We included studies reporting empirical estimates in any SSA country. We calculated incidence rate ratios IRR compared to age-district-year matched total female population incidence estimates. Median HIV incidence was 4. Annual changes in log IRRs were minimal β0. Improved surveillance and standardisation of approaches to obtain empirical estimates of sex worker incidence would enable a clearer understanding of whether we are on track to meet global targets for this population and better support data-driven HIV prevention programming.
Identifying and following-up WESW is often difficult due to the heterogeneous, informal, and hidden nature of sex work, commonly driven by stigma and criminalisation. Sex work encompasses a broad spectrum of sexual transactions occurring in a range of settings, from on the streets, to in homes, brothels, or hotels.
For surveillance, this presents challenges, as those not identifying as sex workers are unlikely to present at WESW-dedicated programmes. Additionally, mobility among WESW is high, 9 and repeated initiation and cessation of sex work common, thus programmes and cohort studies encounter challenges with loss to follow-up. We conducted two searches of peer-reviewed literature available in English and published between January and December RLA additionally searched key population biobehavioural surveillance reports, collated during an earlier key population data collation exercise.
WESW could be women either self-reporting being a sex worker, engaged in a sex worker programme, or reporting selling or exchanging sex for money or goods. For multi-country studies, nationally disaggregated data were required. For closed cohort studies reporting annual estimates, only the overall estimate of incidence from the study was extracted to mitigate against artificial declines in incidence observed with follow-up of the same individuals.
Studies were excluded if the study cohort was exposed to an intervention specifically thought to have impacted HIV incidence, i. In randomised control trials RCT , data from the study control arm were included and, in interventional cohort studies, data from early in the intervention or pre-intervention period included.
