Ghana’s HIV Response

The Ghana Team:Richard N. Amenyah

Matilda Owusu-AnsahEvelyn Awittor

Lord DarteyMercy Bannerman

Background • 1985

– National Advisory Council on AIDS (NACA) – National Technical Committee on AIDS (NTCA)

• 1986- First AIDS Case diagnosed in Ghana

• 1987– National AIDS/STD Control Programme (NACP)

• Sept 2000 – Ghana AIDS Commission

Goals of the National ResponseTo achieve Universal Access, the goals of the

National Response as outlined in the NSF II are:

• Reducing new infections among vulnerable groups and the general population;

• Mitigating the impact of the epidemic on the health and socio-economic systems as well as infected and affected persons; and

• Promoting healthy life-styles, especially in the area of sexual and reproductive health.

Thematic areas

• Within the framework of Universal Access to prevention, treatment, care and support by 2010, the NSF II is programmed around 7 thematic areas:– Policy, Advocacy and Enabling Environment– Coordination and Management of the Decentralized

Response– Mitigating the Economic, Socio-cultural and Legal Impacts– Prevention and Behavioral Change Communication– Treatment, Care and Support– Research, Surveillance, Monitoring and Evaluation– Mobilization of Resources and Funding Arrangement

National HIV Prevalence

HIV Prevalence - HSS, DHS and National

0

0.5

1

1.5

2

2.5

3

3.5

4

1994

1995

1996

1997

1998

1999

2000

2001

2002

2003

2004

2005

2006

Year

Pre

vale

nce

National

HSS

DHS

Source: NACP-Ghana

2.9

3.4 3.6

3.12.7

3.2

0.00.51.01.52.02.53.03.54.0

2001 2002 2003 2004 2005 2006

Prevale

nce

Year

HIV Prevalence Trend 2001 - 2006

Median

Linear (Median )

2.3

1.9

2.0

0.8

1.4

4.0

3.5

2.7

2.4

2.9

4.5

4.44.5

3.6

4.24.3

4.7

4.4

3.2

3.73.5

3.0

2.5

1.9

2.5

0.0

0.5

1.0

1.5

2.0

2.5

3.0

3.5

4.0

4.5

5.0

2002 2003 2004 2005 2006

Mean

Preva

lence

Year

15 to 19

20 to 24

25 to 29

30 to 34

15 to 24

Ghana’s gains– Strategic planning [NSF I –(2001-2005) and NSF II-(2006-

2010), JPR (2004, 2007), 5-POW, APOW]– Policy formulation (National HIV Policy-2004)– Decentralized implementation of the National response– Prevention programmes (Near Universal awareness)– Treatment and care and support (5th year of ART)– Human rights issues (anti-stigma campaigns)– Monitoring and evaluation (M&E Plans for all Levels)– Increased participation of CSOs and GIPA (Partnership

Forum, TWG etc)– Impact mitigation (OVCs, NHIS for PLHIVs, IGAs)

UNIVERSAL ACCESS: NATIONAL TARGETS FOR GHANA

Programmatic area

IndicatorData

SourcesBaseline (year)

2008 2010 Data Collection Type

Impact targetNational HIV prevalence among people aged 15-49 GHS 2.20% (2003) 2.10% 1.90%

NACP Technical Report (HSS/GDHS/Programme Data)

HIV prevalence among young people aged 15-24 GHS 1.9% (2005) 1.4% 1.0% HSS

Prevention

Impact target % of HIV-infected infants born to HIV infected mothers GHS 30% (2004) 22% 15%[1] Routine data collection system

Process target # of centers providing PMTCT services GHS 135 (2005) 190 238 Routine reporting system

Impact target% of people aged 15-49 who both correctly identify ways of

preventing the sexual transmission of HIV and who reject major misconceptions about HIV transmission

GSSGHS

F-38%M-44%(2003)

F-46%M-54%

F-50%M-60%

GDHS(2008)BSS(2006)

MICS(2006)

Treatment

Impact target% of women, men and children with advanced HIV infection

who are receiving antiretroviral combination therapyGHS 6.5% (2005) 42% 66% Routine reporting system

Process target # of centers providing ART services GHS 5 (2005) 50 138 Routine reporting system

Process target # of centers providing VCT services GHS 145 (2005) 190 238 Routine reporting system

Process target# of clients tested for HIV at VCT sites and receiving their

serostatus results in the past 12 monthsGHS 42,206 (2005) 200,000 300,000 Routine reporting system

Impact target% of HIV positive pregnant women who receive a complete course of antiretroviral therapy to prevent mother to child

transmission in the last 12 months.GHS 0.45% (2005) 24.8% 47.6% Routine reporting system

Process target # of centers providing PMTCT services GHS 135 (2005) 190 238 Routine reporting system

Care and support

Impact targetRatio of current school attendance among orphans to that

among non-orphans, aged 10-14GSS 0.79 (2003) 0.9 0.95

GDHSMICS

National commitment

Impact targetAmount of national funds disbursed by government on

HIV/AIDSMoFEP

Cedi 97 billion (2003)

TBD TBD NASA[2]

[1] Impact target: UNAIDS estimated 50% reduction of the proportion of infants infected with HIV. [2] National AIDS Spending Assessment (NASA).Abbreviations: GHS –Ghana Health Service , GSS – Ghana Statistical Service, TBD- To be determined, MoFEP- Ministry of Finance and Economic Planning , MICS – Multiple Cluster Study, BSS-Behaviour Surveillance Survey, HSS-HIV Sentinel Survey, NACP- National AIDS Control Programme, GDHS-Ghana Demographic Health Survey

Key issues in HIV response• Prevention

– An increasing trend in HIV new infections– Slow rate of behavior change– Low risk perception

– Low uptake of prevention services– High levels of stigma– Weak link between community and health services

– Weak integration of HIV programs into sexual reproductive health programs

– Low priority for workplace HIV prevention programs– Inadequate Operational research on prevention

services

• Treatment care and support– 16% of adults who need HAART are on therapy– 10% of HIV infected children <15 years in need of

HAART are on HAART– 10% of HIV infected pregnant women have

received antiretrovirals to reduce the risk of mother to child transmission (past 12 months)

• New combination ARV prophylaxis introduced

– Weak Home Based care programs– Inadequate human resource to support services

Coordination/Management

• Weak Coordination of the multi-sectoral response

• Weak M & E particularly on Prevention activities