142nd APHA Annual Meeting and Exposition

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Mapping for action: Variation in HIV program coverage in rural Malawi

142nd APHA Annual Meeting and Exposition (November 15 - November 19, 2014): http://www.apha.org/events-and-meetings/annual
Tuesday, November 18, 2014 : 12:54 PM - 1:06 PM

Matthew Peckarsky, MS , Monitoring, Evaluation & Quality, Partners In Health, Boston, MA
Ermyas Birru, MS , Monitoring, Evaluation & Quality, Partners In Health, Boston, MA
Alyssa Bilinski , Monitoring, Evaluation and Quality, Partners In Health, Boston, MA
Gay Bronson, JD, MPH , Abwenzi Pa Za Umoyo, Neno, Malawi
Stephen Po-Chedley , Abwenzi Pa Za Umoyo, Neno, MA, Malawi
Regina Banda , Abwenzi Pa Za Umoyo, Neno, Malawi
William Mwale , Abwenzi Pa Za Umoyo, Neno, Malawi
Henry Makungwa , Abwenzi Pa Za Umoyo, Malawi
Blessings Banda , Abwenzi Pa Za Umoyo, Neno, Malawi
Omowunmi Aibana, MD , Abwenzi Pa Za Umoyo, Neno, Malawi
Chembe Kachimanga, MD , Abwenzi Pa Za Umoyo, Neno, Malawi
Junior Bazile, MPH, MD , Partners In Health /Abwenzi Pa Za Umoyo, Neno, Malawi
Jonas Rigodon, MD, MPH , Partners In Health /Abwenzi Pa Za Umoyo, Neno, Malawi
Audio (mp3) recording Recorded Presentation (mp4)
Background: Geographic Information Systems (GIS) is an important tool for monitoring, evaluation and targeted improvement of healthcare services. Abwenzi Pa Za Umoyo (APZU), the sister organization of Partners In Health (PIH) in Malawi, began using GIS in Neno District in 2010 to better understand geographic distribution of patients, facilitate program planning and conduct routine disease surveillance. In this analysis, GIS was used to explore geographic variation in HIV program coverage across the district.

Methods: GPS coordinates for village centroids were captured by locating the chief’s house in 194 villages across the district. Patients’ home villages were extracted from APZU’s HIV EMR, aggregated and mapped at the census enumeration area (EA) level. Expected adult (age 15-49) HIV cases were also mapped by applying rural adult HIV prevalence (8.9%) to projected EA-level adult population data derived from the 2008 Malawi Census.

Results: 4,279 patients were mapped to 157 census enumeration areas within Neno District, where 4,923 adult HIV cases were expected (87.4% coverage). Coverage varied substantially at the EA level (mean = 105.7%, IQR= 0.0%, 114.8%).

Discussion: In rural areas where patients have difficulty accessing HIV services, GIS is an effective tool to rapidly identify geographic gaps in coverage. Mobile clinics can be deployed to locations with lower coverage to offer HIV testing and counseling services and increase program enrollment. GIS can also be used to identify locations where coverage gaps make new static health facilities most needed, as part of a broader strategy to reduce barriers to HIV care and treatment.

Learning Areas:

Epidemiology
Program planning

Learning Objectives:
Assess geographic variation in HIV program coverage across Neno district in rural Malawi.

Keyword(s): HIV/AIDS, International Health

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am the Associate Director of Monitoring, Evaluation and Quality Improvement for Partners in Health. I hold a Master's in Public Health. I co-lead strategy and decision-making for data collection, analysis and dissemination of operational research for HIV program and other clinical services in Neno District, Malawi.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.

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