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Leveraging Routinely Collected Program Data to Inform Extrapolated Size Estimates for Key Populations in Namibia:

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Summary

Estimating the size of female sex workers (FSW) and men who have sex with men (MSM) in Namibia using small area estimation (SAE) and program data improved HIV program planning. These methods provide valuable subnational estimates where direct data are lacking.

Keywords:
HIVNamibiafemale sex workerskey populationsmen who have sex with menpopulation size estimationsmall area estimation

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Area of Science:

  • Epidemiology
  • Biostatistics
  • Public Health

Background:

  • Estimating key populations like female sex workers (FSW) and men who have sex with men (MSM) is crucial for effective HIV program planning and resource allocation.
  • Small area estimation (SAE) can bridge data gaps in areas lacking direct population size estimates (PSEs) by utilizing auxiliary data.
  • Routinely collected program data have not been extensively used as auxiliary data for subnational PSEs of key populations.

Purpose of the Study:

  • To systematically generate regional size estimates for FSW and MSM in Namibia.
  • To integrate routinely collected HIV program data into estimation methods.
  • To inform HIV program strategies through consensus-based approaches with local stakeholders.

Main Methods:

  • Utilized a consensus-informed estimation approach with local stakeholders.
  • Integrated quarterly HIV program data from service providers.
  • Employed Bayesian triangulation to weight existing PSEs with program data.
  • Generated SAEs using simple imputation, stratified imputation, and Poisson regression.
  • Selected final estimates through an iterative qualitative ranking process.

Main Results:

  • National estimates for FSW ranged from 4,777 to 13,148 (1.5%-3.6% of females aged 15-49).
  • National estimates for MSM ranged from 4,611 to 10,171 (0.7%-1.5% of males aged 15-49).
  • Inclusion of program data as priors influenced proportions, e.g., FSW proportion increased from 1.9% to 2.8% via simple imputation.
  • Stratified imputation using HIV prevalence or population density showed varied impacts on FSW and MSM proportions by region and density.

Conclusions:

  • SAE approaches successfully combined epidemiologic and program data for subnational key population size estimates in Namibia.
  • Estimates demonstrated significant sensitivity to the inclusion of program data.
  • Program data offer a valuable supplemental source for aligning PSEs with real-world HIV programs, especially where data collection is challenging.
  • Further research is needed to optimize the inclusion and validation of program data for key population size estimation and enhance HIV response efforts.