of FSW to plan and implement differentiated HIV prevention and treatment services. However, there are limited systematic assessments of the number of FSW in countries across sub-Saharan Africa to facilitate the identification of prevention and treatment gaps. Here we provide estimated population sizes of FSW and the corresponding uncertainties for almost all sub-national areas in sub-Saharan Africa. We first performed a literature review of FSW size estimates and then developed a Bayesian hierarchical model to synthesize these size estimates, resolving competing size estimates in the same area and producing estimates in areas without any data. We estimated that there are 2.5 million (95% uncertainty interval 1.9 to 3.1) FSW aged 15 to 49 in sub-Saharan Africa. This represents a proportion as percent of all women of childbearing age of 1.1% (95% uncertainty interval 0.8 to 1.3%). The analyses further revealed substantial differences between the proportions of FSW among adult females at the sub-national level and studied the relationship between these heterogeneities and many predictors. Ultimately, achieving the vision of no new HIV infections by 2030 necessitates dramatic improvements in our delivery of evidence-based services for sex workers across sub-Saharan Africa.© 2023 National Academy of Sciences. Deposited by shareyourpaper.org and openaccessbutton.org. We've taken reasonable steps to ensure this content doesn't violate copyright. However, if you think it does you can request a takedown by emailing help@openaccessbutton.org.

Background Female genital schistosomiasis (FGS) affects up to 56 million women in sub-Saharan Africa and may increase risk of HIV infection. Methods To assess the association of schistosomiasis with HIV infection, peer-reviewed literature published until 31 December 2018 was examined and a pooled estimate for the odds ratio was generated using Bayesian random effects models. Results Of the 364 abstracts that were identified, 26 were included in the summary. Eight reported odds ratios of the association between schistosomiasis and HIV; one reported a transmission hazard ratio of 1.8 (95% CI, 1.2–2.6) among women and 1.4 (95% CI, 1.0–1.9) among men; 11 described the prevalence of schistosomiasis among HIV-positive people (range, 1.5–36.6%); and six reported the prevalence of HIV among people with schistosomiasis (range, 5.8–57.3%). Six studies were selected for quantitative analysis. The pooled estimate for the odds ratio of HIV among people with schistosomiasis was 2.3 (95% CI, 1.2–4.3). Conclusions A significant association of schistosomiasis with HIV was found. However, a specific summary estimate for FGS could not be generated. A research agenda was provided to determine the effect of FGS on HIV infection. The WHO’s policy on mass drug administration for schistosomiasis may prevent HIV.

Globally, in 2017 35 million people were living with HIV (PLHIV) and 257 million had chronic HBV infection (HBsAg positive). The extent of HIV‐HBsAg co‐infection is unknown. We undertook a systematic review to estimate the global burden of HBsAg co‐infection in PLHIV. We searched MEDLINE, Embase and other databases for published studies (2002‐2018) measuring prevalence of HBsAg among PLHIV. The review was registered with PROSPERO (#CRD42019123388). Populations were categorized by HIV‐exposure category. The global burden of co‐infection was estimated by applying regional co‐infection prevalence estimates to UNAIDS estimates of PLHIV. We conducted a meta‐analysis to estimate the odds of HBsAg among PLHIV compared to HIV‐negative individuals. We identified 506 estimates (475 studies) of HIV‐HBsAg co‐infection prevalence from 80/195 (41.0%) countries. Globally, the prevalence of HIV‐HBsAg co‐infection is 7.6% (IQR 5.6%‐12.1%) in PLHIV, or 2.7 million HIV‐HBsAg co‐infections (IQR 2.0‐4.2). The greatest burden (69% of cases; 1.9 million) is in sub‐Saharan Africa. Globally, there was little difference in prevalence of HIV‐HBsAg co‐infection by population group (approximately 6%‐7%), but it was slightly higher among people who inject drugs (11.8% IQR 6.0%‐16.9%). Odds of HBsAg infection were 1.4 times higher among PLHIV compared to HIV‐negative individuals. There is therefore, a high global burden of HIV‐HBsAg co‐infection, especially in sub‐Saharan Africa. Key prevention strategies include infant HBV vaccination, including a timely birth‐dose. Findings also highlight the importance of targeting PLHIV, especially high‐risk groups for testing, catch‐up HBV vaccination and other preventative interventions. The global scale‐up of antiretroviral therapy (ART) for PLHIV using a tenofovir‐based ART regimen provides an opportunity to simultaneously treat those with HBV co‐infection, and in pregnant women to also reduce mother‐to‐child transmission of HBV alongside HIV.

Objective: The World Health Organization’s guidelines on viral hepatitis testing and treatment recommend prioritizing high prevalence groups. Hepatitis C virus (HCV) infection disproportionately affects people who inject drugs and men who have sex with men, but data on female sex workers (FSW) are limited. The study aimed to determine active HCV infection and risk factors associated with HCV exposure among Vietnamese FSW. Methods: We surveyed 1886 women aged ≥ 18 years from Haiphong, Hanoi and Ho Chi Minh City who had sold sex in the last month. We tested for HCV antibody and HCV core antigen as markers for exposure to HCV and active infection, respectively. Results: Across these provinces, high prevalence of HCV exposure (8.8–30.4%) and active infection (3.6–22.1%) were observed. Significant associations with HCV exposure were HIV infection (aOR = 23.7; 95% CI: 14.8–37.9), injection drug use (aOR = 23.3; 95% CI: 13.1–41.4), history of compulsory detention (aOR = 2.5; 95% CI: 1.4–4.2) and having more than 10 sex clients in the last month (aOR = 1.9; 95% CI: 1.2–3.2). Among FSW who reported never injecting drugs, HIV infection (aOR = 24.2; 95% CI: 14.8–39.4), a history of non-injection drug use (aOR = 3.3, CI: 1.8–5.7), compulsory detention (aOR = 2.2; 95% CI: 1.2–4.0) and having over 10 sex clients in the last month (aOR = 2.2, 95% CI: 1.3–3.7) were independently associated with HCV exposure. Discussion: FSW have elevated HCV risks through sex- and drug-related pathways. These findings highlight the need to offer FSW-targeted HCV interventions and ensure their access to HIV prevention and treatment.

