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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
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Outline
Epidemiology of HIV
–The Global Picture
–The Ghana Situation
Projections
The National Response
Conclusion 8/9/2012 NACP@ CPS Knowledge Fiesta
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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
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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
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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
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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.
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GREATER ACCRA
Dangme EastMaamobi
Ho
VOLTA
Krachi
North TonguEASTERN
Akim Oda
Koforidua
Afram Plains
AgormanyaFanteakwa
Asikuma Odoben Brakwa
CENTRAL
Assin Fosu
Cape Coast
WESTERN
Eikwe
Sefwi Asafo
Takoradi
Tarkwa
ASHANTI
Obuasi
Kumasi
Mampong
AmansieWest
BRONG AHAFO
Kintampo
Sunyani
Wenchi Asunafo
NORTHERN
Salaga
Nalerigu
Tamale
Adibo
Bolgatanga
Bawku
Builsa
Navrongo
JirapaNado liw
Wa
UPPER WEST
UPPER EAST
AdabrakaTema
Korle Bu
Hohoe
Map Showing Location
of HIV Sentinel Sites
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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
7.9%.
PREVALENCE 2011
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SITE PREVALENCE
HIV prevalence amongst ANC clients
ranged from 0.0% in Adibo (rural) to 9.6% in
Cape coast (Urban).
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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
8.8
9.6
0.0
2.0
4.0
6.0
8.0
10.0
12.0
Ad
ibo
Asu
naf
o
Nal
erig
u
Sal
aga
Tam
ale
Buil
sa
Tar
kw
a
Wa
Baw
ku
Jira
pa
Kin
tam
po
Nad
ow
li
Kra
chi
Afr
am P
lain
s
No
rth T
ong
u
Asikuma…
Ku
mas
i
Ak
im O
da
Eik
we
Tak
ora
di
Bolg
atan
ga
Nav
rongo
Tem
a
Ko
fori
du
a
Ho
Sef
wi
Asa
fo
Wen
chi
Ass
in F
osu
Ho
hoe
Am
ansi
e W
est
Maa
mob
i
Mam
pong
Fan
teak
wa
Dan
gm
e E
ast
Ko
rle
Bu
Sun
yan
i
Ad
abra
ka
Ob
uas
i
Ag
orm
anya
Cap
e C
oas
t
HIV PREVALENCE BY SITE - 2011
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0.3
1.0
1.5
1.9
2.0
2.2
3.1
3.2
3.6
4.7
0.0 1.0 2.0 3.0 4.0 5.0
Northern
Upper West
Upper East
Western
Brong Ahafo
Volta
Ashanti
Greater Accra
Eastern
Central
HIV Prevalence By Region - 2011
2011 PREVALENCE
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1.4 1.5
2.6
2.9
0.0
0.5
1.0
1.5
2.0
2.5
3.0
3.5
MEDIAN MEAN
HIV PREVALENCE BY AREA(Rural/Urban) - 2011
RURAL
URBAN
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9.6
8.8
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
1.8
1.0 1.0 0.8
0.4 0.2
0.0
2.0
4.0
6.0
8.0
10.0
12.0
HIV Prevalence By Urban Sites - 2011
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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
1.0
2.0
3.0
4.0
5.0
6.0
7.0
8.0
9.0
HIV Prevalence By Rural Sites - 2011
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1.9
1.5
2.7
2.9 2.8
2.7
2.8
1.7
0.0
0.5
1.0
1.5
2.0
2.5
3.0
3.5
15-19 20-24 25-29 30-34 35-39 40-44 45-49 15-24
HIV Prevalence By Age Group - 2011
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98.0
1.3 0.7
HIV PREVALENCE BY TYPE - 2011
HIV I
HIV I & II
HIV II
Trend
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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
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SYPHILIS PREVALENCE
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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).
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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
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HIV PREVALENCE IN STI
CLIENTS
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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%).
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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.
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HIV PREVALENCE AMONG
MARPS
OTHER DATA SOURCES
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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
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Estimates
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EPIDEMIC
CURVES
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URBAN
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RURAL
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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
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Indicator Lower
Limit
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
0.05
1.46
0.08
1.72
0.12
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
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PROJECTIONS
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Adult Prevalence
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New HIV Infections- Total
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New Infections-Children
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Total HIV Population
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HIV Population-Children
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HIV Population Under Age 1
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Cumulative AIDS Deaths
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Annual AIDS Death – (15+)
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Annual AIDS Deaths- Children
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Deaths- Infants <1year
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AIDS Orphans - Total
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Total ART Need (15+)
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Children Needing ART: 0-14yrs
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Infants (<1year) needing ART
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Unmet Need for ART 15+
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Number Newly Needing Treatment (15+)
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Children Needing Co-trimoxazole
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Mothers Needing PMTCT
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TB Cases
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Indicator Lower
Limit
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
0.05
1.41
0.07
1.67
0.11
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
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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
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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
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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
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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
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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
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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
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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
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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.
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Acknowledgements
Ministry of Health and Ghana Health Service
All Sentinel Site Staff and other health personnel
Regional Health Directorates
Ghana AIDS Commission
WHO
GFATM
All other stakeholders including organizers of this fiesta
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