Post on 11-Jan-2016
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Unpublished Plan for the Acceleration of the Response to HIV/AIDS: 2013-2015”.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).