Aids.ghana

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Aids.ghana

  1. 1. <ul><li>HIV INFECTION IN Ghana </li></ul><ul><li>Current Strategies </li></ul><ul><li>Current stategies and prevention </li></ul>
  2. 2. General Data <ul><li>Ghana’s population = 22,000,000 </li></ul><ul><li>Total cumulative cases of HIV/AIDS=14 385 </li></ul>
  3. 3. Overview <ul><li>Cumulative HIV + AIDS = 14 385 </li></ul><ul><li>Living with HIV + AIDS = 10 278 </li></ul><ul><li>Children living with HIV / AIDS = 7 797 </li></ul><ul><li>Under treatment = 5 547 </li></ul><ul><li> </li></ul>
  4. 4. Trends for Romania <ul><li>maintenance of a high number of new pediatric cases (born between 1987 – 1990), with the disappearance of non-vertical transmission after 1994 and an increase in vertical transmission; </li></ul><ul><li>a rapid increase of the number of new adult cases (especially in young adults), involving heterosexual transmission; </li></ul>
  5. 5. Trends for Ghana <ul><li>an overall increase of the number of HIV positive persons who seek medical care and ARV therapy, that means increasing life expectancy, decreasing mortality, improving the quality of life in HIV / AIDS patients, increasing adherence and compliance to therapy; </li></ul><ul><li>Ghana has a Surveillance and Monitoring Program, developed through 9 Regional Centers; </li></ul>
  6. 6. Trends for Ghana cont. <ul><li>Each center has a Day Clinic for children and adults; </li></ul><ul><li>In our Day Clinic for HIV Children we have registered 985 cases; 610 of them being active cases; mean age is12 – 14 years old; </li></ul><ul><li>198 children benefit by psychological services: psychotherapy – specific interventions to factors causing behavioral disturbances, family counseling throughout the entire disease process, preparing the family and the infected child / adolescent for disclosure , supportive counseling in the terminal stage, continued after the child’s death / loss and grieving. </li></ul>
  7. 7. National HIV / AIDS strategy <ul><li>The last one adopted: 2002 / Low no. 584 </li></ul><ul><li>Partners: </li></ul><ul><ul><ul><li>Government (MNAC): MOH, Education, Defense, Interior, Justice, Youth and Sports, Labour, Finance; </li></ul></ul></ul><ul><ul><ul><li>National Heath Insurance System </li></ul></ul></ul><ul><ul><ul><li>NGO,s </li></ul></ul></ul><ul><ul><ul><li>UN system </li></ul></ul></ul><ul><ul><ul><li>World Bank / Global Fund / PHARE </li></ul></ul></ul><ul><ul><ul><li>Drug Companies: MSD, GSK , BMS, Roche, Abbott, BI </li></ul></ul></ul>
  8. 8. National HIV / AIDS strategy (cont.) <ul><li>Priority areas: </li></ul><ul><ul><ul><li>youth </li></ul></ul></ul><ul><ul><ul><li>vulnerable and disadvantaged groups (sexworkers, homosexuals, IDUs, rroma population, prisoners) </li></ul></ul></ul><ul><ul><ul><li>nosocomial infection control </li></ul></ul></ul><ul><ul><ul><li>health care </li></ul></ul></ul><ul><ul><ul><li>social support </li></ul></ul></ul><ul><ul><ul><li>epidemilogy: testing policies and surveillance </li></ul></ul></ul><ul><ul><ul><li>education </li></ul></ul></ul>
  9. 9. Challenges <ul><ul><ul><li>increasing number of IDU,s </li></ul></ul></ul><ul><ul><ul><li>tuberculosis and HIV / AIDS interaction </li></ul></ul></ul><ul><ul><ul><li>increasing number of STI,s </li></ul></ul></ul><ul><ul><ul><li>the children cohort  adolescents </li></ul></ul></ul><ul><ul><ul><li>human rights issues (eg. discrimination, confidentiality) </li></ul></ul></ul>
  10. 10. The National Program for the Prevention of HIV Infection <ul><li>Sexual Education Programs for General Population </li></ul><ul><ul><li>leaflets; </li></ul></ul><ul><ul><li>condoms; </li></ul></ul><ul><ul><li>TV and Radio broadcasts; </li></ul></ul><ul><ul><li>health education in schools. </li></ul></ul><ul><li>Sexual Education Programs for High Risk Groups </li></ul><ul><ul><li>sex workers; </li></ul></ul><ul><ul><li>homosexuals; </li></ul></ul><ul><ul><li>street children; </li></ul></ul><ul><ul><li>IDU,s. </li></ul></ul>
  11. 11. The National Program for the Prevention of HIV Infection (cont.) <ul><li>Prevention of Vertical Transmission </li></ul><ul><li>HIV screening in areas with a high incidence of HIV infection. </li></ul><ul><li>HIV testing is strongly recommended for pregnant women, but it is not mandatory. </li></ul><ul><li>ARV treatment for HIV pregnant woman </li></ul><ul><li>ARV profilaxis for the new-born </li></ul><ul><li>Avoiding breastfeeding / Milk formula for the new-born </li></ul>
  12. 12. Methodology of pregnant woman testing PREGNANT WOMAN FAMILY DOCTOR PSYCHOLOGIST SOCIAL WORKER GINECOLOGYST INFECTIONIST COUNSELOR HIV TEST RESULT ACREDITATED LAB TEST ACCEPTED 1 2 3 4 5 6 7 8 9 10 Prevention of HIV MTCT
  13. 13. Vertical transmission by year of diagnosis Total: 477
