Prevention of Mother-to-ChildTransmission of HIV in GhanaPrevention of Mother-to-ChildTransmission of HIV in Ghana
Scale-up Plan 2011 – 2015Scale-up Plan 2011 – 2015
•PMTCT performance
•Frameworks informing plan
•The plan
Performance 2009
Service Coverage by Population and Facility in2009
Region
HIV Prevalence
No. of PregnantWomen
% Facilities withPMTCT 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/PolicyFramework
•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 2005and 2010
•The Prevention of Mother-to-Child Transmission High LevelGlobal 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 2005universal access to treatment for all those who need it by2010”.
•June 2006 High-Level Meeting on AIDS by United NationsMember States
–towards the “universal access to comprehensive preventionprogrammes, 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 Counsellingand Testing in Ghana
•Guidelines for Management of Opportunistic Infections and other Related HIVDiseases
•Sexually Transmitted Infections: Guidelines for Management.
(UNAIDS): Virtual Elimination of MTCT by2015
•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 anduninfected by age of 2 years;
•Treatment:
–> 80% of eligible pregnant women living with HIV receive ARTfor their own health;
•Family Planning (FP):
–50% reduction in unmet need for FP across all women livingwith HIV;
•Primary prevention:
–20% reduction in HIV incidence among women aged 15 – 24years.
Vision & Goal
•Vision: “A generation free of HIV andAIDS in Ghana”
•Goal: “Virtual elimination of HIVtransmission from mother to child andimprovement in the health of the familyespecially maternal, newborn and childhealth within the context of HIV inGhana”
8
Guiding Principles
1.Commitment: Govt leadership; commitment at all levelstowards universal coverage of PMTCT services.
2.Quality: Technical and Policy framework to optimizeservice 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 improveservice delivery.
6.Monitoring: to track programme performance, outcomesand impact.
7.Partnerships: at national, regional and district levels.
9
Main thrust
•Increasing availability and utilisation of therecommended package of services for PMTCTat more health facilities;
•Improving the comprehensiveness (four-strategic prongs) and integration with moreone-stop service delivery points;
•Consolidating the quality of services providedbased on the national guidelines andstandards.
Four-pronged strategic approach
•i) Primary prevention of HIV among women ofreproductive age
•ii) Prevention of unintended pregnancies amongwomen living with HIV
•iii) Prevention of HIV transmission from womenliving with HIV to their babies
•iv) Provision of appropriate treatment, care andsupport to mothers living with HIV and theirfamilies.
Objectives: By 2015
1.To increase utilisation of HIV and STI prevention servicesto 90% of the expected pregnant women in the country.
2.To increase utilisation of family planning (FP) services by90% of the HIV infected women and their partners whoaccess clinical services.
3.To increase utilisation of the standardised package forPMTCT to 90% of HIV infected pregnant and lactatingwomen and their babies.
4.To increase utilisation of comprehensive, family-centredHIV care and treatment to 90% of pregnant and lactatingwomen identified under the PMTCT programme.
12
Broad Strategic Interventions
1.Review, update and wide dissemination ofPolicies, Guidelines and other Standards
2.Strengthening programme management,resource mobilisation and coordination atnational, regional and district levels
3.Strengthening the human resource capacityfor provision of integrated, comprehensivePMTCT services
4.Improvement in service delivery of integratedcomprehensive PMTCT interventions at alllevels, including community involvement
13
Broad Strategic Interventions…
5.Strengthening the infrastructure andequipment capacity for provision ofintegrated, comprehensive PMTCT services
6.Improvement in the procurement and supplychain management system for comprehensivePMTCT
7.Strengthening the management informationsystem, including operational research
14
Targets
Indicator
Target
Functional ANC facilities with comprehensive, integrated PMTCTservices
90%
Pregnant women counselled, tested and receive HIV results
95%
HIV negative women counselled and provided information on HIV andSTI prevention, and how to remain HIV free
90%
Male partners of pregnant and lactating women counselled, tested andgiven HIV results
