Hot or Not: Using Maps to Identify

HIV Hotspots

Andrea VazzanoNena do Nascimento

Isabel Brodsky Anita Datar

March 2015

Photo by: Health Policy Project

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Why Maps Matter

Identifying Priority Districts in Mozambique

Examining Regional HIV Prevalence in Tanzania

Agenda

Source: UCLA School of Public Health, Department of Epidemiology Web site, Jan 2010

Source: John Snow’s famous cholera analysis data in modern GIS formats, Robin’s Blog, http://blog.rtwilson.com/john-snows-famous-cholera-analysis-data-in-modern-gis-formats/

John Snow’s Map: Updated Version

Source: Local Epidemics Issue Brief, UNAIDS, http://www.unaids.org/sites/default/files/media_asset/JC2559_local-epidemics_en.pdf

July 2013

Applying geospatial analysis to identify HIV epidemic ‘hotspots’ has the potential to inform smarter, more strategic resource allocation and programming at the country level.

A Call for Action: Taking a Geographic Approach

Source: AIDSVu (www.aidsvu.org). Emory University, Rollins School of Public Health. Accessed February 12, 2015.

Source: PEPFAR 3.0, http://www.pepfar.gov/documents/organization/234744.pdf

The Right Thing

The Right Place

The Right Time

What make Data Geographic?

Each distinct geographic entity is assigned a unique geographic identifier

How can you map data? Use geographic identifiers such as:

district names longitude and latitude street addresses

Source: MEASURE Evaluation, GIS Techniques for M&E of HIV/AIDS and Related Programs, https://training.measureevaluation.org/node/90

Identifying Priority Districts in Mozambique

Source: Geology.com, Map of Mozambique, http://geology.com/world/mozambique-satellite-image.shtml

Longer coastline than the East Coast of the United States

Almost twice the size of California!

Shares a border with six countries

Contextualizing Mozambique

Top ten most-affected countries (UNAIDS, 2014)

National adult HIV prevalence is 11.5% (AIDS Indicator Survey, 2009)

Regional HIV epidemic understanding

HIV in Mozambique

AIDS Indicator Survey, 2009

Unpublished Plan for the Acceleration of the Response to HIV/AIDS: 2013-2015”. Maputo: Mozambique

Reduce the number of infections by 50%

Reduce mother-to-child transmission to 5%

Increase the percentage of HIV-positive adults and children on ART to 80%

HIV Response Acceleration Plan 2013-2015

Developed a methodology to find districts with high HIV positivity and low numbers of people on treatment

Priority = more than 1,000 HIV-positive patients in need of treatment

Priority Districts

Data Source: AIDS Indicator Survey 2009, Mozambique Ministry of Health PMTCT 2013

Zooming In

Legend

New Adult Priority Districts 2014

Old Adult Priority Districts 2012

Provinces

Priority Districts2012 and 2014

Data Source: Ministry of Health, Mozambique, PMTCT 2012 & 2014

How low can you go?Examining Regional HIV Prevalence in Tanzania

Source: University of Texas at Austin, Perry-Castañeda Library Map Collection, http://www.lib.utexas.edu/maps/tanzania.html

Located in Eastern Africa

Diverse population of 44.9 million (many ethnic, linguistic, and religious groups)

Borders eight countries and the Indian Ocean

Contextualizing Tanzania

HIV in Tanzania

National HIV prevalence is 5.1%*

Known regional variations in HIV

HPP Goal: Examine variations in HIV prevalence within regions using HIV testing data from facilities

Adult HIV Prevalence by Region

Women & Men ages 15-49, 2011

*Source: DHS Program, Tanzania HIV/AIDS and Malaria Indicator Survey 2011-12, http://dhsprogram.com/pubs/pdf/SR196/SR196.pdf

Steps of the Analysis

Estimate % of HIV positivity using prevention of mother-to-child transmission testing data at each health facility

Use HIV positivity to estimate HIV prevalence at each facility

Estimate HIV prevalence for entire region by using interpolation from known HIV prevalence at health facilities

1

2

3

Annual Report 2013, MOH Tanzania with support from PEPFAR

HIV Point Prevalence at Health Facilities

Esri, HERE, DeLorme, MapmyIndia, © OpenStreetMap contributors, and the GIS user community

Legend

% HIV point prevalence

0.0 - 0.6

0.7 - 1.4

1.5 - 2.7

2.8 - 6.8

District

Estimated HIV Prevalence Tanga

Esri, HERE, DeLorme, MapmyIndia, © OpenStreetMap contributors, and the GIS user community

Legend

Light Gray Canvas Reference

District

% HIV prevalence

ValueHigh : 4.5

Low : 0

Light Gray Canvas Base

Annual Report 2013, MOH Tanzania with support from PEPFAR

Estimated HIV Prevalencewith Major Roads Overlay

Esri, HERE, DeLorme, MapmyIndia, © OpenStreetMap contributors, and the GIS user community

75 0 7537.5 Kilometers

Legend

Light Gray Canvas Reference

TangaRoad

District

% HIV prevalence

ValueHigh : 4.5

Low : 0

Light Gray Canvas Base

Annual Report 2013, MOH Tanzania with support from PEPFAR

Next Steps

HIV epidemics are not uniformly distributed

Hotspots within hotspots

Mapping is an important tool for decisionmakers Monitoring and management

Strategic resource allocation

Layering data allows information from multiple sources to be viewed simultaneously

Take Aways

Everything happens somewhere, which provides a geographic component to

human activity.

Mapping shows ‘where’ and helps develop better questions to understand the ‘why’.

— MEASURE Evaluation

Source: http://upload.wikimedia.org/wikipedia/commons/e/ec/World_map_blank_without_borders.svg

AcknowledgmentsUSAID

• Mai Hijazi• Noah Bartlett• Emily Roseman

OGAC• Nate Heard• Vanessa Brown• Christy Wahle• Emily Hughes

MISAU, Mozambique

National AIDS Control Program, Tanzania

PEPFAR Tanzania

Project LEAD, Futures Group

Global Fund• Jinkou Zhao• Ryuichi Komatsu

HPP• Farley Cleghorn• Sarah Clark• Suneeta Sharma• Ron MacInnis• John Stover• Ian Wanyeki• Lucy Nganga• Benard Mitto

www.healthpolicyproject.com

Thank You!

The Health Policy Project is a five-year cooperative agreement funded by the U.S. Agency for International Development under Agreement No. AID-OAA-A-10-00067, beginning September 30, 2010. The project’s HIV activities are supported by the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR). It is implemented by Futures Group, in collaboration with Plan International USA, Avenir Health (formerly Futures Institute), Partners in Population and Development, Africa Regional Office (PPD ARO), Population Reference Bureau (PRB), RTI International, and the White Ribbon Alliance for Safe Motherhood (WRA).