BackgroundIn 2014, the Joint United Nations Program on HIV/AIDS (UNAIDS) set out a treatment target with the objective to help end the AIDS epidemic by 2030. This was supported by the UNAIDS ’90-90-90’ target that by 2020, 90% of all people living with HIV (PLHIV) will know their HIV status; 90% of all those diagnosed with HIV will be on sustained antiretroviral therapy; and 90% of all people receiving antiretroviral therapy will have viral suppression. The concept of offering differentiated care services using community-based models is evidence-based and is suggested as a means to bring this target into reality. This study sought to explore the possible predictors and acceptability of Community-based health service provision among PLHIV accessing ART services at the Cape Coast Teaching Hospital (CCTH) in Ghana.MethodsA qualitative study, using 5 focus group discussions (FGD) of 8 participants per group, was conducted at the HIV Clinic in CCTH, in the Central Region of Ghana. Facilitators administered open-ended topic-guided questions. Answers were audio recorded, later transcribed and combined with notes taken during the discussions. Themes around Facility-based and Community-based service delivery and sub-themes developed from the codes, were verified and analyzed by the authors, with the group as the unit for analysis.ResultsParticipants expressed preference for facility–based service provision with the construct that, it ensures comprehensive health checks before provision of necessary medications. PLHIV in this study wished that the facility-based visits be more streamlined so “stable clients” could visit twice in a year to reduce the associated time and financial cost. The main barrier to community-based service delivery was concerns about stigmatization and abandonment in the community upon inadvertent disclosure of status.ConclusionsAlthough existing evidence suggests that facility-based care was relatively more expensive and time consuming, PLHIV preferred facility-based individualized differentiated model to a community-based model. The fear of stigma and discrimination was very strong and is the main barrier to community-based model among PLHIV in this study and this needs to be explored further and managed.

BackgroundDespite global scale up of interventions for Preventing Mother to child HIV Transmissions (PMTCT), there still remain high pediatric HIV infections, which result from unequal access in resource-constrained settings. Sub-Saharan Africa alone contributes more than 90 % of global Mother-to-Child Transmission (MTCT) burden. As part of efforts to address this, African countries (including Ghana) disproportionately contributing to MTCT burden were earmarked in 2009 for rapid PMTCT interventions scale-up within their primary care system for maternal and child health. In this study, we reviewed records in Ghana, on ANC registrants eligible for PMTCT services to describe regional disparities and national trends in key PMTCT indicators. We also assessed distribution of missed opportunities for testing pregnant women and treating those who are HIV positive across the country. Implications for scaling up HIV-related maternal and child health services to ensure equitable access and eliminate mother-to-child transmissions by 2015 are also discussed.MethodsData for this review is National AIDS/STI Control Programme (NACP) regional disaggregated records on registered antenatal clinic (ANC) attendees across the country, who are also eligible to receive PMTCT services. These records cover a period of 3 years (2011–2013). Number of ANC registrants, utilization of HIV Testing and Counseling among ANC registrants, number of HIV positive pregnant women, and number of HIV positive pregnant women initiated on ARVs were extracted. Trends were examined by comparing these indicators over time (2011–2013) and across the ten administrative regions. Descriptive statistics were conducted on the dataset and presented in simple frequencies, proportions and percentages. These are used to determine gaps in utilization of PMTCT services. All analyses were conducted using Microsoft Excel 2010 version.ResultsAlthough there was a decline in HIV prevalence among pregnant women, untested ANC registrants increased from 17 % in 2011 to 25 % in 2013. There were varying levels of missed opportunities for testing across the ten regions, which led to a total of 487,725 untested ANC clients during the period under review. In 2013, Greater Accra (31 %), Northern (27 %) and Volta (48 %) regions recorded high percentages of untested ANC clients. Overall, HIV positive pregnant women initiated onto ARVs remarkably increased from 57% (2011) to 82 % (2013), yet about a third (33 %) of them in the Volta and Northern regions did not receive ARVs in 2013.ConclusionsMissed opportunities to test pregnant women for HIV and also initiate those who are positive on ARVs across all the regions pose challenges to the quest to eliminate mother-to-child transmission of HIV in Ghana. For some regions these missed opportunities mimic previously observed gaps in continuous use of primary care for maternal and child health in those areas. Increased national and regional efforts aimed at improving maternal and child healthcare delivery, as well as HIV-related care, is paramo...

