Knowledge generated by communities is playing a vital role in informing HIV prevention and treatment programmes as health NGO Right to Care gears up to find innovative ways to reach UNAIDS 90-90-90 targets by 2020. These are ambitious treatment targets to help end the AIDS epidemic.,
Dorman Chimhamhiwa, head of Right to Care’s Geographic Information System (GIS) and Planning unit, says, “Communities’ role in knowledge generation may be one of the most helpful ways to advance decision making about HIV programmes. Local knowledge and sharing are done through GIS-driven social mapping based on the premise that local people have expert knowledge of their own environments.
“Social mapping enables communities to share insights about social and cultural habits and customs in the areas where they live and work. Insights captured through social mapping, often excluded from mainstream or official maps, enable the Right to Care GIS team to zone in on specific areas and unpack the nuances around what is driving HIV transmission. This knowledge goes on to inform localised HIV programme strategies.”
He continues, “Context is important. Seasonal farmworkers, for instance, who are between jobs and highly mobile populations need different communication and intervention strategies. We use everything from door-to-door visits to texting. We monitor the success of our strategies through the numbers of people returning to healthcare facilities,” says Chimhamhiwa.
Social mapping, also referred to as participatory mapping, allows for quicker, better healthcare intervention by location and healthcare facility. It has been so effective that Right to Care is using it in Zambia and Malawi as well.
In a Zambian province, social mapping resulted in a targeted approach that saw HIV positive test rates increase from 6% in July to 31% in August. “The key to getting people into the clinics is being able to communicate in a way that speaks to their specific needs,” says Chimhamhiwa.
In 2015, Right to Care started developing GIS-driven systems, which combined data from multiple sources, such as the National Department of Health, the Department of Home Affairs, Statistics South Africa and local municipalities, to create location-driven systems that allow it to drill down into the demographics of areas with high rates of HIV/Aids.
“The system is all about the where,” says Chimhamhiwa. “It enables GIS-driven tracking and tracing of patients that are lost to follow up – those that don’t return to facilities to collect their repeat medication or to see their healthcare worker. Using our GIS system, we can identify clinics which are losing patients, perhaps because the patient has moved to another facility. We also investigate the best performing facilities to find out what is working and use this information to boost treatement adherence rates at nearby facilities which are not performing well.
“For the first 90 of the UNAIDS targets: to get 90% of a country’s population to know their status, Right to Care finds out where a high number of people are testing HIV positive and then develops plans to address this.
“There are still challenges in linking HIV-positive people to care. This means that for the second 90, to get 90% of HIV positive people onto antiretroviral treatment, we pull all the testing data and map it against healthcare facilities. By being able to track adherence by facility, we can plan the best response for each location.
“For the third 90, to get 90% of people receiving antiretroviral therapy to be virally suppressed, various data sources are used to assess viral suppression and then formulate targeted responses,” says Chimhamhiwa.
Testing is central to Right to Care’s innovative GIS system. Working with the National Health Laboratory Service (NHLS) of South Africa, Right to Care analyses routes between facilities and laboratories so specimen movement can be improved. Point of care HIV testing devices can also be placed in facilities that need them most. Consequently, blood samples can be tested on-site instead of having to be sent to laboratories which creates delays and which can compromise the integrity of samples.
This innovative GIS-based health solution is an integral part of Right to Care’s decision-making. It supports Right to Care’s medical male circumcision programme with targeted demand creation approaches that assist in reaching and exceeding circumcision targets. It has also played an essential part in reaching adolescent girls and young women. It is helping Right ePharmacy to identify the best sites for medicine collection.
Chimhamhiwa adds that, “Our GIS programme is also empowering community health workers with tools that support better field implementation, team supervision and improve patient health outcomes. This aligns with the Department of Health‘s programme to strengthen community-based modelling and implement mHealth and eHealth strategies at all levels.”