Developing a data system to inform real-time public health action among female sex workers in Zimbabwe

艾滋病毒和艾滋病仍然是全球优先考虑的传染病，对边缘人群的影响尤为严重。撒哈拉以南非洲的女性性工作者（FSW）是艾滋病毒感染高风险人群之一。据估计，在该地区，性工作者感染艾滋病毒的可能性是不从事性工作的同龄妇女的12倍。据估计，撒哈拉以南非洲的所有女性性工作者中有不到一半的人感染了艾滋病毒，每100人-年随访估计有12.5例新感染。尽管女性性工作者感染艾滋病毒的负担很高，但目前关于新发艾滋病毒感染率和女性性工作者参与艾滋病毒护理的研究有限。在人口调查和常规监测中，由于流动性高、污名化和在许多情况下将性工作定为犯罪，FSW的代表性通常不足。为了更准确地了解撒哈拉以南非洲地区FSW中的艾滋病毒，使用了不同的方法，包括使用受访者驱动的调查和基于地点的滚雪球抽样，但关于如何最好地获得这一人群的代表性数据存在许多争论。为了监测一般人群中的艾滋病毒感染和艾滋病毒服务的使用情况，广泛使用了从公共卫生规划和服务部门常规收集的数据。对于FSW来说，这些数据通常不存在，或者在有数据的地方，通常没有得到充分利用。这些类型的数据是在很长一段时间内以相对较低的成本收集的，它们大量存在，提供了潜在的有价值的信息来源。本项目将使用定量方法分析从津巴布韦国家性工作方案“有声音的姐妹”中例行收集的方案数据。该项目的目的是解决目前在津巴布韦的性工作者中关于艾滋病毒的知识差距，并促进目前关于分析和使用常规收集的保健服务数据的方法的研究，以便更难接触到人群。姐妹会方案为津巴布韦各地的女同性恋者提供艾滋病毒预防以及性健康和生殖健康服务，包括免费获得艾滋病毒检测、性传播感染的诊断和治疗、计划生育、艾滋病毒预防教育、避孕套和法律支持。服务由固定的诊所和流动医疗队提供。在大约10年的时间里，从36个地点收集了超过30,000个垃圾焚烧废物的数据，供分析使用。每次妇女接受该方案的服务时，都会记录性传播感染、艾滋病毒检测和治疗历史的详细情况以及社会人口统计信息。个人客户数据将用于获得艾滋病毒新感染人数和艾滋病毒流行率等估计数，并研究其如何随年龄和地理位置等社会人口因素而变化。这些估计值将与通过横断面调查获得的估计值进行比较，以验证结果。将利用衡量感染艾滋病毒的妇女如何接受该规划提供的服务的措施来考察整个护理过程中的瓶颈。除了用于从这些数据中获得估计的统计方法之外，考虑到客户医疗保健信息的管理和使用，将应用卫生信息学方法来开发实时数据使用系统，以改善服务提供。随着全球艾滋病毒规划和研究经费的减少，以及人口调查的高成本，更好地利用常规数据来源将有助于提高艾滋病毒感染风险增加的人口群体对艾滋病毒的了解，包括性工作者。了解这些数据的优点和局限性，并能够解释和建立实时使用的系统，对于改善服务提供和加强对艾滋病毒的公共卫生反应至关重要。

HIV and AIDS remain a global infectious disease priority, which disproportionally affects marginalised populations. Female sex workers (FSW) in sub-Saharan Africa are one such population at high risk of HIV infection. In the region, FSW are estimated to be 12 times more likely to have HIV than women of the same age who are not engaged in sex work. Just under half of all FSW in sub-Saharan Africa are thought to be living with HIV, with an estimated 12.5 new infections per 100 person-years of follow up. Despite the high burden of HIV among FSW, current research into the rate of new HIV infections and engagement of FSW throughout HIV care is limited. In population surveys and routine surveillance, FSW are typically under-represented due to high mobility, stigma and the criminalisation of sex work in many settings. To get a more accurate understanding of HIV among FSW in sub-Saharan Africa, different approaches including surveys using respondent driven and venue based snowball sampling have been used, yet there is much debate on how best to obtain representative data for this population. To monitor HIV infections and use of HIV services among the general population, data routinely collected from public health programmes and services are widely used. For FSW these data often don't exist, or where they do, are generally underused. These type of data are collected over long periods of time and at relatively low cost, they exist in large quantities providing a potentially valuable source of information. This project will use quantitative methods to analyse routinely collected programme data from Zimbabwe's National Sex Work programme, "Sisters with a Voice". The project aims to address current knowledge gaps on HIV among FSW in Zimbabwe and contribute to current research on methods for analysing and using routinely collected health service data for harder to reach populations. The Sisters programme provides HIV prevention and sexual and reproductive health services for FSW across Zimbabwe, including free access to HIV testing, diagnosis and treatment for sexually transmitted infection (STIs), family planning, HIV prevention education, condoms and legal support. Services are provided from fixed clinic sites and through mobile teams. Data on more than 30,000 FSW collected over approximately 10 years from 36 sites will be available for analysis. Every time a woman receives services from the programme, details of STIs, HIV testing and treatment history, along with socio-demographic information are recorded. Individual client data will be used to obtain estimates such as the number of new HIV infections and HIV prevalence and look at how this varies by socio-demographic factors including age and geographic location. These estimates will be compared to those obtained through cross-sectional surveys to validate findings. Measures of how women living with HIV engage with services provided by the programme will be used to look at bottlenecks throughout the course of care. Beyond the statistical methods applied to obtain estimates from this data, health informatics approaches, considering the management and use of client health care information, will be applied to develop systems of real-time data use to improve service delivery. With the global reduction in funding for HIV programming and research, and the high cost of population surveys, better use of routine data sources will facilitate increased understanding of HIV among population groups that are at increased risk of HIV infection, including FSW. Understanding the strengths and limitations of this data and being able to interpret and establish systems for real-time use is vital for improving service delivery and strengthening public heath responses to HIV.