Skip to content

EpiC Blog

PEPFAR, USAID, MOSAIC
  • Home
  • About
  • Events
  • Resources
    • Social and Behavior Change
    • Mental Health and Psychosocial Support
  • COVID-19
  • Follow Us
Search
START TYPING AND PRESS ENTER TO SEARCH
  • Home
  • About
  • Events
  • Resources
    • Social and Behavior Change
    • Mental Health and Psychosocial Support
  • COVID-19
  • Follow Us

Using Geographic Information System (GIS) for targeted HIV case finding in Cross River State, Nigeria

June 22, 2020

Philip Imohi, Michael Egbe, Frank Eyam, Cajetan Obi, Antor Ndep, Olusola Sanwo, Satish Raj Pandey, Hadiza Khamofu, Robert Chiegil, Moses Bateganya, & Ezekiel James


In alignment with the global drive toward the control of the HIV epidemic, members of the FHI 360 team working with the Strengthening Integrated Delivery of HIV/AIDS Services (SIDHAS) project, funded by the U.S. Agency for International Development (USAID), initiated the mapping of potential hot spots in communities using Geographic Information System (GIS). The goal was to further target HIV testing, increase case finding, and achieve treatment saturation across all supported local government areas (LGAs) in Cross River State, Nigeria.

Cross River has an HIV prevalence of 2.0 percent (Figure 1) and high unmet need for antiretroviral therapy (ART) and other HIV services. Most of the adjacent states also have prevalence rates higher than the national average of 1.4 percent; Abia, 2.1 percent; Akwa Ibom, 5.5 percent; Benue, 5.3 percent; and Ebonyi, 0.8 percent. The Revised National HIV and AIDS Strategic Framework 2019–2021 identifies low access to and limited coverage of quality HIV testing services (HTS)—estimated nationally at 37 percent—as limiting factors in fast-tracking the national response toward ending the HIV epidemic in Nigeria.2 Increasing access to high-quality comprehensive HIV prevention, treatment, care, and related services through improved efficiencies in service delivery is the main objective of SIDHAS in Cross River and the surrounding high-burden states.

Figure 1. HIV prevalence by state in the South-South Zone, Nigeria (Source: NACA, 2019)

fig1

A key component of the SIDHAS project in Cross River is the use of Community ART Management (CAM) teams—an initiative adopted to extend HIV services from supported health facilities to the community. Sixteen CAM teams were constituted in Cross River and each of these mini-mobile health groups includes a medical doctor, pharmacist, laboratory scientist, partner notification officer, case manager, HIV identification expert, and data entry clerks. These teams conduct community outreach and visit non-SIDHAS supported facilities as potential locations to reach people at risk of HIV with HTS.

To enhance targeted community HTS, the Cross River State SIDHAS team introduced mobile technology and GIS mapping to complement other strategies being used for improved case identification. The first step was the mapping of potential hot spots in the community—locations where PLHIV and individuals at high risk of exposure to HIV were most likely to be found. These sites included patent medicine vendors, private laboratories, healing homes, prayer houses, community pharmacies, traditional birth attendants, and others (Figure 2).

Figure 2. Hot spots in Akpabuyo local government area (LGA), Cross River data (Note: Cold spots and not-significant clusters correspond to areas where HIV positivity is low [on average, less than 30%]).

fig2

The second step was born out of the recognition of the possibility of using HIV testing data collected over time—which includes testing locations—to further map potential sites where the intended target population could be found. These testing locations were mapped (Figure 3) to show patterns in HIV positivity at a more granular (settlement) level to better streamline HIV testing to areas where previously undiagnosed cases are more likely to be located. This map identified 634 of these new potential locations, largely at the outskirts of urban centers and in the rural riverine communities with a large non-indigenous population of cross-border traders, fishermen, maritime workers, and inter-community taxi drivers. Possible transactional sex within and between this highly mobile population with a seasonal rural-urban migratory pattern could be responsible for the higher HIV positivity rates within these locations.

