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HIV and AIDS in Ghana

Epidemic update National AIDS/STI Control Programme

Ghana Health Service

CPS Medical Knowledge Fiesta

August 2012

8/9/2012 NACP@ CPS Knowledge Fiesta 2012 1

Outline

Epidemiology of HIV

–The Global Picture

–The Ghana Situation

Projections

The National Response

Conclusion 8/9/2012 NACP@ CPS Knowledge Fiesta

Epidemiology of the HIV

Global HIV and AIDS in 2009

33.3million (31.4-35.3 million) people are living with

HIV/AIDS

– Sub Saharan Africa -67%

New HIV Infection 2.6 million(2.3-2.8 million)

– Sub Saharan Africa 70%(1.8 million)

Deaths due to AIDS in 2008 1.8 million (1.3m in Sub-Saharan Africa

8/9/2012 NACP@ CPS Knowledge Fiesta

EPIDIMIOLOGY 2009

Children <15years living with HIV - 2.5 million

– 2.3 million in Sub-Sahara Africa

Children <15years newly infected 370,000

– 330,000 in Sub-Sahara Africa

AIDS related deaths in< 15years 260,000

– 230,000 in Sub-Sahara Africa

– Over 7000 new infections a day in 2009

• Almost 51% are among women

• About 41% are among young people (15 - 24)

• About 1000 are in children under 15 years of age

HIV prevalence is

consistently over 1%

among pregnant women

Although sub-populations

at high risk may continue to

contribute

disproportionately to the

spread of HIV, sexual

networking in the general

population is sufficient to

sustain an epidemic

independent of sub-

populations at higher risk

for infection.

The Ghana Situation:

Ghana Has a Generalised Epidemic

National HIV Prevalence

The annual HIV sentinel surveys (HSS) is conducted on antenatal women and from STI clinics

GDHS included testing for HIV prevalence measurement for both males and females.

The availability of both HSS and DHS+ data allows for the derivation of the National HIV Prevalence and projections of the potential impact of the epidemic

The production of the National Estimates and Projections 2011 - 2015 was done using data from HSS (1994 to 2011) and the 2003 DHS+ and 2008 DHS.

GREATER ACCRA

Dangme EastMaamobi

Krachi

North TonguEASTERN

Akim Oda

Koforidua

Afram Plains

AgormanyaFanteakwa

Asikuma Odoben Brakwa

CENTRAL

Assin Fosu

Cape Coast

WESTERN

Sefwi Asafo

Takoradi

Tarkwa

ASHANTI

Obuasi

Kumasi

Mampong

AmansieWest

BRONG AHAFO

Kintampo

Sunyani

Wenchi Asunafo

NORTHERN

Salaga

Nalerigu

Tamale

Bolgatanga

Builsa

Navrongo

JirapaNado liw

UPPER WEST

UPPER EAST

AdabrakaTema

Korle Bu

Map Showing Location

of HIV Sentinel Sites

Median ANC HIV

prevalence for 2011

was 2.1% (Confidence

limits: 1.48-2.72)

The median syphilis

prevalence was 1.7% (C.L. 0.77-2.63).

Prevalence of HIV

among STI clients was

PREVALENCE 2011

SITE PREVALENCE

HIV prevalence amongst ANC clients

ranged from 0.0% in Adibo (rural) to 9.6% in

Cape coast (Urban).

