Layering map data to increase HIV testing and counseling services

A PEPFAR implementing partner in Tanzania combines community-generated data of nightlife hotspots with health facility locations to improve referrals and assist female sex workers.
Tanzania

Background

Jeremia Henry is a monitoring and evaluation specialist at KIHUMBE, a community-based HIV and AIDS service PEPFAR implementing partner. KIHUMBE operates in four districts including Mbeya City Council in the southern highlands of Tanzania—a priority district with some of the highest HIV prevalence rates in the region. KIHUMBE works across a range of sectors related to the fight against HIV/AIDS, including testing and counseling services, support to orphans and vulnerable children (OVCs), and initiatives to counter gender-based violence.

Problem

In December 2017, the Data Zetu team met with Petro Emanuel, Mbeya Regional Coordinator for the Tanzania Commission on AIDS (TACAIDS). There, after learning about community mapping efforts in Temeke¹, he requested that the Humanitarian OpenStreetMap Team (HOT, a Data Zetu partner) help his partners including PEPFAR implementers to map hotspots and HIV service facilities in Mbeya City Council. Understanding exactly where HIV transmission is most prevalent is vital for Jeremia and his colleagues to develop targeted local intervention measures, such as where to deploy KIHUMBE’s peer educators for sex workers who linger near these hotspots. However, HOT and the Data Zetu team heard from several frontline workers who shared that current data is inaccurate and insufficient:

“We have reached a stage where we do not need all our data on excel format, but rather on maps where a person can actually see the visualization of information- maps will help us to arrange our resources well to reach targeted groups”

– Deusdedith Clavery, Sauti Project

Moreover, Petro explained, layering that information against other datasets, such as the location of testing facilities or household populations, would help his partners to know where to direct their HIV prevention and support services.

Process

Following initial conversations with Petro, the HOT team met with HIV professionals to learn more about their specific data needs. This turned into a wish list of their location data needs—almost all of which were collected in the mapping efforts that followed.

Replicating the community mapping model already implemented in Dar es Salaam², the team worked with “balozi” leaders (known as “wajumbe” in other regions) and community members to use free, open source data tools, like Open Data Kit on their Android smartphones, to collect household data on access to HIV services.

In May 2017, the HOT team conducted a workshop with HIV stakeholders to showcase this data. Stakeholders included ward and sub-ward leaders, as well as representatives from Mbeya Regional Hospital, Igawilo Hospital, Ruanda Health Centre and HIV-focused development initiatives. There, partners discussed how citizen-generated HIV data could be utilised to improve local health services.

Outcomes and Impact

• Connecting sex workers to location-specific support: Jeremia’s team has already put these maps to use, only weeks after attending May’s workshop. He shared that the maps “help us in identification of key populations” found in those areas. In fact after his team visited the 16 hotspots found in Iyela ward, “using this map, we were able to identify 15 female sex workers” and connect them with their peer educators located in those areas.
• Increasing referrals to health facilities: Says Jeremia, “using these maps has increased the rate of referrals”, since “community providers are able to view [nearby] health facilities” and link clients to them. They have linked 25 clients this way.
  Giving voice to citizens to expose service gaps: The mapping efforts exposed medical shortages by those seeking sexual reproductive health (SRH) support, with 25% noted medicine shortages and a sixth reporting a lack of medical staff at facilities. The distance to reach HIV testing centres was alarmingly high and was found to be a barrier to most residents.
• Targeting HIV services: Workshop stakeholders highlighted how hotspot data will allow them to establish mobile clinics in areas with high HIV transmission rates and pinpoint communities with a lack of HIV awareness to implement HIV education programs and address cultural stigmatization around the issue. A Mtaa Executive Officer from Kalobe ward shared: “The data collected can have multiple uses, for example the outbreak of diseases can be tracked down easily if you have a detailed map like these ones.”
• Informing budgets: Jeremia explained that KIHUMBE will share the maps “with LGAs and see how they can include services in their budgets… as [the maps] will indicate the target population [locations]”.

“Before the workshop I didn’t know that health data could be visualized on a map. As a health personnel our ultimate goal is to reduce new HIV infections. Having a map which indicates HIV hotspots will help us in the provision of education to citizens.” —Dr. Letisia Mgeta (Ruanda Health Center)

Key Collaborators