4 Service Coverage by Population and Facility in 2009 RegionHIV PrevalenceNo. of Pregnant Women% Facilities with PMTCT ServicesAshanti3.9%195,25711%Greater Accra3.2%171,24523%Western3.1%102,2149%Eastern4.2%95,50063%Northern2.0%93,38233%Brong Ahafo2.9%90,68831%Volta2.6%77,492Central3.0%76,86629%Upper East2.2%40,612Upper West26,842970,09825%
5 International commitments/Policy Framework Millennium Development Goals 4, 5 andThe Declaration of Commitment (UNGASS) in 2001reductions of 20% and 50% in infants infected with HIV by 2005 and 2010The Prevention of Mother-to-Child Transmission High Level Global Partners Forum held in December 2005 in Abuja, Nigeriaachievement 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 Statestowards the “universal access to comprehensive prevention programmes, treatment, care and support” by 2010.
6 National Policies and Guidelines The Health Sector Programme of Work 2007 – 2011National Reproductive Health Service Policy and StandardsThe Under 5 Child Health Policy: 2007 – 2015National Guidelines for Prevention of Mother to Child Transmission of HIVEarly Infant HIV Diagnosis in Ghana: Guidelines and ProtocolGuidelines for Antiretroviral Therapy in GhanaNational Guidelines for the Development and Implementation of HIV Counselling and Testing in GhanaGuidelines for Management of Opportunistic Infections and other Related HIV DiseasesSexually Transmitted Infections: Guidelines for Management.
7 (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.
8 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”
9 Guiding PrinciplesCommitment: Govt leadership; commitment at all levels towards universal coverage of PMTCT services.Quality: Technical and Policy framework to optimize service delivery.Integration: with other HIV services as well as maternal, nutrition, newborn and child health programmes; decentralization.Equitable access: for all women and their families, including the most vulnerable due to gender disparities.Health systems: strengthening & utilization to improve service delivery.Monitoring: to track programme performance, outcomes and impact.Partnerships: at national, regional and district levels.
10 Main thrustIncreasing 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.
11 Four-pronged strategic approach i) Primary prevention of HIV among women of reproductive ageii) Prevention of unintended pregnancies among women living with HIViii) Prevention of HIV transmission from women living with HIV to their babiesiv) Provision of appropriate treatment, care and support to mothers living with HIV and their families.
12 Objectives: By 2015To increase utilisation of HIV and STI prevention services to 90% of the expected pregnant women in the country.To increase utilisation of family planning (FP) services by 90% of the HIV infected women and their partners who access clinical services.To increase utilisation of the standardised package for PMTCT to 90% of HIV infected pregnant and lactating women and their babies.To increase utilisation of comprehensive, family-centred HIV care and treatment to 90% of pregnant and lactating women identified under the PMTCT programme.
13 Broad Strategic Interventions Review, update and wide dissemination of Policies, Guidelines and other StandardsStrengthening programme management, resource mobilisation and coordination at national, regional and district levelsStrengthening the human resource capacity for provision of integrated, comprehensive PMTCT servicesImprovement in service delivery of integrated comprehensive PMTCT interventions at all levels, including community involvement
14 Broad Strategic Interventions… Strengthening the infrastructure and equipment capacity for provision of integrated, comprehensive PMTCT servicesImprovement in the procurement and supply chain management system for comprehensive PMTCTStrengthening the management information system, including operational research
15 Targets Target Indicator 90% Functional ANC facilities with comprehensive, integrated PMTCT services90%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 freeMale partners of pregnant and lactating women counselled, tested and given HIV results30%Women living with HIV provided with antiretroviral drugs for PMTCT according to recommended guidelinesHIV exposed infants provided with antiretroviral drugs for PMTCT according to recommended guidelinesPregnant women living with HIV assessed for ART eligibility through immunological or WHO clinical criteria
16 Targets Target Indicator 95% Pregnant and lactating HIV infected women provided infant and young child feeding counselling support95%Pregnant and lactating HIV infected women provided counselling on maternal feedingHIV exposed infants provided with co-trimoxazole prophylaxis from 6 weeks of age90%HIV exposed infants provided with first DNA PCR test within the first two months of lifeEligible HIV positive pregnant and lactating mothers identified under the PMTCT programme receiving HAART for own healthHIV infected infants identified through EID linked to HAART within the first 12 months of ageHIV infected infants from the PMTCT programme by PCR test<5%
17 Programme Monitoring Framework Indicators(Baseline)20112012201320142015Proportion of health facilities providing integrated package of PMTCT services33%41%60%70%80%90%Proportion of health facilities providing EID services using DBS1%Estimated # of pregnant women973,320993,5201,014,1201,033,8801,055,9601,077,000# of pregnant women registering for ANC (95%)924,654943,844963,414982,1861,003,1621,023,150Proportion of pregnant women accessing services from facilities with PMTCT services83%95%Proportion of pregnant women tested for HIV and received results76%85%Proportion of HIV negative women counselled and provided information on HIV and STI prevention, and how to remain HIV free50%Proportion of HIV infected women1.7%1.6%Proportion of infected pregnant women assessed for ART eligibility (CD4 count or clinical staging)75%
18 Programme Monitoring Framework Indicators(Baseline)20112012201320142015Proportion of infected women who received ARVs for PMTCT70%75%85%90%Proportion of eligible infected pregnant women received HAART for own health60%80%Proportion of eligible infected pregnant women on co-trimoxazole prophylaxis (20% of total)50%Proportion of infected women provided counselling and support on maternal feeding95%Proportion of HIV infected pregnant women counselled on infant feeding by a trained counsellorProportion of HIV infected pregnant women provided with family planning services after delivery30%Proportion of exposed infants receiving ARV prophylaxis for PMTCT40%Proportion of exposed infants started on co- trimoxazole prophylaxis within 2 months ageProportion of exposed infants received first HIV virological test within two months age20%Proportion of HIV exposed infants who are on EBF, RF or mixed feeding at DPT3 visitEBF 90% RF 10%
19 Programme Monitoring Framework Indicators(Baseline)20112012201320142015Proportion of HIV exposed infants who are breastfeeding and covered by ARV prophylaxis50%70%80%90%Proportion of HIV exposed children who test positive by DNA PCR10%8%5%<5%HIV infected infants identified through EID linked to HAART within the first 12 months of age60%95%Proportion of infected children (0-14) receiving Antiretroviral treatment (ART)21%32%43%54%65%85%Proportion of male partners counselled and tested for HIV in ANC setting15%20%25%30%Proportion of HIV infected women of reproductive age attending HIV services with unmet need for family planning35%17%
20 Costing Major Activity Total Review, update and widely disseminate Policies, Guidelines and other Standards480,250Strengthen programme management, resource mobilisation and coordination at national, regional and district levels1,038,000Strengthen the human resource capacity for provision of the integrated package of PMTCT services6,Improve service delivery of integrated package of PMTCT services at all levels, including the community involvement1,107,500Strengthen the infrastructure and equipment capacity for provision of integrated package of PMTCT services32,583,650Improve the procurement and supply chain management system for PMTCT services87,397,932Strengthen the management information system, including operational research3,619,275143,087,707