Overview

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.

Malawi 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 and Distance 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.

Geographical Distance

Walking Time

District/TA analysis

To support the analysis, we have computed the proportion of PLHIV that is 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.

District Level (%PLHIV)

District Level (Nr. PLHIV)

TA Level (%PLHIV)

TA Level (Nr. PLHIV)

Proposed Facilities & Locations

Below we provide analyse the proposed facilities and locations for scaling-up activities. The top 25 facilities and locations are illustrated on the maps. Green areas indicate additional PLHIV that can be reached through the proposed facilities and locations.

Candidate Facilities (60 Minutes)

List of top 25 optimal non-ART facilities 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.
ID	Source	District	TA	Name	Type	Authority	Long.	Lat.	PLHIV	95% CI
2561	SARA	Mangochi	TA Chimwala	Assalam Clinic	Clinic	CHAM or mission/faith-based	35.19	-14.55	1487	(1054-1982)
1088	DHAMIS	Thyolo	TA Bvumbwe	BLM Bvumbwe	Special / other site	Indep NGO	35.08	-15.93	1407	(1106-1747)
3337	SARA	Chikwawa	TA Makhwira	Mitondo Health Post	Health Post	Government/public	35.06	-16.27	1118	(770-1570)
2992	SARA	Blantyre City	Mapanga Ward	Amitofo Care Centre	Clinic	Indep NGO	35.11	-15.75	1852	(1483-2287)
2630	SARA	Machinga	STA Nsanama	MOLIPA	Health Post	Government/public	35.39	-15.05	851	(585-1182)
3713	SARA	Neno	TA Symon Likongwe	Zalewa DAPP VCT Station	Clinic	Indep NGO	34.85	-15.45	821	(588-1082)
4065	SARA	Lilongwe	TA Masumbankhunda	DZABWA	Health Post	CHAM or mission/faith-based	33.57	-14.10	826	(565-1157)
673	DHAMIS	Lilongwe City	Area 38	Chimwala Health Centre	Health centre	Government/public	33.80	-14.05	792	(579-1024)
1322	DHAMIS	Machinga	TA Chikweo	Chipolonga Health Post	Health post	Government/public	35.69	-14.86	804	(524-1151)
3304	SARA	Chikwawa	TA Ngabu	Chapwaila Health Centre	Health Centre	Government/public	34.78	-16.40	782	(539-1087)
1434	SARA	Salima	Salima Town	Ndimoyo Palliative Trust Clini	Clinic	Indep NGO	34.46	-13.78	764	(551-1013)
3163	SARA	Thyolo	TA Mphuka	CHILENGO	Health Post	Government/public	35.02	-16.14	1073	(763-1406)
1410	DHAMIS	Zomba	TA Mwambo	Mikuyu Adult Clinic	Special / other site	Government/public	35.42	-15.42	639	(493-804)
2820	SARA	Chiradzulu	TA Mpama	NJULI	Health Post	Government/public	35.12	-15.71	1791	(1451-2191)
3257	SARA	Mulanje	TA Nkanda	DEMULA	Health Post	CHAM or mission/faith-based	35.48	-15.96	605	(455-790)
3351	SARA	Chikwawa	TA Ngabu	THERERE	Health Post	Government/public	34.68	-16.37	619	(368-929)
3244	SARA	Mulanje	TA Mabuka	Sayama Clinic	Clinic	Company, ESCOM, Tea Estate (SARA)	35.55	-16.07	578	(449-719)
1158	DHAMIS	Zomba	TA Mkumbira	Chisi Health Centre	Health centre	Government/public	35.61	-15.33	598	(364-939)
3259	SARA	Mulanje	TA Chikumbu	KHAYA	Health Post	CHAM or mission/faith-based	35.39	-15.99	595	(461-752)
1393	DHAMIS	Dedza	TA Chilikumwendo	Mdeza Dispensary	Dispensary	Government/public	33.97	-14.24	575	(388-827)
3246	SARA	Mulanje	STA Sunganinzeru	CHILINGWE	Dispensary	Company, ESCOM, Tea Estate (SARA)	35.65	-16.00	544	(395-720)
1850	SARA	Ntcheu	TA Goodson Ganya	Solomon Village Clinic	Clinic	CHAM or mission/faith-based	34.87	-14.71	538	(362-734)
2556	SARA	Mangochi	STA Chiunda	Mbalama Dispensary	Dispensary	Government/public	35.50	-14.71	527	(361-748)
3356	SARA	Chikwawa	TA Ngabu	SAOPA	Health Post	Government/public	34.82	-16.49	568	(401-775)
3416	SARA	Nsanje	TA Tengani	Mkango Health Post	Health Post	Government/public	35.30	-16.82	510	(326-734)

Candidate Facilities (90 Minutes)