30%
Women living with HIV provided with antiretroviral drugs for PMTCTaccording to recommended guidelines
90%
HIV exposed infants provided with antiretroviral drugs for PMTCTaccording to recommended guidelines
90%
Pregnant women living with HIV assessed for ART eligibility throughimmunological or WHO clinical criteria
90%
Targets
Indicator
Target
Pregnant and lactating HIV infected women provided infant andyoung child feeding counselling support
95%
Pregnant and lactating HIV infected women provided counsellingon maternal feeding
95%
HIV exposed infants provided with co-trimoxazole prophylaxis from6 weeks of age
90%
HIV exposed infants provided with first DNA PCR test within thefirst two months of life
90%
Eligible HIV positive pregnant and lactating mothers identifiedunder the PMTCT programme receiving HAART for own health
90%
HIV infected infants identified through EID linked to HAART withinthe first 12 months of age
95%
HIV infected infants from the PMTCT programme by PCR test
<5%
Programme Monitoring FrameworkProgramme Monitoring Framework
Indicators
2010(Baseline)
2011
2012
2013
2014
2015
1.Proportion of health facilities providingintegrated package of PMTCT services
33%
41%
60%
70%
80%
90%
1.Proportion of health facilities providingEID services using DBS
1%
41%
60%
70%
80%
90%
1.Estimated # of pregnant women
973,320
993,520
1,014,120
1,033,880
1,055,960
1,077,000
1.# of pregnant women registering forANC (95%)
924,654
943,844
963,414
982,186
1,003,162
1,023,150
1.Proportion of pregnant womenaccessing services from facilities withPMTCT services
83%
90%
90%
95%
95%
95%
1.Proportion of pregnant women testedfor HIV and received results
76%
80%
85%
90%
95%
95%
1.Proportion of HIV negative womencounselled and provided informationon HIV and STI prevention, and howto 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 pregnantwomen assessed for ART eligibility(CD4 count or clinical staging)
70%
75%
85%
90%
90%
90%
Programme Monitoring FrameworkProgramme Monitoring Framework
Indicators
2010(Baseline)
2011
2012
2013
2014
2015
1.Proportion of infected women who received ARVsfor PMTCT
70%
75%
85%
90%
90%
90%
1.Proportion of eligible infected pregnant womenreceived HAART for own health
60%
80%
85%
90%
90%
90%
1.Proportion of eligible infected pregnant women onco-trimoxazole prophylaxis (20% of total)
50%
70%
80%
90%
90%
90%
1.Proportion of infected women provided counsellingand support on maternal feeding
50%
70%
80%
90%
95%
95%
1.Proportion of HIV infected pregnant womencounselled on infant feeding by a trainedcounsellor
50%
70%
80%
90%
95%
95%
1.Proportion of HIV infected pregnant womenprovided with family planning services afterdelivery
30%
50%
70%
80%
90%
95%
1.Proportion of exposed infants receiving ARVprophylaxis 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 HIVvirological 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 FrameworkProgramme Monitoring Framework
Indicators
2010(Baseline)
2011
2012
2013
2014
2015
1.Proportion of HIV exposed infants who are breastfeedingand covered by ARV prophylaxis
50%
70%
80%
90%
90%
90%
1.Proportion of HIV exposed children who test positive by DNAPCR
10%
10%
8%
5%
5%
<5%
1.HIV infected infants identified through EID linked to HAARTwithin the first 12 months of age
50%
60%
70%
80%
90%
95%
1.Proportion of infected children (0-14) receiving Antiretroviraltreatment (ART)
21%
32%
43%
54%
65%
85%
1.Proportion of male partners counselled and tested for HIV inANC setting
5%
10%
15%
20%
25%
30%
1.Proportion of HIV infected women of reproductive ageattending HIV services with unmet need for family planning
35%
17%
Costing
Major Activity
Total
Review, update and widely disseminate Policies, Guidelines and otherStandards
480,250
Strengthen programme management, resource mobilisation andcoordination at national, regional and district levels
1,038,000
Strengthen the human resource capacity for provision of the integratedpackage of PMTCT services
6,892.100
Improve service delivery of integrated package of PMTCT services at alllevels, including the community involvement
1,107,500
Strengthen the infrastructure and equipment capacity for provision ofintegrated package of PMTCT services
32,583,650
Improve the procurement and supply chain management system forPMTCT services
87,397,932
Strengthen the management information system, including operationalresearch
3,619,275
Total
143,087,707
ACKNOWLEDGEMENT
•MOH/GHS/NACP
•GAC
•PMTCT WORKING GROUP
•UNICEF/WHO/UNAIDS
