Antiretroviral Therapy Program Expansion in Zambézia Province, Mozambique: Geospatial Mapping of Community-Based and Health Facility Data for Integrated Health Planning

Abstract

ObjectiveTo generate maps reflecting the intersection of community-based Voluntary Counseling and Testing (VCT) delivery points with facility-based HIV program demographic information collected at the district level in three districts (Ile, Maganja da Costa and Chinde) of Zambézia Province, Mozambique; in order to guide planning decisions about antiretroviral therapy (ART) program expansion.MethodsProgram information was harvested from two separate open source databases maintained for community-based VCT and facility-based HIV care and treatment monitoring from October 2011 to September 2012. Maps were created using ArcGIS 10.1. Travel distance by foot within a 10 km radius is generally considered a tolerable distance in Mozambique for purposes of adherence and retention planning.ResultsCommunity-based VCT activities in each of three districts were clustered within geographic proximity to clinics providing ART, within communities with easier transportation access, and/or near the homes of VCT volunteers. Community HIV testing results yielded HIV seropositivity rates in some regions that were incongruent with the Ministry of Health’s estimates for the entire district (2–13% vs. 2% in Ile, 2–54% vs. 11.5% in Maganja da Costa, and 23–43% vs. 14.4% in Chinde). All 3 districts revealed gaps in regional disbursement of community-based VCT activities as well as access to clinics offering ART.ConclusionsUse of geospatial mapping in the context of program planning and monitoring allowed for characterizing the location and size of each district’s HIV population. In extremely resource limited and logistically challenging settings, maps are valuable tools for informing evidence-based decisions in planning program expansion, including ART.

Geographic Information Systems, spatial analysis, and HIV in Africa: A scoping review

“…Of note, while this review was focused on more technologically and methodologically sophisticated applications, several articles not included in this review demonstrated the utility of simply visually displaying mapped data points, such as for plotting the locations of HIV services [83] and risky sexual behaviors [84–88]. Mapping the overlap of service provision and demand was useful for selecting priority areas for programmatic expansion [81, 89, 90]. Program implementation could benefit from dynamic, interactive and iteratively updated maps with verified health facility coordinates and infrastructure data [91] and simple mapping may be good entry point for more advanced geospatial techniques.…”

Individual factors associated with time to non-adherence to ART pick-up within HIV care and treatment services in three health facilities of Zambézia Province, Mozambique

“…Much of Zambézia Province´s rural districts, such as Maganja da Costa, have populations dispersed over large geographic regions and consists of subsistence farmers or fisherman, with limited educational opportunities, and who rely on health infrastructure which was heavily damaged or destroyed during Mozambique´s 16-year civil war (1976–1992) [ 8 , 15 ]. In addition, severe health worker shortages, high staff turnover, and fragile health systems further compound the challenges that patients encounter when accessing care in these rural districts [ 10 , 45 , 46 ]. Since the inception of Mozambique´s HIV program, distance needed to travel to a health facility has been thought to be one of the major barriers to accessing care and patient retention.…”

Assessing the Use of Geospatial Data for Immunization Program Implementation and Associated Effects on Coverage and Equity in the Democratic Republic of Congo

“…The potential of Geographic Information System (GIS) and spatial analysis in enhancing the effectiveness of health providers and monitoring immunization coverage has been emphasized in other Central African countries [15][16][17][18]. Other illustrations of the application of geospatial mapping to address health issues such as malnutrition and guiding program planning in resource-limited settings, or reducing measles incidence through frequent supplementary immunization activities were also found in the literature [19,20].…”