  14. 14. The National Program for the Prevention of HIV Infection (cont.) <ul><li>Increasing number of IDU,s; </li></ul><ul><li>Estimated number: 33 000 persons; </li></ul><ul><li>HIV infected IDU,s: 5; </li></ul><ul><li>Harm reduction programs: </li></ul><ul><li>- Romanian Harm Reduction Network </li></ul><ul><li>- decreasing of at-risk behaviors associated to drugs use; </li></ul><ul><li>- prevention of HIV, HBV, HCV transmission among IDU,s </li></ul><ul><li>(needle exchange, testing, vaccination, treatment, </li></ul><ul><li>psychological counseling) </li></ul><ul><li>- Romanian Anti- Drug Agency (strategies and policies) </li></ul>
  15. 15. The National Program for the Prevention of HIV Infection (cont.) <ul><li>Blood donors </li></ul><ul><li>Since 1990 all donated blood is mandatory tested for: </li></ul><ul><li>HIV, HBV, HCV, syphilis; </li></ul><ul><li>All donors for transplantation are tested, too. </li></ul>
  16. 16. Blood donors
  17. 17. The National Program for the Prevention of HIV Infection (cont.) <ul><li>TB patients </li></ul><ul><li>Since 1995 MOH ordered HIV testing with counseling for all TB persons; </li></ul><ul><li>All HIV persons are investigated for TB. </li></ul>
  18. 18. TB patients
  19. 19. The incidence of syphilis
  20. 20. STI,s patients
  21. 21. Medical Care and Monitoring <ul><li>Generally , in hospitals for infectious diseases; </li></ul><ul><li>The associated conditions to HIV infection are treated in clinics of infectious diseases, TB, STI’s and other specialized clinics; </li></ul>
  22. 22. ARV Treatment in Romania <ul><li>ARV therapy was introduced in 1995 (ZDV); </li></ul><ul><li>In 1996, double therapy with ZDV+ddC was introduced; </li></ul><ul><li>Followed by ZDV+3TC in 1997; </li></ul><ul><li>Since late 1997, triple therapy (2 NRTI+1IP) became operational (HAART); </li></ul><ul><li>1998 - the first edition of the“Guide to HIV/AIDS Therapy”. </li></ul>
  23. 23. Principles of ARV Therapy <ul><ul><ul><li>non-discrimination, </li></ul></ul></ul><ul><ul><ul><li>solidarity, </li></ul></ul></ul><ul><ul><ul><li>cost-effectiveness, </li></ul></ul></ul><ul><ul><ul><li>optimum quality </li></ul></ul></ul>ARV Therapy Goals <ul><li>Increasing life expectancy; </li></ul><ul><li>Decreasing mortality; </li></ul><ul><li>Decreasing morbidity through AIDS-related diseases; </li></ul><ul><li>Improving the quality of life in HIV/AIDS patients; </li></ul><ul><li>Increasing adherence to therapy; </li></ul><ul><li>Increasing compliance to therapy; </li></ul><ul><li>Facilitating access to ARV therapy for eligible patients. </li></ul>
  24. 24. ARV Therapy Initiation Criteria <ul><li>Since May 1999, the MOH National AIDS Commission recommends that ARV therapy be initiated according to the following criteria: </li></ul><ul><ul><li>Clinical: </li></ul></ul><ul><ul><ul><li>symptomatic HIV infection </li></ul></ul></ul><ul><ul><ul><li>non-symptomatic HIV infection + immunological criteria </li></ul></ul></ul><ul><ul><ul><li>non-symptomatic HIV infection + virological criteria. </li></ul></ul></ul><ul><ul><li>Immunological: CD4 count<350 cells/mm 3 . </li></ul></ul><ul><ul><li>Virological: HIV-RNA> 50,000 copies/ml. </li></ul></ul>
  25. 25. Factors Ensuring Access to ARV Therapy <ul><li>The political commitment, stated in the program of the current government, to increase access to ARV therapy for the HIV persons; </li></ul><ul><li>Reinforcement of the national capacity to provide preventive and therapeutic strategies; </li></ul><ul><li>Involvement of all social segments (government, non-governmental organizations, pharmaceutical industry, local administration, etc.). </li></ul>
  26. 26. Psychological perspective on priorities and needs in HIV / AIDS <ul><li>pre-testing counseling </li></ul><ul><li>post-testing counseling </li></ul><ul><li>psychotherapy – specific interventions to factors causing behavioural disturbances </li></ul><ul><li>family counseling throughout the entire disease process </li></ul><ul><li>preparing the family and the infected child for disclosure </li></ul><ul><li>supportive counseling in the terminal stage, continued after the child’s death / loss and grieving </li></ul>
  27. 27. Disclosure the diagnosis / Assumptions <ul><li>the child handles the disease in a more appropriate manner if: </li></ul><ul><li>- he is part of the clinical process </li></ul><ul><li>- understands what is happening to him develops trust towards the adults protect him and learns to adjust; </li></ul><ul><li>so </li></ul><ul><li>the child’s life expectancy improves: * the imminent death concept has disappeared, * letting the child know about the diagnosis provides him with new capabilities to face the difficulties associated with HIV infection, * representations are changing; </li></ul>

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