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

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

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

John Snow’s Map: Updated Version 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/

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, http://www.unaids.org/sites/default/files/media_asset/JC2559_local-epidemics_en.pdf

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

The Right Thing The Right Place The Right Time Source: PEPFAR 3.0, http://www.pepfar.gov/documents/organization/234744.pdf

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

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, http://geology.com/world/mozambique-satellite-image.shtml

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

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50% Reduce mother-to-child transmission to 5% Increase the percentage of HIV-positive adults and children on ART to 80% Unpublished Plan for the Acceleration of the Response to HIV/AIDS: 2013-2015”. Maputo: Mozambique

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

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

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

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

Contextualizing Tanzania Located in Eastern Africa Diverse population of 44.9 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, http://www.lib.utexas.edu/maps/tanzania.html

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 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

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

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

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

Next Steps

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

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

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