Introduction The Case Surveillance and Vital Registration (CSAVR) model within Spectrum estimates HIV incidence trends from surveillance data on numbers of new HIV diagnoses and HIV‐related deaths. This article describes developments of the CSAVR tool to more flexibly model diagnosis rates over time, estimate incidence patterns by sex and age group and by key population group. Methods We modelled HIV diagnosis rate trends as a mixture of three factors, including temporal and opportunistic infection components. The tool was expanded to estimate incidence rate ratios by sex and age for countries with disaggregated reporting of new HIV diagnoses and AIDS deaths, and to account for information on key populations such as men who have sex with men (MSM), males who inject drugs (MWID), female sex workers (FSW) and females who inject drugs (FWID). We used a Bayesian framework to calibrate the tool in 71 high‐income or low‐HIV burden countries. Results Across countries, an estimated median 89% (interquartile range [IQR]: 78%–96%) of HIV‐positive adults knew their status in 2019. Mean CD4 counts at diagnosis were stable over time, with a median of 456 cells/μl (IQR: 391–508) across countries in 2019. In European countries reporting new HIV diagnoses among key populations, median estimated proportions of males that are MSM and MWID was 1.3% (IQR: 0.9%–2.0%) and 0.56% (IQR: 0.51%–0.64%), respectively. The median estimated proportions of females that are FSW and FWID were 0.36% (IQR: 0.27%–0.45%) and 0.14 (IQR: 0.13%–0.15%), respectively. HIV incidence per 100 person‐years increased among MSM, with median estimates reaching 0.43 (IQR: 0.29–1.73) in 2019, but remained stable in MWID, FSW and FWID, at around 0.12 (IQR: 0.04–1.9), 0.09 (IQR: 0.06–0.69) and 0.13% (IQR: 0.08%–0.91%) in 2019, respectively. Knowledge of HIV status among HIV‐positive adults gradually increased since the early 1990s to exceed 75% in more than 75% of countries in 2019 among each key population. Conclusions CSAVR offers an approach to using routine surveillance and vital registration data to estimate and project trends in both HIV incidence and knowledge of HIV status.

Introduction Key populations (KP) continue to account for high HIV incidence globally. Still, prioritization of KP in the national HIV prevention response remains insufficient, leading to their suboptimal access to HIV programmes. This commentary aims to share Kenya’s challenges and successes in achieving 2020 global HIV targets and scaling up the KP programme in the last decade. Discussion The KP programme in Kenya has scaled up in the last decade with the inclusion of female sex workers (FSW), men who have sex with men (MSM), people who inject drugs (PWID), transgender people and people in prisons as priority populations in the national HIV response. KP coverage based on official size estimates for FSW is 73%, for MSM is 82%, for PWID through needle syringe programme (NSP) is 71%, and through opioid substitution therapy (OST) is 26% and for transgender people is 5%. The service outcomes for KP have been relatively strong in prevention with high condom use at last paid sex for FSW (92%) and use of sterile equipment among PWID (88%), though condom use at last sex with a non‐regular partner among MSM (78%) is still low. The KP programme has not met care continuum targets for all subpopulations with low case findings. The national KP programme led by the Ministry of Health has scaled up the programme through (a) strategic partnerships with KP‐led and competent organizations, researchers and donors; (b) development of policy guidance and programme standards; (c) continuous sensitization and advocacy to garner support; (d) development of national reporting systems, among others. However, the programme is still struggling with uncertain size estimates; lack of updated bio‐behavioural survey data; inadequate scale‐up of interventions among transgender people and people in prison settings; gaps in reaching adolescent and young KP, and effectively addressing structural barriers like violence and stigma. Conclusions To reach the ambitious global HIV targets, sufficient coverage of KP with quality HIV programmes is critical. Despite scaling up the KP programme, Kenya has not yet achieved the 2020 global HIV targets and needs more efforts to scale‐up quality programmes for KP who are underserved in the HIV response.

Background Stigma is an established barrier to the provision and uptake of HIV prevention, diagnostic, and treatment services. Despite consensus on the importance of addressing stigma, there are currently no country-level summary measures to characterize stigma and track progress in reducing stigma around the globe. This data mapping exercise aimed to assess the potential for existing data to be used to summarize and track stigma, including discrimination, related to HIV status, or key population membership at the country level. Methods and findings This study assessed existing indicators of stigma related to living with HIV or belonging to 1 of 4 key populations including gay men and other men who have sex with men, sex workers, people who use drugs, and transgender persons. UNAIDS Strategic Information Department led an initial drafting of possible domains, subdomains, and indicators, and a 3-week e-consultation was held to provide feedback. From the e-consultation, 44 indicators were proposed for HIV stigma; 14 for sexual minority stigma (including sexual behavior or orientation) related to men who have sex with men; 12 for sex work stigma; 10 for drug use stigma; and 17 for gender identity stigma related to transgender persons. We conducted a global data mapping exercise to identify and describe the availability and quality of stigma data across countries with the following sources: UNAIDS National Commitments and Policies Instrument (NCPI) database; Multiple Indicator Cluster Surveys (MICS); Demographic and Health Surveys (DHS); People Living with HIV Stigma Index surveys; HIV Key Populations Data Repository; Integrated Biological and Behavioral Surveys (IBBS); and network databases. Data extraction was conducted between August and November 2020. Indicators were evaluated based on the following: if an existing data source could be identified; the number of countries for which data were available for the indicator at present and in the future; variation in the indicator across countries; and considerations of data quality or accuracy. This mapping exercise resulted in the identification of 24 HIV stigma indicators and 10 key population indicators as having potential to be used at present in the creation of valid summary measures of stigma at the country level. These indicators may allow assessment of legal, societal, and behavioral manifestations of stigma across population groups and settings. Study limitations include potential selection bias due to available data sources to the research team and other biases due to the exploratory nature of this data mapping process. Conclusions Based on the current state of data available, several indicators have the potential to characterize the level and nature of stigma affecting people living with HIV and key populations across countries and across time. This exercise revealed challenges for an empirical process reliant on existing data to determine how to weight and best combine indicators into indices. However, results for this study can be combined with participatory processes to inform summary measure development and set data collection priorities going forward.