Figure 3. Detailed section of Akpabuyo LGA showing targeted hot spots, Cross River

fig3

Within nine weeks of implementing the GIS mapping from January to March 2020, 3,021 persons were offered HTS in the community including the hard-to-reach locations and residential areas along the creeks, and 703 individuals were found to be HIV positive and initiated on ART. This case-finding rate of 23.3 percent was much higher than the 8.0 percent at the facility (6,019 tested and 484 positives identified) during the same period.

In the nine weeks prior to implementing GIS mapping, only 53 cases were identified from testing 206 individuals in the community while at the facility during same period, 652 cases were identified from testing 8,518 (8 percent).

The GIS mapping gave the CAM teams guidance on what areas of the community to focus on and prioritize for HTS and case identification. This strategy therefore has the potential to accelerate the achievement of treatment saturation in Cross River.

Share this:

  • Tweet

Post navigation

Previous

COVID-19 and HIV: New programmatic resources from the EpiC project

Next

LINKAGES and EpiC at AIDS 2020 Virtual

Archives

Search by Category

Recent Publications

  • EpiC HIV Factsheet
  • EpiC COVID-19 Factsheet

Get Subscribed

Enter your email address to subscribe to this blog and receive notifications of new posts.

We don’t spam! Read our privacy policy for more info.

Check your inbox or spam folder to confirm your subscription.

Follow Us

  • Twitter
  • Facebook
  • Link

This blog is managed by the EpiC project and dedicated to sharing stories, events, and resources from HIV epidemic control efforts around the world.

© EpiC BLOG 2022

  • Home
  • About
  • Events
  • Resources
  • COVID-19
  • Follow Us
Assessment

A questionnaire or “screener” meant to be used with individual patients in a clinical setting to screen for, help diagnose, or monitor progress for individual mental health conditions.

Intervention

Larger packages or broader-reaching resources that describe actions or activities to be implemented. These may be appropriate for individuals, groups, and/or programs.

Anxiety

Feelings of fear, dread, and uneasiness that may occur as a reaction to stress. Anxiety can be a symptom or a feeling; it can also be a clinical diagnosis of a mental health condition.

Burnout

A state of emotional, physical, and mental exhaustion caused by excessive and prolonged stress, typically related to one’s work, that is not managed well. Burnout is considered an occupational phenomenon.

Clinical diagnoses

Mental or neuropsychiatric disorders, or disruptive, unusual, or maladaptive behaviors that have been evaluated and diagnosed by a trained medical professional.

Depression

A mood disorder that causes a persistent feeling of sadness and loss of interest.

Disability

A physical or mental condition that limits a person’s movements, senses, or activities.

Insomnia

A sleep disorder, or disordered sleep pattern, characterized by trouble falling and/or staying asleep.

Overall well-being

The state of being comfortable, healthy, or happy; judging one’s own life positively; generally, “feeling good.”

Post-traumatic stress (PTS)

A normal adaptive response to traumatic or stressful life events that can result in a wide range of distressing symptoms. Post-traumatic stress disorder (PTSD) differs from PTS and is a clinical diagnosis.

Self-efficacy

An individual’s belief in their capacity to act in the ways necessary to reach specific goals.

Self-harm/suicidality

Deliberate injury to oneself as an emotional coping mechanism, ranging from cutting oneself to suicide. Expressions of self-harm and/or suicidality are usually considered an emergency and should be assessed and managed by a trained professional.

Social support

The perception that one is cared for, has assistance available if needed, and that one is part of a supportive social network.

Stress

Any type of change to one’s internal or external environment that causes physical, emotional, or psychological strain. “Managing stress” is an effort to return from this state of strain or disturbance to homeostasis or well-being.

Substance abuse

Use of a substance (usually drugs or alcohol) in amounts or by methods that are harmful to oneself or others. Substance use disorder (SUD) and addiction are distinct clinical diagnoses.

Trauma

Lasting biopsychosocial and/or emotional response that often results from experiencing a terrible event such as an accident, crime, military combat, or natural disaster, or a series of chronic traumatic events like persistent abuse or neglect.

Program beneficiary

Individual who receives program services; an entire group or population may be the recipient of services.

Service provider

Individual who directly provides services to another individual, group, or population (the “program beneficiary”) through a program.

Privacy Policy