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Table 5 Results of meta-analyses on studies reporting HIV prevalence in FSWs and their clients (or proxy populations of clients such as male STI clinic attendees) in the Middle East and North Africa (MENA) by epidemic type

From: HIV epidemiology among female sex workers and their clients in the Middle East and North Africa: systematic review, meta-analyses, and meta-regressions

   Country Studies (N) Samples HIV prevalence Pooled mean HIV prevalence** Heterogeneity measures
Tested HIV positive Median* (%) Range* (%) % 95% CI Q (p value) I2‡ (%; 95% CI) Prediction interval£ (95%)
FSWs Low-level Afghanistan 9 3578 7 0 0–0.90 0.03 0.00–0.18 7.59 (p = 0.4744) 0.0 (0.0–62.9) 0.00–0.22
Bahrain 1 724 6 0.83 0.83¥ 0.30–1.80
Egypt 33 7222 16 0 0–1.49 0.03 0.00–0.14 36.26 (p = 0.2765) 12.8 (0.0–43.4) 0.00–0.34
Iran 32 17,277 211 0.02 0–14.00 0.99 0.34–1.88 569.63 (p < 0.0001) 94.6 (93.2–95.6) 0.00–8.84
Iraq 29 15,852 1 0 0–0.07 0.00 0.00–0.00 6.24 (p = 1.0000) 0.0 (0.0–0.0) 0.00–0.00
Jordan 7 1024 4 0 0–1.33 0.00 0.00–0.31 3.43 (p = 0.7537) 0.0 (0.0–48.9) 0.00–0.48
Lebanon 11 11,589 12 0.07 0–2.40 0.00 0.00–0.07 18.82 (p = 0.0426) 46.9 (0.0–73.6) 0.00–0.33
Pakistan 81 26,678 217 0 0–8.80 0.35 0.18–0.57 368.57 (p < 0.0001) 78.3 (73.3–82.3) 0.00–3.06
Syria 56 97,071 12 0 0–0.20 0.00 0.00–0.00 32.37 (p = 0.9936) 0.0 (0.0–0.0) 0.00–0.00
Tunisia 53 22,224 59 0 0–2.30 0.02 0.00–0.11 124.81 (p < 0.0001) 58.3 (43.6–69.2) 0.00–0.89
Yemen 10 1767 34 0.25 0–7.00 0.82 0.00–2.91 63.01 (p < 0.0001) 85.7 (75.6–91.7) 0.00–11.67
Intermediate-intensity Algeria 33 4241 179 2.00 0–20.00 2.39 1.02–4.15 215.22 (p < 0.0001) 85.1 (80.1–88.9) 0.00–15.05
Libya 4 1249 28 8.43 1.08–18.18 4.86 0.81–11.37 34.41 (p < 0.0001) 91.3 (80.8–96.0) 0.00–47.09
Morocco 200 40,507 804 1.07 0–52.90 1.11 0.83–1.41 851.66 (p < 0.0001) 76.6 (73.3–79.6) 0.00–5.98
Somalia 17 2015 57 0.35 0–47.06 1.64 0.42–3.39 61.50 (p < 0.0001) 74.0 (57.7–83.8) 0.00–10.24
Sudan 22 7207 128 0.95 0–7.70 1.30 0.76–1.96 98.06 (p < 0.0001) 78.6 (68.1–85.6) 0.00–5.26
Concentrated Djibouti 68 22,028 4618 18.75 0–70.00 17.89 13.62–22.60 5127.36 (p < 0.0001) 98.7 (98.6–98.8) 0.00–63.91
South Sudan 8 5466 1108 18.50 2.82–37.90 17.32 8.66–28.14 554.81 (p < 0.0001) 98.7 (98.3–99.1) 0.00–61.99
All countries 674 287,719 7501 0.26 0–70.00 1.44 1.14–1.76 24,605.29 (p < 0.0001) 97.3 (97.2–97.4) 0.00–16.49
Clients of FSWs Low-level Egypt 6 1362 3 0.17 0–0.80 0.09 0.00–0.42 4.82 (p = 0.4386) 0.0 (0.0–73.7) 0.00–0.60
Kuwait 6 6505 1 0 0–0.02 0.00 0.00–0.04 0.36 (p = 0.9963) 0.0 (0.0–0.0) 0.00–0.07
Pakistan 12 6498 9 0 0–1.10 0.00 0.00–0.10 14.93 (p = 0.1857) 26.3 (0.0–62.6) 0.00–0.42
Yemen 1 30 0 0 0.00¥ 0.00–11.57
Intermediate-intensity Algeria 7 728 22 7.29 0–25.80 3.51 0.32–8.90 39.79 (p < 0.0001) 84.9 (70.8–92.2) 0.00–27.63
Morocco 84 10,348 47 0 0–8.00 0.00 0.00–0.05 76.30 (p = 0.6854) 0.0 (0.0–19.9) 0.00–0.05
Somalia 11 1010 21 0.94 0–9.62 1.38 0.25–3.11 25.74 (p = 0.0041) 61.1 (25.0–79.9) 0.00–8.46
Sudan 4 791 14 1.61 0–2.51 1.22 0.16–2.97 7.02 (p = 0.0711) 57.3 (0.0–85.8) 0.00–11.65
Concentrated Djibouti 15 2222 217 2.20 0–34.60 5.36 1.53–10.81 244.98 (p < 0.0001) 94.3 (92.0–95.9) 0.00–35.23
South Sudan 1 37 5 13.5 13.5¥ 4.54–28.77
All countries 147 29,531 339 0 0–34.60 0.38 0.14–0.71 977.96 (p < 0.0001) 85.1 (82.9–87.0) 0.00–6.60
  1. Abbreviations: CI confidence interval, FSWs female sex workers
  2. *These medians and ranges are calculated on the stratified HIV prevalence measures
  3. **Missing sample sizes for measures (or their strata) were imputed using median sample size calculated from studies with available information. Analyses excluding these studies had no impact on study findings
  4. Q—the Cochran’s Q statistic is a measure assessing the existence of heterogeneity in effect size (here, HIV prevalence) across studies
  5. I2—a measure assessing the magnitude of between-study variation that is due to the differences in effect size (here, HIV prevalence) across studies rather than chance
  6. £Prediction interval—a measure estimating the 95% interval of the distribution of true effect sizes (here, HIV prevalence)
  7. Based on results of meta-analyses for FSWs, countries were classified as having low-level HIV epidemic (prevalence < 1%), intermediate-intensity HIV epidemic (prevalence 1–5%), and concentrated HIV epidemic (prevalence > 5%)
  8. ¥Point estimate as only one study was available
  9. Before 2011, South Sudan was part of Sudan, and thus, earlier measures from Sudan were based on studies that may have included participants from both Sudan and South Sudan