List of top 25 optimal non-ART facilities in the analysis. The column “PLHIV” indicates the number of PLHIV that currently need more than 90 minutes to walk to the closest ART facility but less than 90 minutes to the listed health facility in the table.
ID	Source	District	TA	Name	Type	Authority	Long.	Lat.	PLHIV	95% CI
3337	SARA	Chikwawa	TA Makhwira	Mitondo Health Post	Health Post	Government/public	35.06	-16.27	1107	(765-1545)
3338	SARA	Chikwawa	TA Makhwira	Nkhate Health Post	Health Post	Government/public	34.96	-16.15	1090	(747-1495)
3351	SARA	Chikwawa	TA Ngabu	THERERE	Health Post	Government/public	34.68	-16.37	848	(522-1242)
2630	SARA	Machinga	STA Nsanama	MOLIPA	Health Post	Government/public	35.39	-15.05	798	(535-1142)
2577	SARA	Mangochi	TA Chimwala	MWATAKATA	Health Post	Government/public	35.11	-14.76	764	(522-1047)
1158	DHAMIS	Zomba	TA Mkumbira	Chisi Health Centre	Health centre	Government/public	35.61	-15.33	598	(364-939)
2632	SARA	Machinga	STA Nchinguza	LIKHONYOWA	Health Post	Government/public	35.79	-14.96	620	(307-1167)
1322	DHAMIS	Machinga	TA Chikweo	Chipolonga Health Post	Health post	Government/public	35.69	-14.86	549	(345-828)
3331	SARA	Chikwawa	TA Lundu	SUCOMA Lengwe	Clinic	Company, ESCOM, Tea Estate (SARA)	34.80	-16.20	533	(356-755)
4065	SARA	Lilongwe	TA Masumbankhunda	DZABWA	Health Post	CHAM or mission/faith-based	33.57	-14.10	519	(345-746)
390	DHAMIS	Karonga	TA Kyungu	Mlare Health Post	Health post	Government/public	34.04	-10.17	539	(306-880)
1850	SARA	Ntcheu	TA Goodson Ganya	Solomon Village Clinic	Clinic	CHAM or mission/faith-based	34.87	-14.71	517	(351-720)
2764	SARA	Zomba	TA Mkumbira	LUNGAZI	Health Post	Government/public	35.85	-15.42	533	(245-968)
2571	SARA	Mangochi	TA Chimwala	St. Johns Seminary	Clinic	CHAM or mission/faith-based	35.18	-14.55	489	(349-656)
3416	SARA	Nsanje	TA Tengani	Mkango Health Post	Health Post	Government/public	35.30	-16.82	460	(290-664)
1059	SARA	Kasungu	STA M’nyanja	MAFUPHIZI	Health Post	Government/public	33.44	-12.71	437	(263-677)
3355	SARA	Chikwawa	TA Ngabu	KHOKHWA	Health Post	Government/public	34.85	-16.53	418	(270-618)
3415	SARA	Nsanje	TA Makoko	Ching’oma Health Post	Health Post	Government/public	35.11	-17.00	418	(259-620)
2763	SARA	Zomba	TA Mkumbira	CHINGUMA	Health Post	Government/public	35.80	-15.23	442	(212-788)
2572	SARA	Mangochi	TA Makanjila	LUKOLOMA	Dispensary	Government/public	35.10	-13.83	416	(218-713)
4072	SARA	Lilongwe	TA Kalumbu	NYANJA	Health Post	Government/public	33.94	-14.14	391	(256-581)
1842	SARA	Ntcheu	TA Masasa	Phanga Dispensary	Dispensary	Government/public	34.72	-14.34	357	(239-507)
1630	SARA	Mchinji	STA Pitala	PITALA	Health Post	Government/public	33.03	-13.55	338	(220-493)
1184	DHAMIS	Mchinji	STA Gumba	Chimwamkango Health Centre	Health centre	Government/public	32.99	-13.40	334	(191-539)
1331	DHAMIS	Mchinji	TA Kazyozyo	Kazyozyo Health Centre	Health centre	Government/public	32.86	-13.58	318	(184-532)

Candidate Locations (60 Minutes)