Introduction Over the past 20 years, the response to the HIV epidemic has achieved remarkable results. These results have often been motivated by targets adopted by countries through United Nations (UN) Political Declarations on HIV. The 2016 political declaration included two impact targets, to achieve a 75% decline in new HIV infections and AIDS‐related deaths between 2010 and 2020, and to reach the 90‐90‐90 testing and treatment targets by 2020. Our objective is to summarize progress towards these targets using robust and comparable HIV estimates released by UNAIDS in July 2021. In addition, we comment on the importance of targets and the modelled estimates required to quantify those targets. Discussion The UNAIDS estimates indicate that at the global and regional levels, the 2020 targets were missed: new infections declined by 31% and AIDS‐related deaths declined by 47% between 2010 and 2020, compared to a target of 75% decline for both indicators. Similarly, no region achieved the 90‐90‐90 testing and treatment targets. Some countries, in diverse settings, achieved these targets showing that the targets were not overly ambitious if the right funding, policies and evidence‐informed interventions at the right scale were in place. The 2021 UN Political Declaration on HIV, adopted on 8 June 2021, has set out a new set of ambitious but achievable targets for 2025. The 2025 targets and the required actions to reach those targets are described in the Global AIDS Strategy 2021–2026, which provides a framework to reprioritize HIV responses by reducing inequalities and building on the achievements of multiple Sustainable Development Goals. The Strategy encourages countries to monitor progress against targets for different geographic areas and populations to maximize equitable services and ensure accountability and also to understand why targets are being missed. Conclusions The UNAIDS epidemiological estimates provide information that promote accountability and estimate progress towards global targets at the national level. Additional strategic information and analyses are required to identify the populations that are furthest from the targets and the programmes and policies that are keeping countries from meeting their targets.

© 2020 The Authors. Journal of the International AIDS Society published by John Wiley & Sons Ltd on behalf of the International AIDS Society. Introduction: Key populations at elevated risk to contract or transmit HIV may also be at higher risk of COVID-19 complications and adverse outcomes associated with public health prevention measures. However, the conditions faced by specific populations vary according to social, structural and environmental factors, including stigma and discrimination, criminalization, social and economic safety nets and the local epidemiology of HIV and COVID-19, which determine risk of exposure and vulnerability to adverse health outcomes, as well as the ability to comply with measures such as physical distancing. This commentary identifies common vulnerabilities and cross-cutting themes in terms of the impacts of COVID-19 on key populations before addressing issues and concerns specific to particular populations. Discussion: Cross-cutting themes include direct impacts such as disrupted access to essential medicines, commodities and services such as anti-retroviral treatment, HIV pre-exposure prophylaxis, opioid agonist treatment, viral load monitoring, HIV and sexually transmitted infections testing, condoms and syringes. Indirect impacts include significant collateral damage arising from prevention measures which restrict human rights, increase or impose criminal penalties, and expand police powers to target vulnerable and criminalized populations. Significant heterogeneity in the COVID-19 pandemic, the underlying HIV epidemic and the ability of key populations to protect themselves means that people who inject drugs and sex workers face particular challenges, including indirect impacts as a result of police targeting, loss of income and sometimes both. Geographical variations mean that transgender people and men who have sex with men in regions like Africa and the middle east remain criminalized, as well as stigmatized and discriminated against, increasing their vulnerability to adverse outcomes in relation to COVID-19. Conclusions: Disruptions to both licit and illicit supply chains, loss of income and livelihoods and changes in behaviour as a result of lockdowns and physical distancing have the potential to exacerbate the impacts of the COVID-19 pandemic on key populations. While these impacts will vary significantly, human-rights approaches to COVID-19 emergency laws and public health prevention measures that are population-specific and sensitive, will be key to reducing adverse health outcomes and ensuring that no one is left behind.

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.

ObjectivesIn sub-Saharan Africa (SSA) where HIV burden is highest, access to testing, a key entry point for prevention and treatment, remains low for adolescents (aged 10–19). Access may be hampered by policies requiring parental consent for adolescents to receive HIV testing services (HTS). In 2013, the WHO recommended countries to review HTS age of consent policies. Here, we investigate country progress and policies on age of consent for HIV testing.DesignComprehensive policy review.Data sourcesPolicies addressing HTS were obtained through searching WHO repositories and governmental and non-governmental websites and consulting country and regional experts.Eligibility criteriaHTS policies published by SSA governments before 2019 that included age of consent.Data extraction and synthesisData were extracted on HTS age of consent including exceptions based on risk and maturity. Descriptive analyses of included policies were disaggregated by Eastern and Southern Africa (ESA) and Western and Central Africa (WCA) subregions.ResultsThirty-nine policies were reviewed, 38 were eligible; 19/38 (50%) permitted HTS for adolescents ≤16 years old without parental consent. Of these, six allowed HTS at ≥12 years old, two at ≥13, two at ≥14, five at ≥15 and four at ≥16. In ESA, 71% (n=15/21) allowed those of ≤16 years old to access HTS, while only 24% (n=6/25) of WCA countries allowed the same. Maturity exceptions including marriage, sexual activity, pregnancy or key population were identified in 18 policies. In 2019, 63% (n=19/30) of policies with clear age-based criteria allowed adolescents of 12–16 years old to access HIV testing without parental consent, an increase from 37% (n=14/38) in 2013.ConclusionsWhile many countries in SSA have revised their HTS policies, many do not specify age of consent. Revision of SSA consent to HTS policies, particularly in WCA, remains a priority to achieve the 2025 goal of 95% of people with HIV knowing their status.

