1. Hot or Not: Using Maps to Identify HIV Hotspots
March 2015
Andrea Vazzano
Nena do Nascimento
Isabel Brodsky
Anita Datar
Photo by: Health Policy Project

2. Agenda Why Maps Matter Identifying Priority Districts in Mozambique
Examining Regional HIV Prevalence in Tanzania
Photo by: Andrea Vazzano, Health Policy Project

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

4. John Snow’s Map: Updated Version
Source: John Snow’s famous cholera analysis data in modern GIS formats, Robin’s Blog,

5. A Call for Action: Taking a Geographic Approach
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.
Source: Local Epidemics Issue Brief, UNAIDS,

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

7. The Right Thing The Right Place The Right Time
Source: PEPFAR 3.0,

8. 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,

9. Identifying Priority Districts in Mozambique

10. Contextualizing Mozambique
Longer coastline than the East Coast of the United States
Almost twice the size of California!
Shares a border with six countries .
Source: Geology.com, Map of Mozambique,

11. HIV in Mozambique Top ten most-affected countries (UNAIDS, 2014)
National adult HIV prevalence is 11.5% (AIDS Indicator Survey, 2009)
Regional HIV epidemic understanding
AIDS Indicator Survey, 2009

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Unpublished Plan for the Acceleration of the Response to HIV/AIDS: ”.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

13. Priority Districts
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

14. Zooming In
Data Source: AIDS Indicator Survey 2009, Mozambique Ministry of Health PMTCT 2013

15. Priority Districts 2012 and 2014
Data Source: Ministry of Health, Mozambique, PMTCT 2012 & 2014

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

17. Contextualizing Tanzania
Located in Eastern Africa
Diverse population of million (many ethnic, linguistic, and religious groups)
Borders eight countries and the Indian Ocean
Source: University of Texas at Austin, Perry-Castañeda Library Map Collection,

18. Adult HIV Prevalence by Region Women & Men ages 15-49, 2011
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 ,

19. 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

20. HIV Point Prevalence at Health Facilities
Annual Report 2013, MOH Tanzania with support from PEPFAR

21. Estimated HIV Prevalence Tanga
Annual Report 2013, MOH Tanzania with support from PEPFAR

22. Estimated HIV Prevalence with Major Roads Overlay
Annual Report 2013, MOH Tanzania with support from PEPFAR

23. Next Steps

24. Take Aways 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

25. 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:

26. Acknowledgments USAID 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