HIV and AIDS in Ghana Epidemic update National AIDS/STI Control Programme Ghana Health Service CPS Medical Knowledge Fiesta August 8/9/ NACP@ CPS Knowledge Fiesta 1
Outline Epidemiology of HIV The Global Picture The Ghana Situation Projections The National Response Conclusion 8/9/ NACP@ CPS Knowledge Fiesta 2
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/ NACP@ CPS Knowledge Fiesta 3
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 8/9/ NACP@ CPS Knowledge Fiesta 4
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
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. 8/9/ NACP@ CPS Knowledge Fiesta 6
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/ NACP@ 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
PREVALENCE 2011 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). 8/9/ NACP@ CPS Knowledge Fiesta Prevalence of HIV among STI clients was 7.9%. 8
SITE PREVALENCE HIV prevalence amongst ANC clients ranged from 0.0% in Adibo (rural) to 9.6% in Cape coast (Urban). 8/9/ NACP@ CPS Knowledge Fiesta 9
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 - 2011 12.0 10.0 9.6 8.8 8.0 6.0 4.0 2.0 0.0 4.2 3.6 3.8 2.6 2.8 2.8 2.8 3.0 3.0 3.2 3.2 3.2 3.3 3.4 2.4 2.2 2.2 2.2 1.8 1.8 2.0 2.0 0.8 1.0 1.0 1.2 1.2 1.3 1.4 1.5 1.6 0.6 0.6 0.4 0.4 0.2 0.2 0.0 8/9/ NACP@ CPS Knowledge Fiesta 10
HIV Prevalence By Region - 2011 Central 4.7 Eastern 3.6 Greater Accra Ashanti 3.1 3.2 Volta 2.2 Brong Ahafo Western 2.0 1.9 2011 PREVALENCE Upper East 1.5 Upper West 1.0 Northern 0.3 0.0 1.0 2.0 3.0 4.0 5.0 8/9/ NACP@ CPS Knowledge Fiesta 11
3.5 HIV PREVALENCE BY AREA(Rural/Urban) - 2011 3.0 2.9 2.5 2.6 RURAL 2.0 URBAN 1.5 1.4 1.5 1.0 0.5 0.0 MEDIAN MEAN 8/9/ NACP@ CPS Knowledge Fiesta 12
HIV Prevalence By Urban Sites - 2011 2.0 0.0 9.6 8.8 8.0 6.0 4.0 2.0 0.0 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 8/9/ NACP@ CPS Knowledge Fiesta 13
HIV Prevalence By Rural Sites - 2011 9.0 8.0 7.0 6.0 5.0 4.0 3.0 3.3 3.2 3.0 2.8 2.0 2.0 1.8 1.6 1.5 1.4 1.3 1.2 1.2 1.0 0.0 0.6 0.6 0.4 0.2 0.0 8/9/ NACP@ CPS Knowledge Fiesta 14
HIV Prevalence By Age Group - 2011 3.5 3.0 2.7 2.9 2.8 2.7 2.8 2.5 2.0 1.9 1.5 1.5 1.7 1.0 0.5 0.0 15-19 20-24 25-29 30-34 35-39 40-44 45-49 15-24 8/9/ NACP@ CPS Knowledge Fiesta 15
HIV PREVALENCE BY TYPE - 2011 1.3 0.7 HIV I HIV I & II HIV II 98.0 8/9/ NACP@ CPS Knowledge Fiesta 16
Trend 8/9/ NACP@ CPS Knowledge Fiesta 17
8/9/ NACP@ CPS Knowledge Fiesta 18
8/9/ NACP@ CPS Knowledge Fiesta 19
8/9/ NACP@ CPS Knowledge Fiesta 20
8/9/ NACP@ CPS Knowledge Fiesta 21
8/9/ NACP@ CPS Knowledge Fiesta 22
8/9/ NACP@ CPS Knowledge Fiesta 23
8/9/ NACP@ CPS Knowledge Fiesta 24
8/9/ NACP@ CPS Knowledge Fiesta 25
8/9/ NACP@ CPS Knowledge Fiesta 26
8/9/ NACP@ CPS Knowledge Fiesta 27
8/9/ NACP@ CPS Knowledge Fiesta 28
8/9/ NACP@ CPS Knowledge Fiesta 29
8/9/ NACP@ CPS Knowledge Fiesta 30
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 8/9/ NACP@ CPS Knowledge Fiesta 31
8/9/ NACP@ CPS Knowledge Fiesta 32
SYPHILIS PREVALENCE 8/9/ NACP@ CPS Knowledge Fiesta 33
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). 8/9/ NACP@ CPS Knowledge Fiesta 34