Supplemental Digital Content is available in the text, Background: In 2014, the Joint United Nations Programme on HIV/AIDS (UNAIDS) and partners set the 90–90–90 target for the year 2020: diagnose 90% of all people living with HIV (PLHIV); treat 90% of people who know their status; and suppress the virus in 90% of people on treatment. In 2015, countries began reporting to UNAIDS on progress against 90–90–90 using standard definitions and methods. Methods: We used data submitted to UNAIDS from 170 countries to assess country-specific progress towards 90–90–90 through 2018. To assess global and regional progress, overall and by sex for adults aged 15 years and older, we combined country-reported data with estimates generated with a Bayesian hierarchical model. Results: A total of 60 countries reported on all three 90s in 2018, up from 23 in 2015. Among all PLHIV worldwide, 79% (67–92%) knew their HIV status. Of these, 78% (69–82%) were accessing treatment and 86% (72–92%) of people accessing treatment had suppressed viral loads. Of the 37.9 million (32.7–44.0 million) PLHIV worldwide, 53% (43–63%) had suppressed viral loads. The gap to fully achieving 73% of PLHIV with suppressed viral load was 7.7 million; 15 countries had already achieved this target by 2018. Conclusion: Increased data availability has led to improved measures of country and global progress towards the 90–90–90 target. Although gains in access to testing and treatment continue, many countries and regions are unlikely to reach the 90–90–90 target by 2020.

Background: Global targets call for a 75% reduction in new HIV infections and AIDS deaths between 2010 and 2020. UNAIDS supports countries to measure progress towards these targets. In 2019, this effort resulted in revised national, regional and global estimates reflecting the best available data. Methods: Spectrum software was used to develop estimates for 170 countries. Country teams from 151 countries developed HIV estimates directly and estimates for an additional 19 country were developed by UNAIDS based on available evidence. 107 countries employed models using HIV prevalence data from sentinel surveillance, routinely collected HIV testing and household surveys while the remaining 63 countries applied models using HIV case surveillance and/or reported AIDS deaths. Model parameters were informed by the UNAIDS Reference Group on Estimates, Modeling and Projections. Results: HIV estimates were available for 170 countries representing 99% of the global population. An estimated 37.9 million (uncertainty bounds 32.7–44.0 million) people were living with HIV in 2018. There were 1.7 million (1.4–2.3 million) new infections and 770 000 (570 000–1.1 million) AIDS-related deaths. New HIV infections declined in five of eight regions and AIDS deaths were declining in six of eight regions between 2010 and 2018. Conclusion: The estimates demonstrate progress towards ending the AIDS epidemic by 2030, however, through 2018 declines in new HIV infections and AIDS-related deaths were not sufficient to meet global interim targets. The UNAIDS estimates have made important contributions to guide decisions about the HIV response at global, regional and country level.

Salamanders have the remarkable ability to functionally regenerate after spinal cord transection. In response to injury, GFAP+ glial cells in the axolotl spinal cord proliferate and migrate to replace the missing neural tube and create a permissive environment for axon regeneration. Molecular pathways that regulate the pro-regenerative axolotl glial cell response are poorly understood. Here we show axolotl glial cells up-regulate AP-1cFos/JunB after injury, which promotes a pro-regenerative glial cell response. Injury induced upregulation of miR-200a in glial cells supresses c-Jun expression in these cells. Inhibition of miR-200a during regeneration causes defects in axonal regrowth and transcriptomic analysis revealed that miR-200a inhibition leads to differential regulation of genes involved with reactive gliosis, the glial scar, extracellular matrix remodeling and axon guidance. This work identifies a unique role for miR-200a in inhibiting reactive gliosis in axolotl glial cells during spinal cord regeneration.

There was no global guidance or agreement regarding when a country has an adequate system to report on the service packages among human immunodeficiency virus (HIV) key populations. This article describes an approach to categorizing the system in a country for reporting the service package among HIV key populations. The approach consists of four dimensions, namely the epidemiological significance, comprehensiveness of the service packages, geographic coverage of services, and adequacy of the monitoring system. The proposed categorization approach utilizes available information and can inform the improvement of the service delivery and monitoring systems among HIV key populations. Electronic supplementary material The online version of this article (10.1186/s40249-019-0570-4) contains supplementary material, which is available to authorized users.

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.

