HIV and AIDS in Ghana. Epidemic update National AIDS/STI Control Programme Ghana Health Service

Transcription

1 HIV and AIDS in Ghana Epidemic update National AIDS/STI Control Programme Ghana Health Service CPS Medical Knowledge Fiesta August 8/9/ CPS Knowledge Fiesta 1

2 Outline Epidemiology of HIV The Global Picture The Ghana Situation Projections The National Response Conclusion 8/9/ CPS Knowledge Fiesta 2

3 Epidemiology of the HIV Global HIV and AIDS in million ( million) people are living with HIV/AIDS Sub Saharan Africa -67% New HIV Infection 2.6 million( million) Sub Saharan Africa 70%(1.8 million) Deaths due to AIDS in million (1.3m in Sub- Saharan Africa 8/9/ CPS Knowledge Fiesta 3

4 EPIDIMIOLOGY 2009 Children <15years living with HIV million 2.3 million in Sub-Sahara Africa Children <15years newly infected 370, ,000 in Sub-Sahara Africa AIDS related deaths in< 15years 260, ,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 8/9/ NACP@ CPS Knowledge Fiesta 4

5 The Ghana Situation: Ghana Has a Generalised Epidemic 8/9/ NACP@ CPS Knowledge Fiesta 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 subpopulations at higher risk for infection. 5

6 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 was done using data from HSS (1994 to 2011) and the 2003 DHS+ and 2008 DHS. 8/9/ CPS Knowledge Fiesta 6

7 Map Showing Location of HIV Sentinel Sites Nadow li Jirapa UPPER WEST Wa Navrongo Bolgatanga UPPER EAST Builsa Adibo Bawku NORTHERN Tamale Nalerigu Salaga Wenchi Kintampo BRONG AHAFO Asunafo Krachi Sunyani Assin Fosu EASTERN Agormanya Fanteakwa Koforidua Akim Oda Afram Plains WESTERN Asikuma Odoben Brakwa CENTRAL Tarkwa 8/9/ CPS Knowledge Cape Fiesta Coast Eikwe Sefwi Asafo Kumasi Obuasi Takoradi ASHANTI Mampong Amansie West Hohoe Ho VOLTA North Tongu GREATER ACCRA Maamobi Tema Dangme East Adabraka Korle Bu 7

8 PREVALENCE 2011 Median ANC HIV prevalence for 2011 was 2.1% (Confidence limits: ) The median syphilis prevalence was 1.7% (C.L ). 8/9/ CPS Knowledge Fiesta Prevalence of HIV among STI clients was 7.9%. 8

9 SITE PREVALENCE HIV prevalence amongst ANC clients ranged from 0.0% in Adibo (rural) to 9.6% in Cape coast (Urban). 8/9/ CPS Knowledge Fiesta 9

10 Adibo Asunafo Nalerigu Salaga Tamale Builsa Tarkwa Wa Bawku Jirapa Kintampo Nadowli Krachi Afram Plains North Tongu Asikuma Kumasi Akim Oda Eikwe Takoradi Bolgatanga Navrongo Tema Koforidua Ho Sefwi Asafo Wenchi Assin Fosu Hohoe Amansie West Maamobi Mampong Fanteakwa Dangme East Korle Bu Sunyani Adabraka Obuasi Agormanya Cape Coast HIV PREVALENCE BY SITE /9/ NACP@ CPS Knowledge Fiesta 10

11 HIV Prevalence By Region Central 4.7 Eastern 3.6 Greater Accra Ashanti Volta 2.2 Brong Ahafo Western PREVALENCE Upper East 1.5 Upper West 1.0 Northern /9/ NACP@ CPS Knowledge Fiesta 11

12 3.5 HIV PREVALENCE BY AREA(Rural/Urban) RURAL 2.0 URBAN MEDIAN MEAN 8/9/ NACP@ CPS Knowledge Fiesta 12

13 HIV Prevalence By Urban Sites /9/ NACP@ CPS Knowledge Fiesta 13

14 HIV Prevalence By Rural Sites /9/ NACP@ CPS Knowledge Fiesta 14

15 HIV Prevalence By Age Group /9/ NACP@ CPS Knowledge Fiesta 15

16 HIV PREVALENCE BY TYPE HIV I HIV I & II HIV II /9/ NACP@ CPS Knowledge Fiesta 16

17 Trend 8/9/ CPS Knowledge Fiesta 17

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31 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 /9/ NACP@ CPS Knowledge Fiesta 31

