Overview (Neno)

The goals of this analysis are:

For given travel times (60, 90, 120 minutes) or geographical distances (5, 8, 10 km), estimate the proportion and number of PLHIV that can reach their closest ART facility. This is done on a district and traditional authority (TA) level.
Produce a gridded PLHIV prevalence map of Malawi using the WorldPop population density map and Naomi PLHIV estimates that supports the identification of locations that may be underserved.
Incorporate travel time maps that indicate the time and distance needed to reach the closest ART facilities, based on a combination of digital elevation and land cover maps as well as road layouts in Malawi.
Identify and propose new candidate facilities and locations for ART treatment scaling-up activities.

For the detailed methodology on how these maps were created, please refer to the supplementary material provided.

Download the full district report here.

Neno Maps

Population, PLHIV and Travel Times

Malawi Overview Map

Each pixel on the map corresponds to an area of 1km x 1km. Below we display a map of Malawi with some general information:

Population: population density using the WorldPop population density map, adjusted to the 2018 census numbers.
PLHIV: gridded prevalence estimates of the number of people living with HIV (“PLHIV density estimates”).
HIV Prevalence: estimated gridded HIV prevalence.
Geographical distance: direct distance (in km) to the closest ART facility.
Walking time: estimated travel time (in minutes) to the closest ART facility at a given pixel.

Additionally, it is possible to add markers with facility locations to the map:

ART Facilities: health facilities that provide ART services and had at least one patient on ART in 2020 (based on the DHA-MIS database).
- “Private for profit” facilities are excluded from the analysis.
- The number of ART patients in Q3/2020 is provided in the brackets.
Non-ART Facilities (Static): other (nonprofit) health facilities that do not currently provide ART facilities. (These include facilities that have indicated that they have capacity to provide ART services).

Time Thresholds

By comining the travel time maps with the gridded PLHIV prevalence, the number of PLHIV that is not reached within a certain time limit or distance (km) is computed. This is visualised in the below two maps, stratified by geographical distance and walking time.

Example interpretations:

Walking 15 minutes: this gives a map of the regions with PLHIV for which the closest facility is more than 15 mintues (walking time) away.
5km distance: this gives a map of the regions with PLHIV for which the closest facility is more than 5km (geographical distance) away.

TA analysis

To support the analysis, we have computed the proportion and number of PLHIV that are not reached within a given time or distance. Higher percentages correspond to a larger proportion of PLHIV that is not reached within the relevant area.

Candidate Facilities (60 Minutes)

Below we provide proposed facilities for scaling-up activities, illustrated on the maps. Green areas indicate additional PLHIV that can be reached through the proposed facilities within 60 minutes. Note: facility labels were aligned to district reports that were disseminated.

Summary Information

Summary estimates for Neno, September 2020.
Total PLHIV (all ages)	8,573 (7,142–10,208)
HIV prevalence, age 15-49 years	9.0% (7.5%–10.7%)
Total patients receiving ART	24,343
Average walking time to nearest ART (minutes)	48 (46–50)
Number PLHIV > 60 minutes walking time	2,891 (2,409–3,427)
Percentage PLHIV > 60 minutes walking time	34.4% (32.0%–36.7%)