In bio-behavioural surveys measuring prevalence of infection with human immunodeficiency virus (HIV), respondents should be asked the results of their last HIV test. However, many government authorities, nongovernmental organizations, researchers and other civil society stakeholders have stated that respondents involved in such surveys should not be asked to self-report their HIV status. The reasons offered for not asking respondents to report their status are that responses may be inaccurate and that asking about HIV status may violate the respondents' human rights and exacerbate stigma and discrimination. Nevertheless, we contend that, in the antiretroviral therapy era, asking respondents in bio-behavioural surveys to self-report their HIV status is essential for measuring and improving access to - and coverage of - services for the care, treatment and prevention of HIV infection. It is also important for estimating the true size of the unmet needs in addressing the HIV epidemic and for interpreting the behaviours associated with the acquisition and transmission of HIV infection correctly. The data available indicate that most participants in health-related surveys are willing to respond to a question about HIV status - as one of possibly several sensitive questions about sexual and drug use behaviours. Ultimately, normalizing the self-reporting of HIV status could help the global community move from an era of so-called exceptionalism to one of destigmatization - and so improve the epidemic response worldwide.Dans les enquêtes bio-comportementales évaluant la prévalence de l'infection par le virus de l'immunodéficience humaine (VIH), il conviendrait de demander aux répondants le résultat de leur dernier test de dépistage du VIH. Mais nombre d'autorités gouvernementales, d'organisations non gouvernementales, de chercheurs et d'acteurs de la société civile sont défavorables à ce que l’on demande aux répondants de déclarer leur statut VIH dans ce type d'enquêtes. Parmi les raisons invoquées pour ne pas demander le statut VIH figure le fait que les réponses peuvent être inexactes et qu'une telle demande pourrait transgresser les droits humains des répondants et accentuer les problèmes de stigmatisation et de discrimination. Néanmoins, nous soutenons qu'aujourd'hui, à l'ère de la thérapie antirétrovirale, le fait de demander leur statut VIH aux répondants des enquêtes bio-comportementales est essentiel à des fins d'évaluation des services de soins, traitement et prévention de l'infection à VIH et pour en optimiser l'accès et la couverture. Cela est également fondamental pour évaluer la véritable ampleur des besoins non satisfaits dans la gestion de l'épidémie de VIH et pour correctement interpréter les comportements associés à l'acquisition et à la transmission du VIH. Les données disponibles indiquent que la plupart des participants aux enquêtes liées à la santé acceptent de répondre à une question sur leur statut VIH, parmi d'autres questions sensibles concernant les comportements sexuels et l'usage de drogues. Enfin, une normalisation de l'auto-déclaration du statut VIH pourrait aider la communauté mondiale à dépasser ce que l'on appelle « l'exceptionnalisme » pour ouvrir une ère de déstigmatisation, ce qui permettrait d'améliorer la réponse face à l'épidémie dans le monde entier.Durante la realización de encuestas bioconductuales que miden la prevalencia del contagio del virus de la inmunodeficiencia humana (VIH), los encuestados deberían entregar los resultados de la última prueba de VIH a la que se hayan sometido. No obstante, muchas autoridades gubernamentales, organizaciones no gubernamentales, investigadores y otras partes interesadas de la sociedad civil han declarado que las personas encuestadas implicadas en dichas encuestas no deberían tener que realizar una autodeclaración de su estado con relación al VIH. Las razones expuestas para no pedir a los encuestados que informen de su condición son que las respuestas pueden ser inexactas y que preguntarles por su estado en relación al VIH puede violar sus derechos humanos y exacerbar la estigmatización y la discriminación. Sin embargo, se sostiene que, en la era de terapias antirretrovirales, solicitar a los encuestados en encuestas bioconductuales que declaren su estado en relación al VIH es fundamental para medir y mejorar el acceso a, y la cobertura de, servicios para la atención, el tratamiento y la prevención del contagio del VIH. También es importante para estimar el verdadero alcance de las necesidades insatisfechas a la hora de abordar la epidemia de VIH, así como para interpretar las conductas asociadas a la adquisición y transmisión del virus de forma adecuada. Los datos disponibles indican que la mayor parte de los participantes en encuestas relacionadas con la salud están dispuestos a responder una pregunta sobre su estado en relación al VIH como una de las muchas posibles preguntas delicadas sobre comportamientos sexuales y de consumo de drogas. Por último, normalizar las declaraciones sobre el estado en relación al VIH podría ayudar a la comunidad mundial a pasar de una época caracterizada por el “excepcionalismo” a una caracterizada por la “desestigmatización”, y, de este modo, mejorar la respuesta frente a las epidemias a nivel mundial.يجب أن يُسأل المشاركون في المسوح السلوكية الحيوية التي تقيس معدل انتشار العدوى بفيروس العوز المناعي البشري (HIV) عن نتائج آخر اختبار خضعوا له للكشف عن الإصابة بالفيروس. إلا أن العديد من السلطات الحكومية والمنظمات غير الحكومية والباحثين وغيرهم من الجهات المعنية في المجتمع المدني قد أعلنوا أن المشاركين في مثل هذه المسوح لا يجب أن يُطلب منهم الإفصاح عن وضعية إصابتهم بفيروس العوز المناعي البشري. وتتمثل الأسباب المقدمة لعدم توجيه الطلب إلى المشاركين للإبلاغ عن حالتهم في شبهة عدم دقة الإجابات، كما أن السؤال عن حالة الإصابة بفيروس العوز المناعي البشري قد ينتهك حقوق الإنسان للمشاركين ويثير في نفوسهم الشعور بالحرج الاجتماعي والتمييز. ومع ذلك، فإننا نؤكد على أنه في أوقات العلاج بمضادات الفيروسات، يكون طلب الإبلاغ ذاتيًا عن حالة الإصابة بفيروس العوز المناعي البشري من المشاركين في المسوح السلوكية الحيوية أمرًا ضروريًا لقياس وتحسين سبل الوصول إلى خدمات الرعاية والعلاج والوقاية من عدوى فيروس العوز المناعي البشري، ومدى التغطية التي تقدمها تلك الخدمات. وهذا الأمر مهم أيضًا للوقوف على الحجم الحقيقي لمقدار العجز في تلبية احتياجات التصدي لوباء فيروس العوز المناعي البشري، والوصول إلى تفسير سليم للسلوكيات المرتبطة بانتقال والإصابة بعدوى فيروس العوز المناعي. تشير البيانات المتاحة إلى أن معظم المشاركين في المسوح المتعلقة بالصحة على استعداد للرد عن أي سؤال يتعلق بحالة إصابتهم بفيروس العوز المناعي البشري – باعتباره سؤالاً من بين عدة أسئلة حساسة محتمل طرحها عن السلوكيات الجنسية وتعاطي المخدرات. وأخيرًا، يمكن أن يسهم تطبيع إجراءات الإبلاغ الذاتي عن حالة الإصابة بفيروس العوز المناعي البشري في مساعدة المجتمع العالمي للمضي قدمًا من عصر ما يسمى "الاستثنائية" إلى عصر "التخلص من الحرج الاجتماعي" – وبذلك يتم تحسين سبل التصدي للوباء في جميع أنحاء العالم.在开展测量人体免疫缺损病毒 (HIV) 发病率的生物行为调查中，应该询问受访者上次的 HIV 检测结果。 但是，许多政府主管部门、非政府组织、研究人员以及其他民间社会利益相关者表示不应该要求参与此类调查的受访者自我报告其 HIV 状况。 他们对此给出的解释是受访者给出的回答可能不准确，而且询问受访者的 HIV 状况可能侵犯了他们的人权，并加剧其耻辱感和受歧视感。 然而，我们认为在抗逆转录病毒治疗时期，要求受访者在生物行为调查中自我报告其 HIV 状况对衡量和改进 HIV 感染护理、治疗和预防服务以及此类服务的覆盖面至关重要。 此外，在评估在应对 HIV 流行病方面未满足的真正需求量以及正确解释与 HIV 的感染与传播相关的行为方面，自我报告也非常重要。 现有数据表明，大多数健康相关调查的参与者愿意回答与 HIV 状况相关的问题，该问题为可能与性和吸毒行为相关的若干敏感问题之一。 最后，对 HIV 状况的自我报告的标准化有助于国际社会从所谓的例外主义转向一种反污名化态度，从而改善全球范围内对流行病的应对水平。.В рамках биоповеденческих исследований, нацеленных на определение распространенности заражения вирусом иммунодефицита человека (ВИЧ), респондентов следует опрашивать относительно результатов их последнего тестирования на ВИЧ. Однако многие государственные органы, неправительственные организации, исследователи и прочие заинтересованные члены гражданского общества заявляли, что респондентам, участвующим в таких исследованиях, не следует задавать вопросы относительно собственного ВИЧ-статуса. Доводы против просьб о самостоятельном сообщении респондентами своего статуса сводятся к тому, что ответы могут быть неточными и что вопросы о ВИЧ-статусе могут являться нарушением человеческих прав респондентов и усугубить стигматизацию и дискриминацию. Несмотря на это, авторы данной статьи настаивают, что в эпоху антиретровирусной терапии необходимо просить респондентов, участвующих в биоповеденческих исследованиях, самостоятельно сообщить о своем ВИЧ-статусе. С помощью этих сообщений удастся определить и улучшить доступность служб для предоставления людям, зараженным ВИЧ, соответствующей помощи и лечения, для профилактики этой инфекции, а также охват такими службами. Кроме того, это важно для оценки реального объема неудовлетворенных потребностей в борьбе с эпидемией ВИЧ и для правильной интерпретации поведения, сопряженного с заражением и передачей ВИЧ. Судя по имеющимся данным, большинство участников исследований состояния здоровья готовы ответить на вопрос о ВИЧ-статусе, являющийся одним из нескольких возможных вопросов конфиденциального характера, касающихся сексуального поведения и употребления наркотиков. В конечном счете признание самостоятельных сообщений о ВИЧ-статусе нормальным явлением могло бы содействовать переходу мирового сообщества от эпохи так называемой исключительности к эпохе дестигматизации, а также совершенствованию реагирования на эпидемию во всем мире.

