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Table 6 Results of meta-regression analyses to identify associations with HIV prevalence, sources of between-study heterogeneity, and trend in HIV prevalence in FSWs in the Middle East and North Africa (MENA)

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

Variables   Studies Samples Univariable analyses Multivariable analysis
Total N Total N OR (95% CI) LR test p value Variance explained R (%) AOR (95% CI) p value LR test p value¥
Country/subregion*          
 Eastern MENA Afghanistan, Iran, Pakistan 122 47,533 1.00 < 0.001 39.80 1.00   < 0.001
 Fertile Crescent Egypt, Iraq, Jordan, Lebanon, Syria 136 132,758 0.17 (0.10–0.27)    0.21 (0.12–0.36) < 0.001  
 Bahrain and Yemen Bahrain and Yemen 11 2491 2.60 (0.78–8.67)    1.77 (0.52–6.01) 0.357  
 Horn of Africa Djibouti, Somalia, South Sudan 93 29,509 33.45 (19.77–56.58)    45.43 (24.66–83.68) < 0.001  
 North Africa Algeria, Libya, Morocco, Sudan, Tunisia 312 75,428 3.14 (2.09–4.72)    2.90 (1.80–4.68) < 0.001  
Population type Street-based, venue-based, and other FSWs 619 220,363 1.00 0.002 1.29 1.00   0.163
Bar girls 55 67,356 0.33 (0.17–0.67)    0.66 (0.37–1.18) 0.163  
Total sample size of tested FSWs < 100 participants 75 4008 1.00 0.001 1.54 1.00   < 0.001
≥ 100 participants 599 283,711 0.36 (0.20–0.65)    0.35 (0.21–0.56) < 0.001  
Median year of data collection** < 1993 104 36,038 1.00 0.001 1.96 1.00   0.005
1993–2002 169 98,221 0.31 (0.17–0.56)    1.18 (0.71–1.95) 0.522  
≥ 2003 401 153,460 0.57 (0.33–0.97)    2.03 (1.24–3.33) 0.005  
Sampling methodology Non-probability sampling 570 254,072 1.00 0.217 0.08
Probability-based sampling 104 33,647 0.72 (0.42–1.21)   
Response rate ≥ 60% 96 31,161 1.00 0.043 0.64 1.00   0.544
< 60%/unclear 62 14,102 2.76 (1.24–6.13)    1.17 (0.60–2.27) 0.645  
Not applicable 516 242,456 1.37 (0.80–2.37)    1.33 (0.79–2.23) 0.279  
Validity of sex work definition Clear and valid definition 117 36,431 1.00 0.161 0.25
Poorly defined/unclear 41 8832 2.35 (0.96–5.73)   
Not applicable 516 242,456 1.15 (0.70–1.90)   
HIV ascertainment Biological assays 157 44,894 1.00 0.786 0
Self-report, unclear, and not applicable 517 242,825 0.94 (0.60–1.47)   
  1. Abbreviations: AOR adjusted odds ratio, CI confidence interval, FSWs female sex workers, LR likelihood ratio, OR odds ratio
  2. *Countries were grouped based on geography and similarity in HIV prevalence levels. Given the large fraction of studies with zero HIV prevalence, particularly in the Fertile Crescent, an increment of 0.1 was added to a number of events in all studies when generating log odds, and Eastern MENA was thus used also as a statistically better reference. While this choice of increment was arbitrary, other increments yielded the same findings, though some of the effect sizes changed in scale
  3. **Year grouping was driven by independent evidence identifying the emergence of HIV epidemics among both men who have sex with men [10] and people who inject drugs [11] in multiple MENA countries around 2003. Missing values for year of data collection (only six stratified measures) were imputed using data for year of publication adjusted by the median difference between year of publication and median year of data collection (for studies with complete information)
  4. A large fraction of studies did not separate the different forms of female sex workers, and thus it was not possible to analyze these as separate categories
  5. Measures extracted only from routine databases with no reports describing the study methodology were not included in the ROB assessment
  6. Predictors with p value ≤ 0.1 were considered as showing strong evidence for an association with (prevalence) odds and were hence included in the multivariable analysis
  7. £Adjusted R2 in the final multivariable model = 49.21%
  8. ¥Predictors with p value ≤ 0.1 in the multivariable model were considered as showing strong evidence for an association with (prevalence) odds