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4th Regional Advisory Panel on TAP Accra, Ghana January 18th 19th 2007 GHANA Status of TAP Implemen

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4th Regional Advisory Panel on TAP Accra, Ghana January 18th 19th 2007 GHANA Status of TAP Implemen

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    1. 4th Regional Advisory Panel on TAP Accra, Ghana January 18th – 19th 2007 GHANA *Status of TAP Implementation *PMTCT Update *Drug Resistance Monitoring

    2. PART I Status of TAP Implementation in Ghana

    3. HIV/AIDS in Ghana Population 20+ M people HIV/AIDS burden Prevalence: 2.7% (2005) 270,000 PLWH (2005) 53,000 in need of treatment (2005) Number on ART: 6200 (Sept 2006)

    4. HIV/AIDS in Ghana Cost of Treatment VCT: 5000 cedis ($.50) PMTCT: Free Clinical care: 50,000 cedis $5 / month Funding Government of Ghana Global Fund World Bank DfID GTZ

    5. HIV/AIDS in Ghana

    6. HIV/AIDS in Ghana

    7. Kakum National Park, Central Region

    8. TAP Public and Private Sector Partners Public sector NACP/MOH/GHS Mandate: HIV treatment, care and support Private sector TAP implementing partners Family Health International (FHI) Worldwide TA in HIV/AIDS Piloted ART in Ghana – June 2003 National Catholic Health Service (NCHS) Responsible for 25% health delivery Pioneer in home based care Private Enterprises Foundation (PEF) Workplace HIV/AIDS programmes Private sector mobilization in HIV care

    9. TAP Achievements : Scaling up HIV Care FHI 4 private protégé sites VCT, PMTCT, OI, ART Outreach programmes Radio Private maternity homes: PMTCT Surrounding small scale enterprises : peer education Community linkages

    10. TAP Achievements : Scaling up HIV Care

    11. TAP Achievements : Scaling up HIV Care NCHS Teams trained Refurbishment ongoing 6 accredited treatment centers VCT, PMTCT, OI ART (5 sites) Home Based Care programmes (5 sites)

    13. TAP Achievements Private Enterprise Foundation Newly recruited IP: Sept 2006 Private sector mobilization in HIV care Baseline survey of businesses conducted Interventions among businesses Longitudinal surveys

    14. TAP Achievements: Strengthening Institutional Capacity WHO Technical Advisory Services 2 new TO recruited (total 3) TA for adaptation of IMAI training manuals Support for drawing up HIV drug resistance monitoring plan/protocol Ongoing support for Technical Working Group on ART Support for monitoring HIV drug resistance

    15. TAP Achievements : Regional Learning Participation in RAP meetings Documentation of lessons from TAP implementation PEF contribution to TAP learning agenda Participation in household surveys

    16. Upper Wli Falls, Hohoe, Volta Region

    17. TAP Challenges Private sector facilities under TAP Synchronization with national programme Figuring out “after TAP” : service continuity after TAP Capacity building at TAP sites Public sector constraints Delay in procurement of equipment and logistics PEF – late entrant Taking advantage of WHO technical support

    18. Way Forward Continue comprehensive HIV care roll out in TAP sites Documentation of TAP learning experiences Move household survey forward TAP into WHO technical assistance HIV drug resistance monitoring Complete IMAI manual adaptation for training Set up M & E system

    19. Thank You

    20. Ghana’s PMTCT

    21. New PMTCT Direction HIV testing for pregnant women Use of Highly Active Anti-Retroviral Treatment (HAART) in HIV+ pregnant women Use of (HAART) in infants of HIV+ women

    22. HIV testing for pregnant women: Principal rule Offer all pregnant women HIV testing as part of initial and subsequent ANC counselling Routine offer of HIV testing not routine testing Diagnostic counselling and testing. All routine offer of counselling and testing shall be undertaken by counsellors

    23. Criteria for establishing need: The role of CD4 All HIV-infected pregnant women shall be evaluated using the CD4 count. Where CD4 not available use WHO clinical staging

    24. Antiretroviral Therapy in Pregnancy All HIV positive pregnant women CD4 cell count <350, irrespective of clinical stage: Treat with HAART. All HIV positive pregnant women with WHO Clinical Stage III and IV, irrespective of CD4 count: Treat with HAART All HIV positive pregnant women CD4 cell count >350: ARV prophylaxis from 28 weeks

    25. HAART in Infants of HIV+ Women: Prophylaxis Regimen for PMTCT Infant: Single-dose NVP within 72 hrs of delivery plus One week of Zidovudine/Lamivudine twice daily. N/B Where mother receives less than four weeks of prophylaxis, extend infant’s Zidovudine/Lamivudine to six (6) weeks

