2. 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

3. 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

4. GHANA’S AMBITIOUS TARGETS
Ghana Launched 90/90/90 in July 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%

5. 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

6. 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

7. 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.

8. 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.

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

10. 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

11. 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

12. 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.

13. 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.

14. 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

15. 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

16. Thank you
GOD BLESS OUR HOMELAND
GHANA