撒哈拉以南非洲关键人群的人口规模、艾滋病毒流行率和抗逆转录病毒治疗覆盖率：2010-2023 年调查数据的整理和综合。

BACKGROUND: Key population HIV programmes in sub-Saharan Africa require epidemiological information to ensure equitable and universal access to effective services. We aimed to consolidate and harmonise survey data among female sex workers, men who have sex with men, people who inject drugs, and transgender people to estimate key population size, HIV prevalence, and antiretroviral therapy (ART) coverage for countries in mainland sub-Saharan Africa. METHODS: Key population size estimates, HIV prevalence, and ART coverage data from 39 sub-Saharan Africa countries between 2010 and 2023 were collated from existing databases and verified against source documents. We used Bayesian mixed-effects spatial regression to model urban key population size estimates as a proportion of the gender-matched, year-matched, and area-matched population aged 15-49 years. We modelled subnational key population HIV prevalence and ART coverage with age-matched, gender-matched, year-matched, and province-matched total population estimates as predictors. FINDINGS: We extracted 2065 key population size data points, 1183 HIV prevalence data points, and 259 ART coverage data points. Across national urban populations, a median of 1·65% (IQR 1·35-1·91) of adult cisgender women were female sex workers, 0·89% (0·77-0·95) were men who have sex with men, 0·32% (0·31-0·34) were men who injected drugs, and 0·10% (0·06-0·12) were women who were transgender. HIV prevalence among key populations was, on average, four to six times higher than matched total population prevalence, and ART coverage was correlated with, but lower than, the total population ART coverage with wide heterogeneity in relative ART coverage across studies. Across sub-Saharan Africa, key populations were estimated as comprising 1·2% (95% credible interval 0·9-1·6) of the total population aged 15-49 years but 6·1% (4·5-8·2) of people living with HIV. INTERPRETATION: Key populations in sub-Saharan Africa experience higher HIV prevalence and lower ART coverage, underscoring the need for focused prevention and treatment services. In 2024, limited data availability and heterogeneity constrain precise estimates for programming and monitoring trends. Strengthening key population surveys and routine data within national HIV strategic information systems would support more precise estimates. FUNDING: UNAIDS, Bill & Melinda Gates Foundation, and US National Institutes of Health.

背景：撒哈拉以南非洲的关键人群艾滋病毒规划需要流行病学信息，以确保公平和普及获得有效服务。我们旨在整合和协调女同性恋者、男同性恋者、双性恋者、跨性别者、性工作者、注射吸毒者的调查数据，以估计撒哈拉以南非洲大陆国家的关键人群规模、艾滋病毒流行率和抗逆转录病毒治疗（ART）覆盖率。

方法：我们从现有的数据库中收集了 2010 年至 2023 年撒哈拉以南非洲 39 个国家的关键人群规模估计数、艾滋病毒流行率和 ART 覆盖率数据，并与原始文件进行了核对。我们使用贝叶斯混合效应空间回归模型，将城市关键人群规模估计数建模为与性别匹配、年龄匹配和面积匹配的 15-49 岁人群的比例。我们使用年龄匹配、性别匹配、年份匹配和省份匹配的总人口估计数作为预测因素，对亚国家关键人群的艾滋病毒流行率和 ART 覆盖率进行建模。

结果：我们提取了 2065 个关键人群规模数据点、1183 个艾滋病毒流行率数据点和 259 个 ART 覆盖率数据点。在全国城市人口中，中位数为 1.65%（1.35-1.91）的成年顺性别女性为性工作者，0.89%（0.77-0.95）为男同性恋者，0.32%（0.31-0.34）为男性注射吸毒者，0.10%（0.06-0.12）为跨性别女性。关键人群的艾滋病毒流行率平均比匹配的总人口流行率高四到六倍，ART 覆盖率与总人口 ART 覆盖率相关，但低于总人口 ART 覆盖率，且研究之间的相对 ART 覆盖率存在很大差异。在撒哈拉以南非洲，关键人群估计占 15-49 岁总人口的 1.2%（95%可信区间 0.9-1.6），但占艾滋病毒感染者的 6.1%（4.5-8.2）。

解释：撒哈拉以南非洲的关键人群艾滋病毒感染率较高，抗逆转录病毒治疗覆盖率较低，这突出表明需要有针对性地提供预防和治疗服务。2024 年，数据有限且存在异质性，限制了规划和监测趋势的精确估计。加强关键人群调查和国家艾滋病毒战略信息系统中的常规数据将支持更精确的估计。

资金：联合国艾滋病规划署、比尔及梅林达·盖茨基金会和美国国立卫生研究院。