Salamanders, such as the Mexican axolotl, are some of the few vertebrates fortunate in their ability to regenerate diverse structures after injury. Unlike mammals they are able to regenerate a fully functional spinal cord after injury. However, the molecular circuitry required to initiate a pro-regenerative response after spinal cord injury is not well understood.To address this question we developed a spinal cord injury model in axolotls and used in vivo imaging of labeled ependymoglial cells to characterize the response of these cells to injury. Using in vivo imaging of ion sensitive dyes we identified that spinal cord injury induces a rapid and dynamic change in the resting membrane potential of ependymoglial cells. Prolonged depolarization of ependymoglial cells after injury inhibits ependymoglial cell proliferation and subsequent axon regeneration. Using transcriptional profiling we identified c-Fos as a key voltage sensitive early response gene that is expressed specifically in the ependymoglial cells after injury. This data establishes that dynamic changes in the membrane potential after injury are essential for regulating the specific spatiotemporal expression of c-Fos that is critical for promoting faithful spinal cord regeneration in axolotl.

UNSTRUCTURED Low-income and middle-income countries (LMICs) are undergoing an epidemiological transition, in which the burden of noncommunicable diseases (NCDs) is rising and mortality will shift from infectious diseases to NCDs. Specifically, cardiovascular disease, diabetes, renal diseases, chronic respiratory diseases, and cancer are becoming more prevalent. In some regions, particularly sub-Saharan Africa, the dual HIV and NCD epidemics will pose challenges because their joint burden will have adverse effects on the quality of life and will likely increase global inequities. Given the austere clinical infrastructure in many LMICs, innovative models of care delivery are needed to provide comprehensive care in resource-limited settings. Improved data collection and surveillance of NCDs among HIV-infected persons in LMICs are necessary to inform integrated NCD-HIV prevention, care, and treatment models that are effective across a range of geographic settings. These efforts will preserve the considerable investments that have been made to prevent the number of lives lost to HIV, promote healthy aging of persons living with HIV, and contribute to meeting United Nations Sustainable Development Goals.

Introduction The UNAIDS 90‐90‐90 targets to diagnose 90% of people living with HIV, put 90% of them on treatment, and for 90% of them to have suppressed viral load have focused the international HIV response on the goal of eliminating HIV by 2030. They are also a constructive tool for measuring progress toward reaching this goal but their utility is dependent upon data availability. Though more than 25% of new infections are among key populations (KP)‐ sex workers, men who have sex with men, transgender people, people who inject drugs, and prisoners‐ and their sex partners, there is a dearth of treatment cascade data for KP. We assess the availability of cascade data and review the opportunities offered by biobehavioral and programme data to inform the HIV response. Discussion The emphasis on the collection of treatment cascade data among the general population in higher prevalence countries has not led to a similar increase in the availability of cascade data for KP. The limited data available for KP highlight large gaps in service uptake across the cascade, particularly in the first 90, awareness of HIV status. Biobehavioral surveys (BBS), with linked population size estimation, provide population‐based data on the treatment cascade and should be conducted every two to three years in locations with services for KP. With the inclusion of viral load testing, these surveys are able to monitor the entire treatment cascade among KP regardless of whether these populations access HIV services targeting the general population or KP. BBS also reach people accessing services and those who do not, thereby providing a unique opportunity to learn about barriers to service uptake including stigma and discrimination. At the same time high‐quality programme data can play a complementary role in identifying missed opportunities that can be addressed in real‐time. Conclusions Data are more important than ever for guiding the HIV response toward reaching 90‐90‐90 targets and eliminating HIV, particularly in the face of decreased funding for HIV and specifically for KP. Timely high‐quality BBS data can be triangulated with high‐quality programme data to provide a comprehensive picture of the epidemic response for KP.

Evidence documenting the global burden of disease from viral hepatitis was essential for the World Health Assembly to endorse the first Global Health Sector Strategy (GHSS) on viral hepatitis in May 2016. The GHSS on viral hepatitis proposes to eliminate viral hepatitis as a public health threat by 2030. The GHSS on viral hepatitis is in line with targets for HIV infection and tuberculosis as part of the Sustainable Development Goals. As coordination between hepatitis and HIV programs aims to optimize the use of resources, guidance is also needed to align the strategic information components of the 2 programs. The World Health Organization monitoring and evaluation framework for viral hepatitis B and C follows an approach similar to the one of HIV, including components on the following: (1) context (prevalence of infection), (2) input, (3) output and outcome, including the cascade of prevention and treatment, and (4) impact (incidence and mortality). Data systems that are needed to inform this framework include (1) surveillance for acute hepatitis, chronic infections, and sequelae and (2) program data documenting prevention and treatment, which for the latter includes a database of patients. Overall, the commonalities between HIV and hepatitis at the strategic, policy, technical, and implementation levels justify coordination, strategic linkage, or integration, depending on the type of HIV and viral hepatitis epidemics. Strategic information is a critical area of this alignment under the principle of what gets measured gets done. It is facilitated because the monitoring and evaluation frameworks for HIV and viral hepatitis were constructed using a similar approach. However, for areas where elimination of viral hepatitis requires data that cannot be collected through the HIV program, collaborations are needed with immunization, communicable disease control, tuberculosis, and hepatology centers to ensure collection of information for the remaining indicators.