    26. Achieving New PMTCT Direction: Steps Taken HIV Testing by Counsellors New PMTCT Training Package Training

    27. HIV Testing by Counsellors Training of all counsellors in HIV testing ongoing Testing algorithm Serial testing using two rapid HIV testing kits First test Determine HIV 1&2 Confirmation of reactive samples Oraquick orasure HIV 1/2 rapid HIV-1/2 antibody test

    28. New PMTCT Training Package Adaptation of WHO/CDC PMTCT training package using national guidelines Specific Interventions to Prevent MTCT HIV Counselling and Testing for PMTCT Infant and Young Child Feeding in the Context of HIV Infection. Stigma and Discrimination Related to MTCT of HIV Linkages to Treatment, Care, and Support for Mothers, their Partners and Families with HIV Infection

    29. Training Training of trainers (TOT) 2006 Three TOT for regional trainers Roll out in 2007 Refresher for already trained counsellors & midwives Training in new PMTCT direction for untrained staff

    30. New PMTCT Direction: Challenges Training Reorganization of ANC services Space for testing Logistics Establishing linkages Antenatal Clinics Child Welfare Clinics ART sites

    31. Thank you

    32. HIV Drug Resistance Monitoring in Ghana: Update

    33. As at the 3rd RAP…… Experience in Resistance Monitoring Pilot Resistance Study October 2003 Sequencer procured – TAP funds Building local capacity in resistance testing for HIV Plans of forming drug resistance expert committee

    34. HIV Drug Resistance Monitoring in Ghana: Update Strategies for Monitoring HIVDR National HIVDR Working Group Development of the detailed National HIVDR Strategy /Plan HIVDR prevention activities Identify and agree on HIVDR Early Warning Indicators (EWI) Surveillance of transmitted HIVDR Build capacity in-country for HIVDR monitoring

    35. Strategies for Monitoring HIVDR National Expert Committee on HIVDR formed July 2006 Mandate Provide TA towards HIV DR surveillance and monitoring in Ghana Responsible for development and implementation of work plan for HIVDR Build capacity for HIVDR through site training review of guidelines, manuals adaptation of protocols.

    36. Strategies for Monitoring HIVDR Development of the detailed National HIVDR Strategy /Plan Update National Expert Committee on HIV DR – first draft TA from WHO-AFRO and HQ Submitted to consensus meeting Finalization stage

    37. Strategies for Monitoring HIVDR HIVDR prevention activities - good ART scale up program Ghana’s ART Scale up Plan Capacity building Provision of drugs Site accreditation etc Incorporation of HIVDR Prevention into ART scale up plans National first/second line drug supply, ART according to guidelines, Adherence support measures in place etc.

    38. Strategies for Monitoring HIVDR Identify and agree on HIVDR Early Warning Indicators (EWI) Activities National targets for EWIs set (Nov 2006) Set up data systems and managers at sites by December 2006 Train data managers and sensitize site staff from (scheduled January 2007) Begin data collection by March 2007 Collect, collate and analyze data from all other sites by June 2008 Establish meetings for the dissemination of information on EWI

    39. Strategies for Monitoring HIVDR Surveillance of transmitted HIVDR Draft protocol developed Site assessment of 2 pilot facilities Build capacity in operational procedures for survey Designation of genotypying laboratory Surveillance initiation during 2007 HIV Sentinel Survey

    40. Strategies for Monitoring HIVDR Monitor HIVDR emerging in cohorts starting ART by December 2007 Seek TA for development of country protocols 5 sites identified (ART first initiated) Develop training manuals and guidelines by March 2007 Capacity building Recruit cohort and follow for one year Collect plasma for monitoring and surveillance by December 2008

    41. Strategies for Monitoring HIVDR Build capacity in-country for HIVDR monitoring Genetic analyzer procured (TAP) Establish HIV genotypic methodology Oct 2007 Establish links with at least one HIVDR ResNet laboratory for QA/QC Build staff capacity staff by Oct 2007 Request for inspection for accreditation as a ResNet laboratory by Dec 2007 Begin HIV sequencing to detect HIVDR by March 2008 Request assessment of the laboratory by Dec 2008 for accreditation as an HIV RestNet laboratory

    42. Strategies for Monitoring HIVDR Regular reports on: HIVDR situation Contributing factors Recommendations for ART and HIV prevention and implementation programme adjustments Surveillance and monitoring planning for the following year

    43. Thank you

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