Abstract
Estimating the size of key risk populations is essential for determining the resources needed to implement effective public health intervention programs. Several standard methods for population size estimation exist, but the statistical and practical assumptions required for their use may not be met when applied to HIV risk groups. We apply three approaches to estimate the number of people who inject drugs (PWID) in the Kohtla-Järve region of Estonia using data from a respondent-driven sampling (RDS) study: the standard “multiplier” estimate gives 654 people (95% CI 509–804), the “successive sampling” method gives estimates between 600 and 2500 people, and a network-based estimate that uses the RDS recruitment chain gives between 700 and 2800 people. We critically assess the strengths and weaknesses of these statistical approaches for estimating the size of hidden or hard-to-reach HIV risk groups.
Highlights
Estimating the size of key HIV risk populations is difficult because these groups may be hidden, hard to reach, or socially stigmatized
We evaluate three approaches to estimate the number of people who inject drugs (PWID) in KohtlaJarve region, Estonia using data from an respondent-driven sampling (RDS) study of 600 PWID conducted in 2012
We have used data from a large RDS study to estimate the number of PWID in the Kohtla-Jarve region using the multiplier method, the network-based method, and the successive sampling (SS) method
Summary
Estimating the size of key HIV risk populations is difficult because these groups may be hidden, hard to reach, or socially stigmatized. People who inject drugs (PWID) often suffer from high HIV infection, but because their drug use may be criminalized, PWID may not be willing to participate in a public health research study, or to report accurately about their risk behaviors. Understanding the course of the injection drug use epidemic and reducing HIV incidence in PWID depends on accurate estimation of the number of PWID for design and implementation of harm reduction and prevention programs that reach a substantial proportion of the PWID population. Estimating the number of PWID is essential in evaluating the coverage of these programs and estimating changes in population-level characteristics such as HIV prevalence and risk behaviors.
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