Prevention of Mother-to-Child Transmission of HIV in Ghana

Scale-up Plan 2011 – 2015

• PMTCT performance • Frameworks informing plan• The plan

Performance 2009

Service Coverage by Population and Facility in 2009

Region HIV Prevalence

No. of Pregnant Women

% Facilities with PMTCT Services

Ashanti 3.9% 195,257 11%

Greater Accra 3.2% 171,245 23%

Western 3.1% 102,214 9%

Eastern 4.2% 95,500 63%

Northern 2.0% 93,382 33%

Brong Ahafo 2.9% 90,688 31%

Volta 2.6% 77,492 9%

Central 3.0% 76,866 29%

Upper East 2.2% 40,612 29%

Upper West 3.1% 26,842 29%

2.9% 970,098 25%

International commitments/Policy Framework• Millennium Development Goals 4, 5 and 6 2015• The Declaration of Commitment (UNGASS) in 2001

– reductions of 20% and 50% in infants infected with HIV by 2005 and 2010

• The Prevention of Mother-to-Child Transmission High Level Global Partners Forum held in December 2005 in Abuja, Nigeria – achievement of an HIV and AIDS-free generation by 2015.

• The commitment by leaders of the G8 countries in 2005 universal access to treatment for all those who need it by 2010”.

• June 2006 High-Level Meeting on AIDS by United Nations Member States – towards the “universal access to comprehensive prevention

programmes, treatment, care and support” by 2010.

National Policies and Guidelines• The Health Sector Programme of Work 2007 – 2011

• National Reproductive Health Service Policy and Standards

• The Under 5 Child Health Policy: 2007 – 2015

• National Guidelines for Prevention of Mother to Child Transmission of HIV

• Early Infant HIV Diagnosis in Ghana: Guidelines and Protocol

• Guidelines for Antiretroviral Therapy in Ghana

• National Guidelines for the Development and Implementation of HIV Counselling and Testing in Ghana

• Guidelines for Management of Opportunistic Infections and other Related HIV Diseases

• Sexually Transmitted Infections: Guidelines for Management.

(UNAIDS): Virtual Elimination of MTCT by 2015

• Mother-to-child transmission: – 90% reduction of new infant infections – <5% transmission;

• HIV-free survival: – >90% of all infants born to women living with HIV alive and

uninfected by age of 2 years;• Treatment:

– > 80% of eligible pregnant women living with HIV receive ART for their own health;

• Family Planning (FP): – 50% reduction in unmet need for FP across all women living with

HIV;• Primary prevention:

– 20% reduction in HIV incidence among women aged 15 – 24 years.

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Vision & Goal

• Vision: “A generation free of HIV and AIDS in Ghana”

• Goal: “Virtual elimination of HIV transmission from mother to child and improvement in the health of the family especially maternal, newborn and child health within the context of HIV in Ghana”

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Guiding Principles1. Commitment: Govt leadership; commitment at all levels

towards universal coverage of PMTCT services.2. Quality: Technical and Policy framework to optimize service

delivery.3. Integration: with other HIV services as well as maternal,

nutrition, newborn and child health programmes; decentralization.

4. Equitable access: for all women and their families, including the most vulnerable due to gender disparities.

5. Health systems: strengthening & utilization to improve service delivery.

6. Monitoring: to track programme performance, outcomes and impact.

7. Partnerships: at national, regional and district levels.

Main thrust

• Increasing availability and utilisation of the recommended package of services for PMTCT at more health facilities;

• Improving the comprehensiveness (four-strategic prongs) and integration with more one-stop service delivery points;

• Consolidating the quality of services provided based on the national guidelines and standards.

Four-pronged strategic approach

• i) Primary prevention of HIV among women of reproductive age

• ii) Prevention of unintended pregnancies among women living with HIV

• iii) Prevention of HIV transmission from women living with HIV to their babies

• iv) Provision of appropriate treatment, care and support to mothers living with HIV and their families.

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Objectives: By 20151. To increase utilisation of HIV and STI prevention services

to 90% of the expected pregnant women in the country.2. To increase utilisation of family planning (FP) services by

90% of the HIV infected women and their partners who access clinical services.

3. To increase utilisation of the standardised package for PMTCT to 90% of HIV infected pregnant and lactating women and their babies.

4. To increase utilisation of comprehensive, family-centred HIV care and treatment to 90% of pregnant and lactating women identified under the PMTCT programme.

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Broad Strategic Interventions

1. Review, update and wide dissemination of Policies, Guidelines and other Standards

2. Strengthening programme management, resource mobilisation and coordination at national, regional and district levels

3. Strengthening the human resource capacity for provision of integrated, comprehensive PMTCT services

4. Improvement in service delivery of integrated comprehensive PMTCT interventions at all levels, including community involvement

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Broad Strategic Interventions…

5. Strengthening the infrastructure and equipment capacity for provision of integrated, comprehensive PMTCT services

6. Improvement in the procurement and supply chain management system for comprehensive PMTCT

7. Strengthening the management information system, including operational research

TargetsIndicator

Target

Functional ANC facilities with comprehensive, integrated PMTCT services 90%

Pregnant women counselled, tested and receive HIV results95%

HIV negative women counselled and provided information on HIV and STI prevention, and how to remain HIV free 90%

