Overview of Overview of HIV/AIDS Care and HIV/AIDS Care and

TreatmentTreatmentCountry Situation Country Situation

& KATH& KATH Lambert T. AppiahLambert T. Appiah

OutlineOutline

• A brief background of HIV AIDS in A brief background of HIV AIDS in GhanaGhana

• National ResponseNational Response

• KATH situationKATH situation

HIV prevalence from population-based surveys HIV prevalence from population-based surveys in countries in West and Central Africa, 2003–2006in countries in West and Central Africa, 2003–2006

Mali

Burkina Faso

Cameroon

Central African Republic

Chad

Cote d’Ivoire

DemocraticRepublic of Congo

Guinea Nigeria

Senegal

Sierra Leone

Togo

Niger

GambiaGuinea-Bissau

Equatorial Guinea

GabonCongo

GhanaBenin

LiberiaAdult HIV prevalence %

6.0 – 8.0%4.0 – <6.0%2.0 – <4.0%

0 – <2.0%No available data

7

Sources: Various surveys and reports.

The median HIV The median HIV prevalenceprevalence

Country population of Country population of 24 million 24 million

Courtesy NACP

04/10/2304/10/23NACP_ HSS 2010NACP_ HSS 2010 55

What is Driving the What is Driving the Epidemic in Ghana?Epidemic in Ghana?

Factors Driving the EpidemicFactors Driving the Epidemic

• Youthful population 41% under 15 yearsYouthful population 41% under 15 years

• PovertyPoverty

• UrbanisationUrbanisation

• Migration Migration

• CulturalCultural practices- widowhood rites, polygamy practices- widowhood rites, polygamy

Protective FactorsProtective Factors

• Awareness of HIV is High 98-99% Awareness of HIV is High 98-99% (GDHS 2003)(GDHS 2003)

• Condom use with non-cohabiting partners -28% Condom use with non-cohabiting partners -28% (GDHS 2003)(GDHS 2003)

National Strategic National Strategic Framework (NSF II) 2006-Framework (NSF II) 2006-

20102010

Policy advocacy and enabling Policy advocacy and enabling environment environment Prevention and behavioural Prevention and behavioural change communication change communication Treatment care and support Treatment care and support Mitigating the social, cultural, Mitigating the social, cultural, legal and economic impact legal and economic impact Coordination management Coordination management and institutional and institutional arrangements arrangements Research Monitoring and Research Monitoring and evaluation evaluation Resource mobilisationResource mobilisation

Key Components

Ghana HIV/AIDS Strategic Framework

2006-2010

Republic of Ghana

Ghana HIV/AIDS Strategic Framework

2006-2010

Republic of Ghana

Challenges Challenges

Addressing HIV DRAddressing HIV DR

Differential performance across regionsDifferential performance across regions

Long lag phase between setup and Long lag phase between setup and initiation of services initiation of services

Strengthening TB/HIV collaborationStrengthening TB/HIV collaboration

Komfo Anokye Komfo Anokye Teaching Teaching

Comprehensive care Comprehensive care programme situation programme situation

BACKGROUNDBACKGROUNDSet up within the Chest Clinic.Set up within the Chest Clinic.

↑↑Privacy for Clients/Families. Privacy for Clients/Families. ↓Stigma/Discrimination within hospital↓Stigma/Discrimination within hospital

Trained staff already dealing with Trained staff already dealing with DOTS- skills needed for effective DOTS- skills needed for effective delivery of HAART.delivery of HAART.

Core group of TB/HIV co-infected Core group of TB/HIV co-infected patients to kick start HAART patients to kick start HAART

Clinic Days: DAILY for CT inflowClinic Days: DAILY for CT inflow

2 Major Clinics: Mondays/Fridays2 Major Clinics: Mondays/Fridays

Wednesdays for Adherence Counseling Wednesdays for Adherence Counseling sessionssessions

Mondays/Fridays for Clinical Consultation, Mondays/Fridays for Clinical Consultation, Ave 4 Doctors on Mondays & 4 on Fridays. Ave 4 Doctors on Mondays & 4 on Fridays.

Paediatric Clinic on FridaysPaediatric Clinic on Fridays

The laboratory operates throughout the The laboratory operates throughout the weekweek

04/10/2304/10/23Limbe Regional HospitalLimbe Regional Hospital 1313

Important Important milestones milestones

HIV tests free for children 0-14 years and HIV tests free for children 0-14 years and pregnant women and for the general pregnant women and for the general populationpopulation

CD4 test freeCD4 test free

Pre-treatment work (FBC, FBS, Liver Pre-treatment work (FBC, FBS, Liver enzymes) at enzymes) at <$1 <$1

Follow-up lab tests Follow-up lab tests (CD4, FBC, FBS, Liver (CD4, FBC, FBS, Liver enzymes) enzymes) at at ≈ $5≈ $5

Free cotrimoxazole, fluconazole, TB Free cotrimoxazole, fluconazole, TB treatment, and treatment for cerebral treatment, and treatment for cerebral toxoplasmosis toxoplasmosis

ChallengesChallengesHuman Resource – Lack and high turn Human Resource – Lack and high turn over rateover rate

MotivationMotivation

PMTCT – improved considerably PMTCT – improved considerably

Overwhelming workloadOverwhelming workload

Diagnosis and management of some Diagnosis and management of some opportunistic infectionsopportunistic infections

Diagnosis and management of Diagnosis and management of ADR/treatment failure MxADR/treatment failure Mx

Infrastructures and equipments Infrastructures and equipments

Data management constraints Data management constraints

The road is long…!!The road is long…!!

The road is rough…!!The road is rough…!!

The road is windingThe road is winding …!! …!!

HAARTHAART

TB epidemicTB epidemicIntegration/scale-up

Integration/scale-up

Challenges

Challenges

HIV epidemicHIV epidemic

The problem, the solution

Thank you for your attention Thank you for your attention

Contributions+QsContributions+Qs