To guide HIV prevention and treatment activities up to 2020, we need to generate and make better use of high quality HIV surveillance data. To highlight our surveillance needs, a special collection of papers in JMIR Public Health and Surveillance has been released under the title "Improving Global and National Responses to the HIV Epidemic Through High Quality HIV Surveillance Data." We provide a summary of these papers and highlight methods for developing a new HIV surveillance architecture.

UNSTRUCTURED To guide HIV prevention and treatment activities up to 2020, we need to generate and make better use of high quality HIV surveillance data. To highlight our surveillance needs, a special collection of papers in JMIR Public Health and Surveillance has been released under the title “Improving Global and National Responses to the HIV Epidemic Through High Quality HIV Surveillance Data.” We provide a summary of these papers and highlight methods for developing a new HIV surveillance architecture.

Surveillance for human immunodeficiency virus (HIV) in low- and middle-income countries started in the 1980s. However, the questions of whether the results of HIV tests should be given to participants, and if so how, has still not been resolved. In the absence of effective treatment, it was considered acceptable to withhold results from HIV-positive participants. However, when antiretroviral treatment is available, some argue for beneficence - that it is the researcher's duty to return the test results to all those who provide samples for surveillance. The corollary is that only participants who wish to receive their test results would be eligible to participate in surveys. Others argue for autonomy - that to obtain a more representative result for the general population, surveys should not exclude participants who do not wish to receive their test results. This round table discussion takes a closer look at those two arguments. We believe that the global community should work towards routine feedback of HIV surveillance while ensuring that participants receive and understand their test results.La surveillance du virus de l'immunodéficience humaine (VIH) dans les pays à revenu faible et intermédiaire a commencé dans les années 1980. Les résultats des tests VIH doivent-ils être communiqués aux participants et si oui, comment ? En l'absence de traitement efficace, il avait été jugé acceptable de ne pas divulguer leur séropositivité aux participants infectés par le VIH. En revanche, dès lors qu'un traitement antirétroviral est disponible, certains évoquent le principe de bienfaisance et estiment qu'il est du devoir du chercheur de communiquer les résultats des tests à tous ceux qui ont fourni des échantillons à des fins de surveillance. Mais le corollaire est que seuls les participants qui acceptent d'être informés des résultats de leur test seraient alors éligibles pour participer à ce type d'enquêtes. D'autres avancent le principe d'autonomie, en disant que pour obtenir un résultat plus représentatif de la population générale, ces enquêtes ne doivent pas exclure les participants qui ne souhaitent pas recevoir leurs résultats. Cette table ronde examine en détail ces deux positions. Nous pensons que la communauté internationale devrait œuvrer pour une rétroaction systématique autour de la surveillance du VIH, en veillant à ce que les participants reçoivent et comprennent les résultats de leurs tests.El seguimiento del virus de la inmunodeficiencia humana (VIH) en países de ingresos bajos y medios empezó en los años ochenta. ¿Deberían proporcionarse los resultados de las pruebas del VIH a los participantes? Si es así, ¿de qué modo? A falta de tratamiento efectivo, se consideró aceptable retener los resultados de los participantes VIH-positivos. Sin embargo, cuando se dispone de tratamiento antirretroviral, hay quien defiende la beneficencia, es decir, que es el deber del investigador informar de los resultados de las pruebas a todos aquellos que proporcionen muestras para el seguimiento. La consecuencia de esto es que solo los participantes que quieran recibir los resultados de sus pruebas reunirían los requisitos para participar en las encuestas. Otros defienden la autonomía, es decir, que para obtener un resultado más representativo de la población en general, las encuestas no deberían excluir a los participantes que no quieran recibir los resultados de sus pruebas. Este debate de mesa redonda analiza con más detenimiento estos dos argumentos. Creemos que la comunidad mundial debería trabajar por la información rutinaria del seguimiento del VIH, al mismo tiempo que garantiza que los participantes reciban y entiendan los resultados de sus pruebas.بدأ الترصُّد لفيروس عوز المناعة البشري (在中低收入国家进行人体免疫缺损病毒 (HIV) 监测于 20 世纪 80 年代开始启动。是否应该将 HIV 检测结果告知受试者？如果是的话，应该采用何种方式？在缺乏有效治疗的情况下，人们认为向 HIV 阳性受试者隐瞒结果是可以接受的。但是，如今，随着抗逆转录病毒治疗的出现，有些人主张善行——认为研究人员有义务将测试结果告知所有提供样本用于监测的受试者。其必然结果是，只有希望获得测试结果的受试者才有资格参与抽样调查。有些人主张自主权——也就是为了获得能够用于大众的更具代表性的结果，抽样调查不应将不希望获得测试结果的受试者排除在外。本次圆桌会议进一步探讨了这两种观点。我们认为全世界都应该在确保受试者获得并理解其测试结果的同时，努力向 HIV 监测的常规反馈迈进。.Надзор за вирусом иммунодефицита человека (ВИЧ) в странах с низким и средним уровнем доходов начался в 1980-х годах. Следует ли отдавать результаты анализов на ВИЧ участникам и, если да, каким образом? В случае отсутствия эффективного лечения не сообщать результаты ВИЧ-позитивным участникам считалось приемлемым. Однако, если доступна антиретровирусная терапия, некоторые медицинские работники утверждают, что с точки зрения принципа «делай благо» исследователь обязан вернуть результаты анализа всем участникам, которые предоставили образцы для наблюдения. Таким образом, только участники, желающие получить результаты своих анализов, будут иметь право принимать участие в исследованиях. Другие медицинские работники являются сторонниками автономии — для получения более репрезентативного результата для населения в целом из исследования не стоит исключать участников, которые не хотят получать результаты своих анализов. Во время заседания за круглым столом мы обсудим эти два утверждения более подробно. Мы считаем, что мировое сообщество должно стремиться к тому, чтобы регулярно оповещать участников исследований о состоянии эпиднадзора за ВИЧ, информировать их о результатах анализов и пояснять эти результаты.