2012 9

0.0 0.2 0.2

0.4 0.4 0.6 0.6

0.8 1.0 1.0

1.2 1.2 1.3 1.4 1.5 1.6 1.8 1.8

2.0 2.0 2.2 2.2 2.2

2.4 2.6

2.8 2.8 2.8 3.0 3.0

3.2 3.2 3.2 3.3 3.4 3.6

3.8 4.2

Asikuma…

HIV PREVALENCE BY SITE - 2011

0.0 1.0 2.0 3.0 4.0 5.0

Northern

Upper West

Upper East

Western

Brong Ahafo

Ashanti

Greater Accra

Eastern

Central

HIV Prevalence By Region - 2011

2011 PREVALENCE

1.4 1.5

MEDIAN MEAN

HIV PREVALENCE BY AREA(Rural/Urban) - 2011

4.2 3.8

3.6 3.4

3.2 3.2 3.0

2.8 2.8 2.6 2.4

2.2 2.2 2.2 2.0

1.0 1.0 0.8

0.4 0.2

HIV Prevalence By Urban Sites - 2011

3.3 3.2 3.0 2.8

2.0 1.8 1.6 1.5 1.4 1.3 1.2 1.2

0.6 0.6 0.4 0.2 0.0 0.0

HIV Prevalence By Rural Sites - 2011

2.9 2.8

15-19 20-24 25-29 30-34 35-39 40-44 45-49 15-24

HIV Prevalence By Age Group - 2011

1.3 0.7

HIV PREVALENCE BY TYPE - 2011

HIV I & II

HIV II

Site HIV prevalence trend

Agomanya was thus replaced by Cape Coast as site with highest prevalence for the first time in the history of these surveys

No Central region site recorded a decrease in prevalence from the 2010 level

Prevalence in Asikuma Odoben Brakwa and Afram plains were the same as in 2010

Only Asunafo, Kintampo and Nalerigu sites have recorded a consistent decline since 2008

SYPHILIS PREVALENCE

The median syphilis prevalence for 2011 is 1.7% (CI: 0.77-2.63).

Syphilis prevalence range from 0.0% in Dangme East(rural) , Bawku, Bolgatanga and Navrongo to 12% in Asikuma Odoben Brakwa (rural).

Site Syphilis prevalence

– Central region is still the region with the

highest syphilis prevalence

– Asikuma Odoben Brakwa is still the site with highest prevalence since 2004.

– Reductions in Syphilis prevalence in 33 out of 40 sites in this survey is very significant

– In fact all regions recorded a drop in syphilis prevalence

– Rural prevalence still higher than urban 8/9/2012 NACP@ CPS Knowledge Fiesta

HIV PREVALENCE IN STI

CLIENTS

HIV Prevalence in STI Sites

Prevalence of HIV among STI clients

was 7.9%.

– Adabraka STI site 14%

– Kumasi STI site 1.1%.

The highest prevalence is in the 45 to 49

year age group (22.2%) for both males

and females and the lowest is in the 15-

19 age group (0.0%).

HIV AMONGST STI CLIENTS- Trend

The consistent increase in prevalence in the Adabraka site in contrast with the Kumasi site ought to be carefully examined

A higher prevalence was observed among males compared to females in this year’s survey.

HIV PREVALENCE AMONG

OTHER DATA SOURCES

HIV Prevalence among MARPs

Female Sex Workers

(FSWs) in Accra

– 50.0% (WAPCAS 1997/98)

– 43.8% (SHARP 2006)

– 29.2% (SHARP 2009)

FSWs in Kumasi

– 34.7% (WAPCAS 2002)

– 31.7% (SHARP 2006)

– 20.0% (SHARP 2009)

FSWs Accra and Kumasi

– 37.5% (SHARP 2006)

– 24.5% (SHARP 2009)

Non-paying Partners

– 12%(WAPCAS 2001)

– <5%(WAPCAS 2009)

MSM (25%) – (SHARP 2006)

Prisoners (5.9%) – Adjei et al 2007

Estimates

EPIDEMIC

CURVES

National Estimates

In 2011, the estimated adult national HIV prevalence is 1.5%,

Estimated 225,478 persons Living with HIV and AIDS

– 30,395 children

New HIV infections (10,373 Adults and 1,704 Children)

15,262 annual AIDS deaths (2,079 Children)

