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Index Testing & Key Populations in Ghana

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These slides were presented by Dr. Henry Nagai during JSI’s Index Testing & Partner Notification for HIV Epidemic Control webinar on April 11th, 2019. Dr. Nagai is currently the Project Director/Chief of Party for the JSI-implemented USAID Strengthening the Care Continuum project in Ghana with a focus on HIV and key populations. Using funding from USAID and PEPFAR, the Project is improving the capacity of the Government of Ghana and civil society partners to provide quality and comprehensive HIV services for key populations and people living with HIV.

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Index Testing & Key Populations in Ghana

  1. 1. 1 Index Testing & Key Populations Henry Nagai, MD, MScCH Chief of Party, USAID Strengthening the Care Continuum Project April 11, 2019
  2. 2. 2 Ghana Epidemiologic Context • General population Prevalence - 1.67% (Nat. HIV and AIDS Estimates 2017) • ANC prevalence 2.1% (GHS/NACP, HSS 2017) • FSW Prevalence - 6.9% (GAC FSW/IBBSS 2015) • MSM Prevalence-18.1% (GAC GMSII 2018) • Annual New Infections - 22,110 (Nat. HIV and AIDS Estimates 2017) • Total PLHIV - 320,479 (Nat. HIV and AIDS Estimates 2017) • Annual AIDS related deaths - 13,416 (Nat. HIV and AIDS Estimates 2017)
  3. 3. 3 Summary Project Details: The Care Continuum Target Group Key populations (MSM, FSWs, Non-PP, KP-PLHIV, Transgender) Focus Regions Started in 2016 with 5 regions, including Eastern. Currently in Western, Greater Accra, Ashanti & Brong Ahafo No. Districts Started with 21, currently in 14 priority districts Award Value/Duration $18,449,066 for 5 years (March 2016-March 2021) Project Implementer JSI Research & Training Institute Inc. Sub-partner Population Council Project Staff 36 (16 Technical, 16 Finance and Admin, 4 Drivers) Grantees Stated with 13, currently working with 11 Civil Society Organizations (CSOs)
  4. 4. 4 PROJECT OBJECTIVES •Enhance technical capacity of Ghanaian stakeholders to implement evidence based HIV care and treatment activities •Improve capabilities and leadership of Ghanaian stakeholders at the community, district, and national levels to scale-up evidence-based activities •Increase access to, uptake of, and retention in HIV Continuum of Care services •Improve coordination and integration of activities among Ghanaian Stakeholders KEY STRATEGIES •Promote Ghanaian Leadership •Strengthen the capacity of stakeholders •Emphasize quality Improvement and effective use of data •Address structural factors related to key population service access and use •Integrate services and focus on referrals to achieve 90/90/90 •Address gender inequality THE GOAL To support the effort of GoG and its partners, in providing quality and comprehensive HIV services for key populations (including FSW, MSM, transgendered persons and their partners) and PLHIV using a coordinated and sustainable country- owned and led approach to improve access to and use of services for KPs
  5. 5. 5 The Need: IndexTesting Into the Strategic Mix • Low yield, at the start of the project due to old approaches by CSOs • Districts dropped from 21 (inherited from previous project) to 11 partly due to low positive yield • Introduction of microsite typology analysis and segmentation • Re-checking and Rethinking the basis/targets  Project need to explore ways to optimize testing based on panorama (data) analysis. • Unmet needs of existing networks found • Good yield from “social network testing” was proxy for success of index testing • Known and approved by WHO, but not adopted and adapted by Ghana so project has to act
  6. 6. 6 Process: A Five Stage Approach to Implementation Continuous feedback of the index testing approach with key stakeholders
  7. 7. Note:What Is IndexTesting? Index ≠ Household HIV-positive index client Sex partner(s) Needle sharing partner(s) Biologic children
  8. 8. Index Testing Schematic Flow
  9. 9. Categories of IndexTesting o Community: led by CSOs There are two forms: through group events organized for index cases and their partners or through targeted door-to-door testing for partners of index cases o Facility: led by CMs Case managers offer index testing to index cases and make follow-up visits for peer-led referrals for testing at a health facility
  10. 10. HIV + Yield for MSM & FSW Over Time
  11. 11. HIV + Yield for MSM & FSW Over Time: Regions
  12. 12. Age Distribution of HTS Clients
  13. 13. Evaluating & scaling high yield testing & treatment strategies Understanding the nuance of each KP’s reaction to the strategies in order to select the right combination of approaches and achieve results. * *The index testing for FSW was limited to their Non paying partners
  14. 14. 14 Field Challenges • Confidentiality o Who gave the information? • “First thoughts” Possible source of the infection and anger o Low literacy about index testing benefits o that is client centered to reduce transmission of infection. • Informing partner involve money, time psychological, energy • “ I don’t know how to do it”, can’t communicate with partner about status. • Feeling of guilt (have put partner and children at risk?)
  15. 15. 15 Way Forward • Advocacy and dialogue with the Ghana Health Service/Ministry of Health to adopt, adapt the tools and institutionalized Index Testing into the standard national testing options. • Using a human centered approach to generate ground-truthed list of barriers and enablers of Index Testing and contextualize tools for max impact. • Update training curriculum and scale up through training and capacity building of all actors involve in case finding at both facility and community levels. • Support all partners in country to prioritized Index Testing and other evidence based approaches which work.

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