32 8/9/ CPS Knowledge Fiesta 32

33 SYPHILIS PREVALENCE 8/9/ CPS Knowledge Fiesta 33

34 SYPHILIS PREVALENCE The median syphilis prevalence for 2011 is 1.7% (CI: ). Syphilis prevalence range from 0.0% in Dangme East(rural), Bawku, Bolgatanga and Navrongo to 12% in Asikuma Odoben Brakwa (rural). 8/9/ CPS Knowledge Fiesta 34

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39 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 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/ NACP@ CPS Knowledge Fiesta 39

40 HIV PREVALENCE IN STI CLIENTS 8/9/ CPS Knowledge Fiesta 40

41 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 age group (0.0%). 8/9/ CPS Knowledge Fiesta 41

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44 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. 8/9/ NACP@ CPS Knowledge Fiesta 44

45 HIV PREVALENCE AMONG MARPS OTHER DATA SOURCES 8/9/ CPS Knowledge Fiesta 45

46 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 /9/ CPS Knowledge Fiesta 46

47 Estimates 8/9/ CPS Knowledge Fiesta 47

48 EPIDEMIC CURVES 8/9/ CPS Knowledge Fiesta 48

49 URBAN 8/9/ CPS Knowledge Fiesta 49

50 RURAL 8/9/ CPS Knowledge Fiesta 50

51 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 8/9/ CPS Knowledge Fiesta 51

52 National HIV Estimates, 2011 Indicator Lower Limit Estimate Upper Limit HIV Adults + Children 194, , ,991 HIV Population Children 24,912 30,395 36,520 Prevalence-Adult Incidence- Adult 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, ,681 Need for ART - Children 13,692 16,864 20,526 8/9/ NAC P@ Mothers Needing PMTCT 8,928 10,753 13,107

53 PROJECTIONS 8/9/ CPS Knowledge Fiesta 53

54 Adult Prevalence 8/9/ CPS Knowledge Fiesta 54

55 New HIV Infections- Total 8/9/ CPS Knowledge Fiesta 55

56 New Infections-Children 8/9/ CPS Knowledge Fiesta 56

57 Total HIV Population 8/9/ CPS Knowledge Fiesta 57

58 HIV Population-Children 8/9/ CPS Knowledge Fiesta 58

59 HIV Population Under Age 1 8/9/ NACP@ CPS Knowledge Fiesta 59

60 Cumulative AIDS Deaths 8/9/ CPS Knowledge Fiesta 60

61 Annual AIDS Death (15+) 8/9/ CPS Knowledge Fiesta 61

62 Annual AIDS Deaths- Children 8/9/ CPS Knowledge Fiesta 62

63 Deaths- Infants <1year 8/9/ CPS Knowledge Fiesta 63

64 AIDS Orphans - Total 8/9/ NACP@ CPS Knowledge Fiesta 64

65 Total ART Need (15+) 8/9/ CPS Knowledge Fiesta 65

66 Children Needing ART: 0-14yrs 8/9/ CPS Knowledge Fiesta 66

67 Infants (<1year) needing ART 8/9/ CPS Knowledge Fiesta 67

68 Unmet Need for ART 15+ 8/9/ CPS Knowledge Fiesta 68

69 Number Newly Needing Treatment (15+) 8/9/ CPS Knowledge Fiesta 69

70 Children Needing Co-trimoxazole 8/9/ CPS Knowledge Fiesta 70

71 Mothers Needing PMTCT 8/9/ CPS Knowledge Fiesta 71

72 TB Cases 8/9/ CPS Knowledge Fiesta 72

73 OUTLOOK FOR Indicator Lower Limit Estimate Upper Limit HIV Adults + Children 192, , ,379 HIV Population Children 23,384 28,508 34,417 Prevalence Adult Incidence Adult 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, ,705 Need for ART - Children 12,463 15,256 18,722 8/9/ NACP@ CPS Knowledge Fiesta Mothers Needing PMTCT 8,458 10,249 12,658 73

74 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: NSF II: NSP: /9/ CPS Knowledge Fiesta 74

75 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 /9/ NACP@ CPS Knowledge Fiesta 75

76 IEC/BCC Reducing New Infections 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 8/9/ CPS Knowledge Fiesta 76

77 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 8/9/ CPS Knowledge Fiesta 77

78 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 8/9/ NACP@ CPS Knowledge Fiesta 78

79 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 8/9/ NACP@ CPS Knowledge Fiesta 79

80 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 8/9/ CPS Knowledge Fiesta 80

81 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. 8/9/ NACP@ CPS Knowledge Fiesta 81

82 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 8/9/ CPS Knowledge Fiesta 82