List of top 25 optimal locations 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 location in the table.
ID	District	TA	Long.	Lat.	PLHIV	95% CI
1	Chiradzulu	TA Mpama	35.12	-15.73	2286	(1841-2874)
2	Mangochi	TA Chimwala	35.18	-14.50	1624	(1166-2162)
3	Phalombe	TA Jenala	35.63	-15.52	1620	(954-2316)
4	Thyolo	STA Boyidi	35.13	-15.93	1532	(1204-1916)
5	Phalombe	TA Chiwalo	35.76	-15.61	1484	(1051-2008)
6	Mulanje	TA Nkanda	35.43	-15.87	1463	(1056-1915)
7	Zomba	STA Ngwelero	35.50	-15.58	1409	(1214-1812)
8	Chikwawa	TA Makhwira	34.99	-16.18	1371	(989-1874)
9	Mangochi	TA Chimwala	35.17	-14.72	1317	(839-1931)
10	Mangochi	TA Nankumba	34.94	-14.18	1242	(881-1801)
11	Chikwawa	STA Ndakwela	34.77	-16.18	1178	(823-1629)
12	Mulanje	TA Laston Njema	35.78	-16.01	1153	(839-1533)
13	Salima	TA Khombedza	34.38	-13.54	1117	(976-1334)
14	Phalombe	TA Mkhumba	35.59	-15.69	1102	(897-1511)
15	Salima	TA Pemba	34.48	-13.82	1089	(889-1517)
16	Chikwawa	TA Makhwira	35.05	-16.28	1119	(755-1902)
17	Salima	TA Khombedza	34.31	-13.59	1118	(896-1814)
18	Lilongwe	TA Kalumba	33.79	-14.09	1022	(787-1321)
19	Mulanje	TA Nkanda	35.46	-15.95	1118	(887-1392)
20	Chikwawa	TA Ngabu	34.93	-16.53	1046	(718-1652)
21	Mchinji	TA Mlonyeni	32.96	-13.87	997	(866-1277)
22	Machinga	TA Mlomba	35.49	-15.09	991	(858-1267)
23	Nsanje	TA Ngabu	35.15	-16.97	980	(744-1323)
24	Lilongwe	TA Masumbankhunda	33.58	-14.13	994	(848-1302)
25	Phalombe	TA Nazombe	35.80	-15.69	967	(811-1247)

Candidate Locations (90 Minutes)

List of top 25 optimal locations in the analysis. The column “PLHIV” indicates the number of PLHIV that currently need more than 90 minutes to walk to the closest ART facility but less than 90 minutes to the listed location in the table.
ID	District	TA	Long.	Lat.	PLHIV	95% CI
1	Chikwawa	TA Makhwira	35.03	-16.22	1869	(1248-2578)
2	Balaka	TA Kalembo	35.18	-14.75	1328	(876-1908)
3	Salima	TA Khombedza	34.36	-13.56	1192	(793-1793)
4	Ntcheu	TA Goodson Ganya	34.70	-14.50	1039	(668-1509)
5	Nsanje	TA Ngabu	35.16	-16.98	994	(654-1377)
6	Mangochi	TA Nankumba	34.95	-14.20	1001	(678-1522)
7	Phalombe	TA Jenala	35.66	-15.52	944	(513-1323)
8	Chikwawa	TA Katunga	34.72	-16.13	939	(602-1331)
9	Machinga	STA Nsanama	35.35	-15.06	909	(663-1258)
10	Chikwawa	TA Ngabu	34.71	-16.37	912	(568-1336)
11	Nsanje	TA Tengani	35.28	-16.78	908	(502-1314)
12	Machinga	STA Nchinguza	35.83	-14.96	889	(714-1154)
13	Mangochi	TA Makanjila	35.12	-13.90	904	(523-1536)
14	Kasungu	TA Santhe	33.24	-13.45	791	(557-1191)
15	Kasungu	TA Chilowamatambe	33.55	-13.16	782	(595-1203)
16	Mangochi	TA Mponda	35.01	-14.43	768	(588-1017)
17	Chikwawa	TA Ngabu	34.91	-16.56	704	(467-1040)
18	Nsanje	TA Ngabu	35.27	-16.98	696	(515-932)
19	Machinga	STA Nchinguza	35.87	-14.97	694	(435-1395)
20	Karonga	TA Kyungu	34.06	-10.18	653	(511-919)
21	Mangochi	STA Chiunda	35.42	-14.70	638	(417-832)
22	Mangochi	TA Nankumba	35.03	-14.34	673	(479-1160)
23	Zomba	TA Mkumbira	35.84	-15.42	647	(442-1024)
24	Zomba	TA Mkumbira	35.61	-15.32	638	(443-952)
25	Machinga	TA Chikweo	35.68	-14.88	631	(507-872)

Summary Information

Surface speed assumptions

The friction surface map below illustrates the speed assumptions we used to produce the travel time surfaces.

Average distance/time to facility

Provided below are summary charts on the average distance/travel time to the nearest facility, stratified at the district level.

Proportion of district-level PLHIV within reach (over thresholds)

The proportion of PLHIV that are within reach (in terms of travel time and distance) is illustrated below. The distance/travel time is on the x-axis, and the proportion of PLHIV that can reach their nearest facility at the given distance/travel time is displayed on the y-axis.

Note: In districts neighbouring water bodies (e.g. Likoma, Nkhata Bay), the proportion of PLHIV within reach may be be underestimated, as some pixels in our analysis lie “on water”. This will be fixed as a next step.