BACKGROUND Normative guidelines from the World Health Organization recommend tracking strategic information indicators among key populations. Monitoring progress in the global response to the HIV epidemic uses indicators put forward by the Joint United Nations Programme on HIV/AIDS. These include the 90-90-90 targets that require a realignment of surveillance data, routinely collected program data, and medical record data, which historically have developed separately. OBJECTIVE The aim of this study was to describe current challenges for monitoring HIV-related strategic information indicators among key populations ((men who have sex with men [MSM], people in prisons and other closed settings, people who inject drugs, sex workers, and transgender people) and identify future opportunities to enhance the use of surveillance data, programmatic data, and medical record data to describe the HIV epidemic among key populations and measure the coverage of HIV prevention, care, and treatment programs. METHODS To provide a historical perspective, we completed a scoping review of the expansion of HIV surveillance among key populations over the past three decades. To describe current efforts, we conducted a review of the literature to identify published examples of SI indicator estimates among key populations. To describe anticipated challenges and future opportunities to improve measurement of strategic information indicators, particularly from routine program and health data, we consulted participants of the Third Global HIV Surveillance Meeting in Bangkok, where the 2015 World Health Organization strategic information guidelines were launched. RESULTS There remains suboptimal alignment of surveillance and programmatic data, as well as routinely collected medical records to facilitate the reporting of the 90-90-90 indicators for HIV among key populations. Studies (n=3) with estimates of all three 90-90-90 indicators rely on cross-sectional survey data. Programmatic data and medical record data continue to be insufficiently robust to provide estimates of the 90-90-90 targets for key populations. CONCLUSIONS Current reliance on more active data collection processes, including key population-specific surveys, remains warranted until the quality and validity of passively collected routine program and medical record data for key populations is optimized.

BACKGROUND The prevention of mother-to-child transmission (PMTCT) of HIV program was introduced in Vietnam in 2005. Despite the scaling up of PMTCT programs, the rate of mother-to-child HIV transmission in Vietnam was estimated as high as 20% in 2013. OBJECTIVE The objective of this study was to assess the outcomes of PMTCT and identified factors associated with mother-to-child transmission and infant survival using survey and program data in a high HIV burden province in Vietnam. METHODS This community-based retrospective cohort study observed pregnant women diagnosed with HIV infection in Thai Nguyen province from October 2008 to December 2012. Data were collected through interviews using a structured questionnaire and through reviews of log books and medical charts in antenatal care and HIV clinics. Logistic regression and survival analysis were used to analyze data using Stata (StataCorp). RESULTS A total of 172 pregnant women living with HIV were identified between 2008 and 2012. Most of these women had acquired the HIV infection from their husband (77/119, 64.7%). Significant improvement in the PMTCT program was documented, including reduction in late diagnosis of HIV for pregnant women from 62.5% in 2008 to 30% in 2012. Access to antiretrovirals (ARVs) improved, increasing from a rate of 18.2% (2008) to 70.0% (2011) for mothers and from 36.4% (2008) to 93.3% (2012) for infants. For infants, early diagnosis within 2 months of birth reached 66.7% in 2012 compared with 16.7% in 2009. Transmission rate reduced from 27.3% in 2008 to 6.7% in 2012. Late diagnosis was associated with increased risk for HIV transmission (odds ratio [OR] 14.7, 95% CI 1.8-121.4, P=.01), whereas ARV therapy for mother and infant in combination with infant formula feeding were associated with reduced risk for HIV transmission (OR 0.01, 95% CI 0.001-0.1; P CONCLUSIONS A combination of program and survey data measured the impact of prevention of HIV transmission from mother-to-child interventions. Significant improvement in access to the interventions was documented in Thai Nguyen province. However, factors that increased the risk of HIV transmission, such as late diagnosis, remain to be addressed.

Monitoring and evaluation indicators for HIV programs’ response to the epidemic among key populations (sex workers, people who inject drugs, men who have sex with men, transgender people) are critical for reviewing the global response. From the beginning of global reporting, insufficiency of data has been a challenge for monitoring the epidemic response among key populations. However, key populations were only indirectly referenced in the 2001 Declaration of Commitment. By the 2006 Political Declaration on HIV/AIDS, data from key populations were still not required from every country, and were sparsely reported compared to other indicators. The 2011 Political Declaration on HIV/AIDS referenced key populations by name for the first time. In 2006, fewer than twenty countries (10%) reported HIV prevalence among key populations, whereas in 2012 the number of countries surpassed sixty (30%).

Background Central Asia is culturally and demographically diverse, both between and within its respective countries. That diversity is represented in the range of individual, network, community, and structural risks for female sex workers (FSWs) regionally. FSWs have several risk factors for HIV acquisition and transmission including behavioral, biological, and structural risk factors. Across Central Asia, sexual risks have become conflated with risks associated with injection and non-injection illicit drug use. Methods Peer-reviewed literature databases and gray literature were searched for articles on sex work in Central Asia. The medial subject heading (MeSH) of “sex work” was cross-referenced with terms associated with Uzbekistan, Tajikistan, Turkmenistan, Kazakhstan, Kyrgyzstan, Mongolia, and Afghanistan. Results HIV prevalence data for FSWs suggest sustained or increasing prevalence in the region. There are increasing data directly linking HIV among FSWs to injection drug use; odds of HIV are up to 20 times higher among FSWs reporting injecting drug use. Though injecting drug use among FSWs is rare in some settings, recreational drugs and alcohol use limits other risk reduction behaviors, such as condom use. Conclusions The Central Asian HIV epidemic has traditionally been assumed to be driven nearly exclusively by drug use, resulting in surveillance systems focused on parenteral transmission. The reviewed data highlight limited attention to characterizing the burden of HIV and risk factors for HIV acquisition and transmission among FSWs who use drugs. Moving forward will require enhanced HIV surveillance and research to inform HIV prevention approaches to address all levels of HIV risks affecting FSWs in Central Asia.