Facility List

ART Facilities

List of active ART facilities that had at least 1 registered ART patient in September 2020. The column “ART” indicates how many ART patients are registered at the ART facility. Facilities outside the district boundaries that may be accessible to residents within the district are marked with “*“.
ID	District	TA	Name	Type	Authority	Long.	Lat.	ART
A1	Neno	Neno Boma	Neno District Hosp.	Rural/Community	Government	34.65	-15.40	1708
A2	Neno	TA Symon Likongwe	Zalewa PIH	Special	NGO	34.83	-15.52	1554
A3	Neno	TA Symon Likongwe	Matope HC	Health centre	CHAM	34.95	-15.35	893
A4	Neno	TA Symon Likongwe	Lisungwi Community Hosp.	Health centre	Government	34.77	-15.44	852
A5	Neno	TA Mlauli	Ligowe HC	Health centre	Government	34.65	-15.47	702
A6	Neno	TA Mlauli	Chifunga HC	Health centre	Government	34.71	-15.62	606
A7	Neno	TA Dambe	Msambe HC	Health centre	Government	34.61	-15.26	488
A8	Neno	TA Symon Likongwe	Midzemba HC	Health centre	Government	34.84	-15.35	424
A9	Neno	TA Chekucheku	Matandani HC	Health centre	Government	34.65	-15.33	412
A10	Neno	TA Mlauli	Magareta HC	Health centre	Government	34.63	-15.55	299
A11	Neno	TA Symon Likongwe	Nkula HC	Health centre	CHAM	34.83	-15.52	292
A12	Neno	TA Dambe	Neno Parish HC	Health centre	CHAM	34.61	-15.44	269
A13	Neno	TA Symon Likongwe	Luwani HC	Health centre	Government	34.74	-15.48	176
A14	Neno	TA Dambe	Dambe HC	Health centre	Government	34.65	-15.40	144
A15	Neno	TA Chekucheku	FPAM Clinic Neno	Health centre	NGO	34.65	-15.40	10
A16*	Ntcheu	TA Mpando	Tsangano HC	Health centre	CHAM	34.61	-15.17	350
A17*	Zomba	TA Mlumbe	Chipini HC	Health centre	CHAM	35.10	-15.39	1667
A18*	Zomba	TA Mlumbe	Chilipa HC Zomba	Health centre	CHAM	35.12	-15.32	665
A19*	Balaka	STA Phalula	Phalula HC	Health centre	CHAM	34.89	-15.23	1516
A20*	Balaka	TA Nkaya	Phimbi HC	Health centre	Government	35.11	-15.25	807
A21*	Blantyre	TA Chigaru	Mdeka HC	Health centre	Government	34.94	-15.47	1588
A22*	Blantyre	TA Kunthembwe	Chikowa HC	Health centre	Government	34.87	-15.67	1078
A23*	Blantyre	TA Chigaru	Lundu HC	Health centre	Government	35.01	-15.42	1057
A24*	Blantyre	TA Kuntaja	Dziwe HC	Health centre	Government	34.88	-15.56	733
A25*	Mwanza	Mwanza Boma	Mwanza District Hosp.	District hospital	Government	34.51	-15.60	4782
A26*	Mwanza	TA Kanduku	Tulonkhondo HC	Health centre	Government	34.52	-15.75	523
A27*	Mwanza	TA Kanduku	Kunenekude HC	Health centre	Government	34.49	-15.46	512
A28*	Chikwawa	TA Kasisi	Chavala HC	Health centre	Government	34.83	-15.83	236

Non-ART Facilities

List of non-ART facilities considered in the analysis. The column “PLHIV” indicates the number of PLHIV that currently need more than 60 minutes to walk to the closest ART facility but less than 60 minutes to the listed health facility in the table. Facilities outside the district boundaries that may be accessible to residents within the district are marked with “*“.
ID	District	TA	Name	Type	Authority	Long.	Lat.	PLHIV	95% CI
F1	Neno	TA Symon Likongwe	Zalewa DAPP VCT Station	Clinic	NGO	34.85	-15.45	821	(588-1082)
F2	Neno	TA Symon Likongwe	Mota-Engil Clinic - Mkwinda Ca	Clinic	Company	34.82	-15.41	628	(448-827)
F3*	Ntcheu	STA Tsikulamowa	Machereza HP	Health Post	Government	34.85	-15.21	161	(102-233)
F4*	Ntcheu	STA Tsikulamowa	Matchereza HP	Health Post	Government	34.85	-15.21	161	(102-233)
F5*	Balaka	TA Nkaya	NJERENJE	Health Post	Government	35.05	-15.24	248	(176-334)
F6*	Blantyre	TA Kunthembwe	TEDZANI	Dispensary	Company	34.79	-15.56	107	(77-142)
F7*	Blantyre	TA Kuntaja	Blantyre Water Board - Walker’	Clinic	Company	34.83	-15.51	38	(28-51)
F8*	Blantyre	TA Kunthembwe	TEDZANI	Dispensary	Company	34.79	-15.56	107	(77-142)
F9*	Mwanza	TA Nthache	Muyendebwino Wellness Centre	Clinic	NGO	34.48	-15.58	450	(307-621)
F10*	Mwanza	Mwanza Boma	BLM Mwanza	Special	NGO	34.52	-15.60	323	(243-417)

Distances and travel times to ART facilities for PLHIV

March 2022