10,753 mothers needing PMTCT

Indicator Lower

Estimate Upper Limit

HIV Adults + Children 194,675 225,478 263,991

HIV Population – Children

24,912 30,395 36,520

Prevalence-Adult 15-49

Incidence- Adult 15-49 1.28

New HIV Infections – Adult

7,000 10,373 15,298

New HIV Infections – Children

1,113 1,704 2,461

Annual AIDS Deaths – Adult (15+) 10,574 13,183 16,112

Annual AIDS Deaths - Children 1,602 2,079 2,642

Need for ART – Adult (15+) 85,313 96,854 109,681

Need for ART - Children 13,692 16,864 20,526

Mothers Needing PMTCT 8,928 10,753 13,107

National HIV Estimates, 2011

8/9/2012 NAC

PROJECTIONS

Adult Prevalence

New HIV Infections- Total

New Infections-Children

Total HIV Population

HIV Population-Children

HIV Population Under Age 1

Cumulative AIDS Deaths

Annual AIDS Death – (15+)

Annual AIDS Deaths- Children

Deaths- Infants <1year

AIDS Orphans - Total

Total ART Need (15+)

Children Needing ART: 0-14yrs

Infants (<1year) needing ART

Unmet Need for ART 15+

Number Newly Needing Treatment (15+)

Children Needing Co-trimoxazole

Mothers Needing PMTCT

TB Cases

Indicator Lower

Estimate Upper Limit

HIV Adults + Children 192,122 222,124 261,379

HIV Population – Children

23,384 28,508 34,417

Prevalence –Adult 15-49

Incidence – Adult 15-49 1.23

New HIV Infections – Adult

6,592 9,882 14,868

New HIV Infections – Children

795 1,080 1,805

Annual AIDS Deaths – Adult (15+) 8,387 11,024 13,935

Annual AIDS Deaths - Children 1,247 1,635 2,151

Need for ART – Adult (15+) 88,235 99,622 112,705

Need for ART - Children 12,463 15,256 18,722

Mothers Needing PMTCT 8,458 10,249 12,658

OUTLOOK FOR 2012

National Response

1987: Establishment of National AIDS/STI

Control Programme (NACP) to lead response

Sept 2000

– Establishment of Ghana AIDS Commission

National Strategic Framework (NSF)

– NSF I: 2001 – 2005

– NSF II: 2006 – 2010

– NSP: 2011-2015

Current National Plan

Incorporates components of previous

framework with emphasis in key areas

Virtual elimination of Mother-to-Child

transmission through the four prong

approach

Vision is to ensure a generation free of

AIDS in Ghana by 2015

Reducing New Infections

IEC/BCC

HIV Testing and Counseling (HTC)

Prevention of mother to child transmission

(PMTCT) of HIV

Prevention and management of STI

Blood Safety

Infection prevention/universal precautions

Condom promotion and distribution

Care and Support Services for PLHIV

Anti-retroviral therapy

Continuous Supportive Counseling

Prevention and Management of

Opportunistic Infections

Effective Home Based Care

Working with PLHIV and their associations

Greater involvement of Persons Living

with HIV

Comprehensive Care

The core component of interventions

– Counseling and Testing - CT

– Prevention of Mother to Child Transmission of HIV (PMTCT)

• Improved ante partum, intrapartum and postpartum care

• Infant feeding

– Anti Retroviral Therapy

– STI management

– Behavioural change communication and targeted risk-reduction program

Summary

National HIV prevalence in 2011 same as 2010 despite marginal rise in ANC prevalence.

The HIV prevalence trend in Ghana since 2000 shows a decline but with lesser momentum

Central Region topped in both HIV and Syphilis prevalence but that should not shift our focus off other regions at all

The significant reductions in Syphilis prevalence must motivate us to strengthen current interventions

WAY FORWARD

Data must be carefully analysed for

planning and decision making by all

stakeholders

More effort and resources should be

channelled into priority areas and

initiatives that are yielding results

PMTCT service data to be used for

possible prevalence monitoring

CONCLUSION

Any complacency in Ghana’s response poses a threat to the country’s development

Need to strengthen the prevention component of the comprehensive package in the continuum of care and the national response

Need to focus on EMTCT to ensure a generation free of HIV by 2015

A comprehensive and truly integrated national response at all levels is essential for efficiency and sustainability.

Acknowledgements

Ministry of Health and Ghana Health Service

All Sentinel Site Staff and other health personnel

Regional Health Directorates

Ghana AIDS Commission

All other stakeholders including organizers of this fiesta

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