Presented by Anita Datar, Futures Group at MEASURE Evaluation Geographic Information Systems (GIS) Working Group Meeting.

1. Using routinely
collected PMTCT data
to identify HIV
epidemic hotspots at
sub-national levels;
lessons learned from
the HPP
Anita Datar
June 2015

2. Agenda
Background
 Overview of HPP’s scope of work
 Approach to analysis
Opportunities and challenges of using routinely collected
PMTCT data for geographic targeting
 Why use routinely collected PMTCT data?
 How does routinely collected PMTCT improve our understanding
of variations in HIV burden at sub-national levels?
Way Forward
 What investments are needed to ensure sustainability at sub-
national levels?

3. Global Fund 2013
 strategic resource allocation
and programming at the
country level
PEPFAR 2014
 Right Thing, Right Place,
Right Time
A Call for Action: Taking a
Geographic Approach
Source: PEPFAR 3.0, http://www.pepfar.gov/documents/organization/234744.pdf
Source: Joint United Nations Programme on HIV/AIDS (UNAIDS). 2014. Local Epidemics Issues Brief. Geneva: UNAIDS. Available
at http://www.unaids.org/sites/default/files/media_asset/JC2559_local-epidemics_en.pdf.

4. HPP: Scope of work

5. Source: Dr. Frank Tanser/University of KwaZulu-Natal
Approach
Estimate HIV positivity using PMTCT testing
data at each health facility
Use HIV positivity to estimate HIV
prevalence at each facility
Interpolate to estimate HIV
prevalence for all areas between
health facilities
Calculate estimated numbers of people
living with HIV (PLHIV) at various
boundary levels
Determine estimated treatment coverage
using numbers of PLHIV and numbers on
antiretroviral therapy (ART)

6. Low cost, readily available
Provides comparable estimates with population
based surveys
More representative at sub-national levels
Why use routinely collected
PMTCT data?

7. PhotoSource:HealthPolicyProject,Ghana
Facility-based health
management information
systems
DHIS 2.0 rolled out in more
than 47 countries
Data use improves data quality
Low-cost, Readily
Available

9. Routinely Collected PMTCT Data
Representative at Granular Levels
1 ANC SS site versus >150 PMTCT sites, Homa Bay County, Kenya

10. Using routinely collected PMTCT data, we can:
 Monitor trends in HIV testing at PMTCT clinics over time
 Estimate # PLHIV
 Estimate HIV prevalence and create interpolated surface
 Estimate HIV prevalence and compare to facilities
 Examine # of patients on ART and compare with estimated
PLHIV in need of treatment
Improved understanding of HIV
variation at subnational levels

11. Trends in HIV Positivity Over Time:
KwaZulu-Natal Province
23.8
21.3
20.5
19
20
21
22
23
24
25
Jan-Dec 2012 Jan-Dec 2013 Jan-Dec 2014
HIVPositivity(%)
90-90 - 90

12. Estimated PLHIV in KwaZulu-Natal,
South Africa, by District, 2014

13. Estimated HIV Prevalence in
Kwa Zulu-Natal, South Africa, 2014

14. Estimated HIV Prevalence in
Eastern Cape, South Africa 2014
Supply and distribution
of health clinics meeting
demand?

15. Patients on ART and Estimated
PLHIV Not on ART, Dec. 2014
0
100,000
200,000
300,000
400,000
500,000
600,000
700,000
On ART
Estimated PLHIV not on ART
90-90-90

16. Data quality, availability, ownership variable across
and within countries
Lack of availability of disaggregated data by age
and gender
Duplication of HIV testing
Limited to those that visit PMTCT clinics
Extrapolating PMTCT data to describe general
population
Challenges and Limitations

17. “Donors and international
technical agencies should
prioritize efforts to strengthen
routine reporting, data
collection and analytic
capacity at the national and
sub-national levels.”
Way Forward
Source: amfAR, The Foundation for AIDS Research; and AVAC, Global
Advocacy for HIV Prevention. 2014. Data Watch: Closing a Persistent Gap
in the AIDS Response. Washington, DC and New York: amfAR and AVAC.

18.  USAID
 OGAC
 The Global Fund to Fight AIDS, Tuberculosis and Malaria
 South Africa National AIDS Council
 University of KwaZulu-Natal
 HPP Team
Acknowledgments

19. Photo by Eftekharul Alam Kingshuk, National AIDS/STD Programme, Bangladesh
Questions?

20. www.healthpolicyproject.com
Thank You!
The Health Policy Project is a five-year cooperative agreement funded by the U.S. Agency for International
Development under Agreement No. AID-OAA-A-10-00067, beginning September 30, 2010. The project’s HIV
activities are supported by the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR). It is implemented by
Futures Group, in collaboration with Plan International USA, Avenir Health (formerly Futures Institute), Partners in
Population and Development, Africa Regional Office (PPD ARO), Population Reference Bureau (PRB), RTI
International, and the White Ribbon Alliance for Safe Motherhood (WRA).