Temporal trend analysis of the HIV/AIDS burden before and after the implementation of antiretroviral therapy at the population level from 1990 to 2020 in Ghana

Abstract

Background Antiretroviral therapy (ART) has helped reduce the burden of human immunodeficiency virus (HIV) and acquired immune deficiency syndrome (AIDS) in the majority of countries. Its contribution to the HIV/AIDS burden in Ghana is still understudied. This study examined HIV/AIDS trends in Ghana before (1990–2004) and after (2004–2020) the implementation and expansion of ART. Methods We obtained HIV/AIDS epidemiology and treatment data for the years 1990–2020 from the United Nations Programme on HIV/AIDS. We investigated the impact of the ART rollout on HIV/AIDS in Ghana using Joinpoint regression models. Results The HIV incidence, prevalence, and AIDS-related deaths decreased significantly after 2004, as ART coverage increased from 1% to 2004 to 60% in 2020. The HIV incidence decreased by approximately 3% (AAPC = -2.6%; 95% CI: -3.2, -1.9) per year from 1990 to 2004 and approximately 5% (AAPC = -4.5%; 95% CI: -4.9, -4.2) per year from 2004 to 2020. Between 1990 and 2004, the HIV prevalence increased by approximately 5% (AAPC = 4.7%; 95% CI: 3.6, 5.8) per year but decreased by 2% (AAPC = -1.9%; 95% CI: -2.1, -1.6) per year between 2004 and 2020. Between 1990 and 2004, the annual increase in AIDS-related mortality was 14% (AAPC = 13.8%; 95% CI: 12.6, 15.0), but between 2004 and 2020, it decreased at nearly a 4% (AAPC= -3.6%; 95% CI: -4.7, -2.5) annual rate. Conclusions We found trends indicating progress in Ghana’s fight against HIV/AIDS. However, the most significant declines occurred after the introduction of ART, suggesting that the scale-up of ART may have contributed to the decline in HIV/AIDS in Ghana. We advocate for the rapid expansion of ART in Ghana.

Achieving the UNAIDS 95-95-95 treatment target by 2025 in Ghana: a myth or a reality?

“…Coupled with the introduction of ART, these measures have significantly contributed to Ghana’s reduction in new HIV infections. Notably, adult HIV incidence decreased by 5% from 2004 to 2020 [ 7 , 17 ]. Nonetheless, further improvements are needed to strengthen Ghana’s HIV prevention efforts.…”

“…These efforts have yielded positive outcomes, including increased awareness, improved access to ART, and a reduction in new infections over the years [ 6 , 16 ]. For instance, the national HIV incidence among adults has decreased by 5% from 2004 to 2020 [ 17 ]. Moreover, a report from WHO [ 15 ] also showed that linkage to ART improved from 85% to 99% in a polyclinic in the Greater Accra region a year after the DSD SI initiative.…”