Overview (Phalombe)

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.

Phalombe 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 Phalombe, September 2020.
Total PLHIV (all ages)	36,552 (31,653–41,400)
HIV prevalence, age 15-49 years	12.6% (10.9%–14.3%)
Total patients receiving ART	54,859
Average walking time to nearest ART (minutes)	41 (39–43)
Number PLHIV > 60 minutes walking time	7,063 (5,782–8,559)
Percentage PLHIV > 60 minutes walking time	19.5% (17.3%–21.6%)

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	Phalombe	TA Chiwalo	Nambazo HC	Health centre	Government	35.82	-15.56	4655
A2	Phalombe	TA Kaduya	Migowi HC	Health centre	Government	35.69	-15.72	3960
A3	Phalombe	TA Nkhulambe	Sukasanje HC	Health centre	CHAM	35.77	-15.93	3838
A4	Phalombe	TA Mkhumba	Phalombe Mission Hospital Holy Family	District hospital	CHAM	35.62	-15.82	3784
A5	Phalombe	TA Nkhulambe	Nkhulambe HC	Health centre	Government	35.75	-15.86	3588
A6	Phalombe	Phalombe Boma	Phalombe HC	Health centre	Government	35.65	-15.81	2889
A7	Phalombe	TA Jenala	Chitekesa HC	Health centre	Government	35.57	-15.55	2828
A8	Phalombe	TA Kaduya	Kalinde HC	Health centre	Government	35.73	-15.67	1957
A9	Phalombe	TA Jenala	Nkhwayi HC	Health centre	Government	35.63	-15.61	1847
A10	Phalombe	TA Mkhumba	Mpasa HC	Health centre	Government	35.61	-15.76	1800
A11	Phalombe	TA Nazombe	Nazombe HC (Gogo Nazombe)	Health centre	Government	35.77	-15.75	1688
A12	Phalombe	TA Jenala	Mwanga HC	Health centre	CHAM	35.53	-15.65	1134
A13	Phalombe	TA Nazombe	Chiringa Mat.	Special	Government	35.77	-15.77	740
A14	Phalombe	TA Nazombe	Chiringa CHAM HC	Health centre	CHAM	35.76	-15.77	728
A15	Phalombe	TA Nkhulambe	Mulungu Alinafe Clinic	Health centre	NGO	35.82	-15.86	363
A16*	Zomba	TA Mwambo	Pirimiti HC	Health centre	CHAM	35.45	-15.48	4592
A17*	Zomba	TA Mwambo	Likangala HC	Health centre	Government	35.54	-15.43	3482
A18*	Zomba	TA Mwambo	Matiya HC	Health centre	CHAM	35.55	-15.53	2643
A19*	Zomba	STA Ngwelero	Ngwelero HC	Health centre	Government	35.43	-15.67	1508
A20*	Zomba	TA Mwambo	Chamba HC	Health centre	Government	35.52	-15.47	1287
A21*	Mulanje	TA Nkanda	Chambe HC	Health centre	Government	35.49	-15.90	2028
A22*	Mulanje	TA Nkanda	Kambenje HC	Health centre	Government	35.56	-15.85	1926
A23*	Mulanje	TA Nkanda	Mulomba HC	Health centre	Government	35.51	-15.77	1594

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	Phalombe	TA Mkhumba	Waruma	Health Post	Government	35.55	-15.77	191	(145-249)
F2	Phalombe	TA Nazombe	Nambiti 2 HP	Health Centre	Government	35.76	-15.80	19	(14-24)
F3	Phalombe	TA Nazombe	Nambiti 1 HC	Health Centre	Government	35.78	-15.75	0	(0-0)
F4	Phalombe	TA Mkhumba	Holy Family Mission Hosp.	District hospital	CHAM	35.62	-15.82	0	(0-0)
F5	Phalombe	TA Nazombe	Chiringa HC	Health Centre	CHAM	35.76	-15.77	0	(0-0)
F6	Phalombe	TA Nazombe	Chiringa HC	Health Centre	Government	35.76	-15.77	0	(0-0)
F7*	Zomba	TA Mkumbira	LUNGAZI	Health Post	Government	35.85	-15.42	533	(245-968)
F8*	Zomba	TA Mwambo	HUNGER	Dispensary	CHAM	35.47	-15.50	466	(346-613)
F9*	Mulanje	STA Sunganinzeru	CHILINGWE	Dispensary	Company	35.65	-16.00	544	(395-720)
F10*	Mulanje	TA Juma	KAMWENDO	Health Post	Government	35.48	-15.67	408	(311-513)
F11*	Mulanje	TA Laston Njema	Chisambo Estate Clinic	Clinic	Company	35.71	-16.04	250	(193-321)
F12*	Mulanje	TA Laston Njema	Phwazi Estate Clinic	Clinic	Company	35.68	-16.02	159	(119-207)

Distances and travel times to ART facilities for PLHIV

March 2022