Background: HIV surveillance surveys are designed to track trends in HIV and AIDS related knowledge, attitudes and behaviours in sub-populations at particular risk of infection and link the behaviour to biological surveillance. This survey determined personal characteristics, high risk sexual behaviours and HIV perception and testing experience among men and women in an urban fishing community in Ghana.Methods: A cross-sectional community survey was conducted in 2013 among men and women in two fishing communities (Chorkor and James Town) in Accra. In all, 554 subjects (≥18 years) were involved, 264 in Chorkor and 290 in James Town. Data on personal and behavioural characteristics, high risk sexual behaviours, HIV perception and testing experience among men and women were collected with a structured questionnaire. Descriptive statistics and Chi square test were used for the analysis at 95% significant level, using SPSS version 21.Results: Of 554 subjects, 329 (59.4%) were females, and median age was 32 years. A higher proportion of women had no formal education, relatively more men were employed and earned statistically significant higher monthly income than women (72.2% vs. 65.9%, p< 0.001). More working men were involved in itinerant occupations compared to women (46.1% vs. 22%; p< 0.001). Half of all respondents have had sexual intercourse less than a month prior to survey, however, only less than a third 153 (28.5%) usedcondom during the last intercourse. High risk HIV sexual behaviour was more common in younger age groups (> 30 years), those living with partners, those with low education, those currently employed, and those without health insurance. It was also higher in those who did not perceive themselves as being at risk of HIV, have never tested for HIV and who were not members of any social groups or clubs.Conclusion: The survey indicated important personnel and behavioural characteristics that are very important for programme planning and control. Targeted health promotion messages, behaviour change communication, and increased engagement withcommunities and groups are necessary to capture vulnerable men and women in high risk settings. Behavioural surveillance surveys should be considered essential component of national control efforts.

Introduction: Enormous national efforts have gone into combating the HIV epidemic in Ghana. This study reviewed data from the National AIDS/STI Control Programme over the period 2005-2010, in terms of time, place and person characteristics of the epidemic.It focused on past and current efforts at combating the epidemic and what future efforts are required.Methods: It was a descriptive review of data from HIV sentinel surveys (HSS) and annual reports of the National AIDS/STI Control Programme (NACP) from 2005 to 2010. The review was conducted in 2011. The analysis described reported HIV and AIDS cases in thegeneral population, median prevalence of HIV among pregnant women (15-49years), and AIDS related mortalities. Also, number of clients on ART, and those lost to follow up was analyzed. These characteristics were disaggregated by sex, age groupings, location andby administrative regions. Department of Community Health, University of Ghana Medical School, College of Health Sciences, Korle-Bu,Accra, Ghana.Results: The review demonstrated an increasing trend in the annual new HIV+ cases. However, the median HIV prevalence amongst pregnant women over the period was declining. There were clear age and regional or urban/rural differences in HIV prevalencein the country. National coverage for ART was 26% in 2009 and 35.2% in 2010. Number of clients on ART lost to follow up increased over the period, especially from 2008 onwards; it was 4.9% in 2008 and 9.2% in 2009. Over the entire review period (2005-2010), number of patients lost to follow up was over a hundred fold.Conclusion: Ghana has made good progress in combating the HIV and AIDS epidemic, however there are challenges. National coverage of ART was low, and patients lost to follow up were high. The unmet need for ART though comparable to that of otherAfrican countries, poses major challenges to Ghana’s quest to reverse the HIV epidemic. Policy measures to increase ART coverage and limit loss-to-follow up are still paramount.