Laurence Palk1, Justin T Okano1, Luckson Dullie2, Sally Blower3. 1. Center for Biomedical Modeling, Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine, University of California, Los Angeles, CA, USA. 2. Partners in Health, Neno, Malawi; School of Public Health and Family Medicine, University of Malawi College of Medicine, Blantyre, Malawi. 3. Center for Biomedical Modeling, Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine, University of California, Los Angeles, CA, USA. Electronic address: sblower@mednet.ucla.edu.
Abstract
BACKGROUND: UNAIDS has prioritised Malawi and 21 other countries in sub-Saharan Africa for fast-tracking the end of their HIV epidemics. UNAIDS' elimination strategy requires achieving a treatment coverage of 90% by 2030. However, many individuals in the prioritised countries have to travel long distances to access HIV treatment and few have access to motorised transportation. Using data-based geospatial modelling, we investigated whether these two factors are barriers to achieving HIV elimination in Malawi and assessed the effect of increasing bicycle availability on expanding treatment coverage. METHODS: We built a data-based geospatial model that we used to estimate the minimum travel time needed to access treatment, for every person living with HIV in Malawi. We constructed our model by combining a spatial map of health-care facilities, a map that showed the number of HIV-infected individuals per km2, and an impedance map. We quantified impedance using data on road and river networks, land cover, and topography. We estimated travel times for the existing coverage of 70%, and the time that HIV-infected individuals would need to spend travelling in order to achieve a coverage of 90%, whether driving, bicycling, or walking. FINDINGS: We identified a quantitative relationship between the maximum achievable coverage of treatment and the minimum travel time to the nearest health-care facility. At 70% coverage, health-care facilities can be reached within approximately 45 min if driving, 65 min if bicycling, and 85 min if walking. Increasing coverage above 70% will become progressively more difficult. To reach 90% coverage, many HIV-infected individuals (who have yet to initiate treatment) will need to travel for almost twice as long as those already on treatment. Bicycling, rather than walking, in rural areas would substantially increase the maximum achievable coverage. INTERPRETATION: The long travel times needed to reach health-care facilities coupled with little motorised transportation in rural areas are substantial barriers to reaching 90% coverage in Malawi. Increased bicycle availability could help eliminate HIV. FUNDING: US National Institute of Allergy and Infectious Diseases.
BACKGROUND: UNAIDS has prioritised Malawi and 21 other countries in sub-Saharan Africa for fast-tracking the end of their HIV epidemics. UNAIDS' elimination strategy requires achieving a treatment coverage of 90% by 2030. However, many individuals in the prioritised countries have to travel long distances to access HIV treatment and few have access to motorised transportation. Using data-based geospatial modelling, we investigated whether these two factors are barriers to achieving HIV elimination in Malawi and assessed the effect of increasing bicycle availability on expanding treatment coverage. METHODS: We built a data-based geospatial model that we used to estimate the minimum travel time needed to access treatment, for every person living with HIV in Malawi. We constructed our model by combining a spatial map of health-care facilities, a map that showed the number of HIV-infected individuals per km2, and an impedance map. We quantified impedance using data on road and river networks, land cover, and topography. We estimated travel times for the existing coverage of 70%, and the time that HIV-infected individuals would need to spend travelling in order to achieve a coverage of 90%, whether driving, bicycling, or walking. FINDINGS: We identified a quantitative relationship between the maximum achievable coverage of treatment and the minimum travel time to the nearest health-care facility. At 70% coverage, health-care facilities can be reached within approximately 45 min if driving, 65 min if bicycling, and 85 min if walking. Increasing coverage above 70% will become progressively more difficult. To reach 90% coverage, many HIV-infected individuals (who have yet to initiate treatment) will need to travel for almost twice as long as those already on treatment. Bicycling, rather than walking, in rural areas would substantially increase the maximum achievable coverage. INTERPRETATION: The long travel times needed to reach health-care facilities coupled with little motorised transportation in rural areas are substantial barriers to reaching 90% coverage in Malawi. Increased bicycle availability could help eliminate HIV. FUNDING: US National Institute of Allergy and Infectious Diseases.
Authors: Risa M Hoffman; Kelvin Balakasi; Ashley R Bardon; Zumbe Siwale; Julie Hubbard; Gift Kakwesa; Mwiza Haambokoma; Thoko Kalua; Pedro Pisa; Crispin Moyo; Kathryn Dovel; Thembi Xulu; Ian Sanne; Matt Fox; Sydney Rosen Journal: AIDS Date: 2020-03-01 Impact factor: 4.177
Authors: Lai Sze Tso; John Best; Rachel Beanland; Meg Doherty; Mellanye Lackey; Qingyan Ma; Brian J Hall; Bin Yang; Joseph D Tucker Journal: AIDS Date: 2016-06-19 Impact factor: 4.177
Authors: Victor A Alegana; Jim A Wright; Uusiku Pentrina; Abdisalan M Noor; Robert W Snow; Peter M Atkinson Journal: Int J Health Geogr Date: 2012-02-15 Impact factor: 3.918
Authors: Francis Bajunirwe; Flora Tumwebaze; Denis Akakimpa; Cissy Kityo; Peter Mugyenyi; George Abongomera Journal: Biomed Res Int Date: 2018-03-21 Impact factor: 3.411
Authors: Dunstan J Matungwa; Jeremiah Kidola; Daniel Pungu; Matthew Ponticiello; Ryan Latulipe; Myung Hee Lee; Robert Peck; Radhika Sundararajan Journal: AIDS Behav Date: 2022-05-13
Authors: Peter S Larson; Joseph N S Eisenberg; Veronica J Berrocal; Don P Mathanga; Mark L Wilson Journal: Malar J Date: 2021-10-24 Impact factor: 2.979
Authors: Pearl Anne Ante-Testard; Mohamed Hamidouche; Bénédicte Apouey; Rachel Baggaley; Joseph Larmarange; Tarik Benmarhnia; Laura Temime; Kévin Jean Journal: AIDS Date: 2022-07-09 Impact factor: 4.632