Male partners of pregnant and lactating women counselled, tested and given HIV results 30%

Women living with HIV provided with antiretroviral drugs for PMTCT according to recommended guidelines 90%

HIV exposed infants provided with antiretroviral drugs for PMTCT according to recommended guidelines 90%

Pregnant women living with HIV assessed for ART eligibility through immunological or WHO clinical criteria 90%

TargetsIndicator

Target

Pregnant and lactating HIV infected women provided infant and young child feeding counselling support 95%

Pregnant and lactating HIV infected women provided counselling on maternal feeding 95%

HIV exposed infants provided with co-trimoxazole prophylaxis from 6 weeks of age 90%

HIV exposed infants provided with first DNA PCR test within the first two months of life 90%

Eligible HIV positive pregnant and lactating mothers identified under the PMTCT programme receiving HAART for own health

90%

HIV infected infants identified through EID linked to HAART within the first 12 months of age 95%

HIV infected infants from the PMTCT programme by PCR test <5%

Programme Monitoring FrameworkIndicators

2010 (Baseline

)2011 2012 2013 2014 2015

1. Proportion of health facilities providing integrated package of PMTCT services

33% 41% 60% 70% 80% 90%

1. Proportion of health facilities providing EID services using DBS

1% 41% 60% 70% 80% 90%

1. Estimated # of pregnant women 973,320 993,520 1,014,120 1,033,880 1,055,9601,077,00

0

1. # of pregnant women registering for ANC (95%)

924,654 943,844 963,414 982,186 1,003,1621,023,15

0

1. Proportion of pregnant women accessing services from facilities with PMTCT services

83% 90% 90% 95% 95% 95%

1. Proportion of pregnant women tested for HIV and received results

76% 80% 85% 90% 95% 95%

1. Proportion of HIV negative women counselled and provided information on HIV and STI prevention, and how to remain HIV free

50% 70% 80% 90% 90% 90%

1. Proportion of HIV infected women 1.7% 1.6% 1.6% 1.6% 1.6% 1.6%

1. Proportion of infected pregnant women assessed for ART eligibility (CD4 count or clinical staging)

70% 75% 85% 90% 90% 90%

Programme Monitoring Framework

Indicators2010

(Baseline)

2011 2012 2013 2014 2015

1. Proportion of infected women who received ARVs for PMTCT 70% 75% 85% 90% 90% 90%

1. Proportion of eligible infected pregnant women received HAART for own health 60% 80% 85% 90% 90% 90%

1. Proportion of eligible infected pregnant women on co-trimoxazole prophylaxis (20% of total)

50% 70% 80% 90% 90% 90%

1. Proportion of infected women provided counselling and support on maternal feeding 50% 70% 80% 90% 95% 95%

1. Proportion of HIV infected pregnant women counselled on infant feeding by a trained counsellor

50% 70% 80% 90% 95% 95%

1. Proportion of HIV infected pregnant women provided with family planning services after delivery

30% 50% 70% 80% 90% 95%

1. Proportion of exposed infants receiving ARV prophylaxis for PMTCT 40% 60% 70% 80% 90% 90%

1. Proportion of exposed infants started on co-trimoxazole prophylaxis within 2 months age 60% 70% 80% 90% 90% 90%

1. Proportion of exposed infants received first HIV virological test within two months age 20% 80% 85% 90% 90% 90%

1. Proportion of HIV exposed infants who are on EBF, RF or mixed feeding at DPT3 visit

EBF 90%RF 10%

EBF 90%RF 10%

EBF 90%RF 10%

EBF 90%RF 10%

EBF 90%RF 10%

EBF 90%

RF 10%

Programme Monitoring FrameworkIndicators

2010 (Baseline)

2011 2012 2013 2014 2015

1. Proportion of HIV exposed infants who are breastfeeding and covered by ARV prophylaxis

50% 70% 80% 90% 90% 90%

1. Proportion of HIV exposed children who test positive by DNA PCR

10% 10% 8% 5% 5% <5%

1. HIV infected infants identified through EID linked to HAART within the first 12 months of age

50% 60% 70% 80% 90% 95%

1. Proportion of infected children (0-14) receiving Antiretroviral treatment (ART)

21% 32% 43% 54% 65% 85%

1. Proportion of male partners counselled and tested for HIV in ANC setting

5% 10% 15% 20% 25% 30%

1. Proportion of HIV infected women of reproductive age attending HIV services with unmet need for family planning

35% 17%

CostingMajor Activity Total

Review, update and widely disseminate Policies, Guidelines and other Standards

480,250

Strengthen programme management, resource mobilisation and coordination at national, regional and district levels

1,038,000

Strengthen the human resource capacity for provision of the integrated package of PMTCT services

6,892.100

Improve service delivery of integrated package of PMTCT services at all levels, including the community involvement

1,107,500

Strengthen the infrastructure and equipment capacity for provision of integrated package of PMTCT services

32,583,650

Improve the procurement and supply chain management system for PMTCT services

87,397,932

Strengthen the management information system, including operational research

3,619,275

Total 143,087,707

ACKNOWLEDGEMENT

• MOH/GHS/NACP• GAC• PMTCT WORKING GROUP • UNICEF/WHO/UNAIDS