8/9/ NACP@ CPS Knowledge Fiesta 35
8/9/ NACP@ CPS Knowledge Fiesta 36
8/9/ NACP@ CPS Knowledge Fiesta 37
8/9/ NACP@ CPS Knowledge Fiesta 38
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/ NACP@ CPS Knowledge Fiesta 39
HIV PREVALENCE IN STI CLIENTS 8/9/ NACP@ CPS Knowledge Fiesta 40
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%). 8/9/ NACP@ CPS Knowledge Fiesta 41
8/9/ NACP@ CPS Knowledge Fiesta 42
8/9/ NACP@ CPS Knowledge Fiesta 43
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
HIV PREVALENCE AMONG MARPS OTHER DATA SOURCES 8/9/ NACP@ CPS Knowledge Fiesta 45
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 8/9/ NACP@ CPS Knowledge Fiesta 46
Estimates 8/9/ NACP@ CPS Knowledge Fiesta 47
EPIDEMIC CURVES 8/9/ NACP@ CPS Knowledge Fiesta 48
URBAN 8/9/ NACP@ CPS Knowledge Fiesta 49
RURAL 8/9/ NACP@ CPS Knowledge Fiesta 50
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/ NACP@ CPS Knowledge Fiesta 51
National HIV Estimates, 2011 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 8/9/ NAC P@ Mothers Needing PMTCT 8,928 10,753 13,107
PROJECTIONS 8/9/ NACP@ CPS Knowledge Fiesta 53
Adult Prevalence 8/9/ NACP@ CPS Knowledge Fiesta 54
New HIV Infections- Total 8/9/ NACP@ CPS Knowledge Fiesta 55
New Infections-Children 8/9/ NACP@ CPS Knowledge Fiesta 56
Total HIV Population 8/9/ NACP@ CPS Knowledge Fiesta 57
HIV Population-Children 8/9/ NACP@ CPS Knowledge Fiesta 58
HIV Population Under Age 1 8/9/ NACP@ CPS Knowledge Fiesta 59
Cumulative AIDS Deaths 8/9/ NACP@ CPS Knowledge Fiesta 60
Annual AIDS Death (15+) 8/9/ NACP@ CPS Knowledge Fiesta 61
Annual AIDS Deaths- Children 8/9/ NACP@ CPS Knowledge Fiesta 62
Deaths- Infants <1year 8/9/ NACP@ CPS Knowledge Fiesta 63
AIDS Orphans - Total 8/9/ NACP@ CPS Knowledge Fiesta 64
Total ART Need (15+) 8/9/ NACP@ CPS Knowledge Fiesta 65
Children Needing ART: 0-14yrs 8/9/ NACP@ CPS Knowledge Fiesta 66
Infants (<1year) needing ART 8/9/ NACP@ CPS Knowledge Fiesta 67
Unmet Need for ART 15+ 8/9/ NACP@ CPS Knowledge Fiesta 68
Number Newly Needing Treatment (15+) 8/9/ NACP@ CPS Knowledge Fiesta 69
Children Needing Co-trimoxazole 8/9/ NACP@ CPS Knowledge Fiesta 70
Mothers Needing PMTCT 8/9/ NACP@ CPS Knowledge Fiesta 71
TB Cases 8/9/ NACP@ CPS Knowledge Fiesta 72
OUTLOOK FOR 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 8/9/ NACP@ CPS Knowledge Fiesta Mothers Needing PMTCT 8,458 10,249 12,658 73
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 8/9/ NACP@ CPS Knowledge Fiesta 74
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 8/9/ NACP@ CPS Knowledge Fiesta 75
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/ NACP@ CPS Knowledge Fiesta 76
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/ NACP@ CPS Knowledge Fiesta 77
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
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
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/ NACP@ CPS Knowledge Fiesta 80
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
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/ NACP@ CPS Knowledge Fiesta 82