Dr. Anthony Nsiah-Asare Achieving HIV Epidemic Control Optimizing Partnerships and Synergies between the health facilities and Community-based interventions Dr. Anthony Nsiah-Asare Director General GHANA Health Service May 09 2018

Achieving Epidemic control means that HIV ceases to be a disease of public health importance HIV related morbidity is eliminated HIV incidence and AIDS-related deaths are significantly minimal below one per 1,000 adults per year, or less than one per 10,000 adults per year The UNAIDS is proposing other metrics to define the end of AIDS with clear targets such as Incidence-mortality ratio which combines HIV incidence and mortality among living with HIV from all causes, and Incidence-prevalence ratio

GHANA’S AMBITIOUS TARGETS Ghana Launched 90/90/90 in July 2016 to Test ~2.6million people annually till 2020 Enroll ~ 185,000 new clients by 2020 Ensure Viral Suppression in ~165,000 ART clients To ensure HIV prevalence below 1% To reduce new infections by 80% To reduce AIDS related illness by 85% To reduce AIDS-related deaths by 90%

The Goal of Ending AIDS by 2030 is possible Through a combination of Commitment, Innovation, Partnership and Action. Dedicated efforts towards global targets such as 90/90/90 Focused actions to realize the Sustainable Development Goals (3 especially). Translating evidence based information or research into policies that Leaves no one behind Is gender sensitive Is closely linked to the Universal Healthcare Coverage (UHC) agenda

Country-specific investment includes Procurement of adequate Commodities & ensuring efficient LMIS Mobilizing the requisite Human resource in quality and quantity Improvement in Infrastructure and equipment Innovative institutional and community partnerships

Health Sector Strategy A five-year roadmap document was developed which sets out national health sector plans to mobilize all health workers and other stakeholders to locate, test, treat and retain PLHIV in ART care, to ensure effective viral load suppression. Maintenance of strong partnerships with non-state actors in the health sector Decentralizing primary health care to communities through the CHPS programme (PMTCT and ART) Improving the health insurance to render it resilient and to reduce barriers to HIV and other health care services.

Enhancing Synergies and Partnerships Development and Dissemination of task sharing policy and guidelines Ensuring that lay counsellors are trained to participate in HIV testing Ensuring that midwives and other health cadres initiate and dispense ARVs in facilities and the community in the near future To empower PLHIVs (Models of hope) and CHWs for greater involvement in the 90/90/90 agenda! Building the capacity of community based organisations to participate in health promotion and prevention programmes To support HIV testing services, condom promotion and overall behavioural change communication. To strengthen linkage to treatment. To improve demand for health services such as Maternal Neonatal Child and Adolescent Health Service within which context PMTCT is delivered.

REACHING 90% OF PEOPLE AT RISK OF HIV WITH COMPREHENSIVE PREVENTION POSSIBLE THROUGH ENHANCED SYNERGIES WITH COMMUNITIES

The Community Health Worker Opportunity 20,000 CHW trained and deployed in all 216 districts of Ghana and 1800 given mobile phones 1,000 e-Technical Assistants trained in eHealth and equipped with tablets for data collection Alignment of activities with 90/90/90 has been done and roadmap developed. Optimizing the role of these CHWs is critical for the way forward

Role of the CHW Registration of all household members into community health register Health promotion and disease prevention (HIV, TB, Malaria etc) Case detection and first aid management of minor/common ailments and their referrals. Telemedicine activities and consultations at the community level Community mobilization and health education. Defaulter identification and referral

Empowering our clients and communities by eliminating Stigma and Discrimination Experiences of HIV-related discrimination in healthcare settings must be documented (People Living with HIV Stigma Index surveys) Employment discrimination because of HIV status must be stopped Verbal or physical harassment because of HIV or key population status to be discontinued Discriminatory attitudes towards people living with HIV to cease. Avoidance of healthcare to Key Populations shouldn’t be encouraged. Legal protections for PLHIV is necessary Law enforcement to minimize gender violence, rape and other risks is key. Parental or spousal consent requirements for services must be relaxed to improve access to services.

Way forward Need for increased resource mobilization outside the health sector. Communities must also help to raise the needed funding to support community work. Build on current partnerships to scale-up HIV testing and treatment coverage through the newly developed Differentiated Service Delivery (DSD) operational Manual. A task team for DSD that includes key stakeholders including the academia has been constituted to support the NACP to quickly disseminate the manual for rapid scale-up towards the achievement of epidemic control.

Differentiated service delivery: Ghana Led by Ghana Health Service/National AIDS/STI Control Programme Differentiated Service Delivery Operational Manual 2017 Stakeholders: Community Health Nurses, Community Health Workers Clinician supervisors Models of Hope (PLHIV) Partners (WHO, GF, UNAIDS, GAC, CBOs, NGOs (EQUIP), NAP+ Community ART is possible through DSD

To not leave anyone behind we MUST… Enable COMMUNITY MONITORING: to monitor quality and access of services along the HIV cascade (resistance). Sub-optimal quality in service delivery is predictive of drug resistance Fund COMMUNITY ADVOCACY: to ensure there is a strong community voice. Strengthen COMMUNITY SYSTEMS: to have more robust organizational structures and capacity to provide innovative services & delivery models. X

Thank you GOD BLESS OUR HOMELAND GHANA