title: Antiretroviral therapy program expansion in Zambézia Province, Mozambique: geospatial mapping of community-based and health facility data for integrated health planning.
abstract: OBJECTIVE
  To generate maps reflecting the intersection of community-based Voluntary Counseling and Testing (VCT) delivery points with facility-based HIV program demographic information collected at the district level in three districts (Ile, Maganja da Costa and Chinde) of Zambézia Province, Mozambique; in order to guide planning decisions about antiretroviral therapy (ART) program expansion.
  
  
  METHODS
  Program information was harvested from two separate open source databases maintained for community-based VCT and facility-based HIV care and treatment monitoring from October 2011 to September 2012. Maps were created using ArcGIS 10.1. Travel distance by foot within a 10 km radius is generally considered a tolerable distance in Mozambique for purposes of adherence and retention planning.
  
  
  RESULTS
  Community-based VCT activities in each of three districts were clustered within geographic proximity to clinics providing ART, within communities with easier transportation access, and/or near the homes of VCT volunteers. Community HIV testing results yielded HIV seropositivity rates in some regions that were incongruent with the Ministry of Health's estimates for the entire district (2-13% vs. 2% in Ile, 2-54% vs. 11.5% in Maganja da Costa, and 23-43% vs. 14.4% in Chinde). All 3 districts revealed gaps in regional disbursement of community-based VCT activities as well as access to clinics offering ART.
  
  
  CONCLUSIONS
  Use of geospatial mapping in the context of program planning and monitoring allowed for characterizing the location and size of each district's HIV population. In extremely resource limited and logistically challenging settings, maps are valuable tools for informing evidence-based decisions in planning program expansion, including ART.
authors.affiliation: Vanderbilt Institute for Global Health, Nashville, Tennessee, United States of America; Friends in Global Health, LLC, Maputo, Mozambique.
authors.forename: Troy D
authors.initials: TD
authors.lastname: Moon
authors.affiliation: Friends in Global Health, LLC, Maputo, Mozambique.
authors.forename: Ezequiel B
authors.initials: EB
authors.lastname: Ossemane
authors.affiliation: Vanderbilt Institute for Global Health, Nashville, Tennessee, United States of America; Friends in Global Health, LLC, Maputo, Mozambique.
authors.forename: Ann F
authors.initials: AF
authors.lastname: Green
authors.affiliation: Friends in Global Health, LLC, Maputo, Mozambique.
authors.forename: Elisée
authors.initials: E
authors.lastname: Ndatimana
authors.affiliation: Friends in Global Health, LLC, Maputo, Mozambique.
authors.forename: Eurico
authors.initials: E
authors.lastname: José
authors.affiliation: Vanderbilt Institute for Global Health, Nashville, Tennessee, United States of America.
authors.forename: Charlotte P
authors.initials: CP
authors.lastname: Buehler
authors.affiliation: Vanderbilt Institute for Global Health, Nashville, Tennessee, United States of America; Friends in Global Health, LLC, Maputo, Mozambique.
authors.forename: C William
authors.initials: CW
authors.lastname: Wester
authors.affiliation: Vanderbilt Institute for Global Health, Nashville, Tennessee, United States of America; Friends in Global Health, LLC, Maputo, Mozambique.
authors.forename: Sten H
authors.initials: SH
authors.lastname: Vermund
authors.affiliation: World Vision, Maputo, Mozambique.
authors.forename: Omo
authors.initials: O
authors.lastname: Olupona
mesh_terms: D019380:Anti-HIV Agents / Q000600:supply & distribution; D018672:Community Health Planning / Q000458:organization & administration / Q000706:statistics & numerical data*; D003153:Community Health Services / Q000458:organization & administration / Q000592:standards / Q000706:statistics & numerical data*; D015658:HIV Infections / Q000175:diagnosis* / Q000188:drug therapy; D006801:Humans; D008403:Mass Screening / Q000458:organization & administration / Q000706:statistics & numerical data*; D009073:Mozambique; D035141:Voluntary Programs / Q000458:organization & administration / Q000706:statistics & numerical data*
chemical_list: D019380:Anti-HIV Agents