Towards elimination of mother-to-child transmission of HIV in Ghana: An analysis of national programme data

  • International Journal for Equity in Health, Volume 15, No. 1, Year 2016

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Study Justification:
– Despite global efforts to prevent mother-to-child transmission of HIV, there are still high rates of pediatric HIV infections in resource-constrained settings.
– Sub-Saharan Africa, including Ghana, contributes more than 90% of the global burden of mother-to-child transmission.
– In 2009, Ghana was identified as a country needing rapid scale-up of interventions for preventing mother-to-child transmission.
– This study aims to analyze national program data in Ghana to identify regional disparities, trends, and missed opportunities in preventing mother-to-child transmission of HIV.
– The findings will inform efforts to scale up HIV-related maternal and child health services and eliminate mother-to-child transmission by 2015.
Highlights:
– HIV prevalence among pregnant women in Ghana has declined.
– However, the percentage of untested antenatal clinic registrants increased from 17% in 2011 to 25% in 2013.
– There were varying levels of missed opportunities for testing pregnant women across the ten administrative regions, resulting in a total of 487,725 untested clients during the study period.
– In 2013, the Greater Accra, Northern, and Volta regions had high percentages of untested clients.
– The percentage of HIV positive pregnant women initiated on antiretroviral therapy (ARVs) increased from 57% in 2011 to 82% in 2013.
– However, in 2013, about a third (33%) of HIV positive pregnant women in the Volta and Northern regions did not receive ARVs.
Recommendations:
– Increase efforts to test pregnant women for HIV across all regions in Ghana to reduce missed opportunities for testing.
– Improve access to and utilization of HIV-related maternal and child health services, particularly in regions with high percentages of untested clients and low ARV initiation rates.
– Strengthen primary care systems for maternal and child health to ensure continuous and equitable access to care.
– Enhance national and regional efforts to improve maternal and child healthcare delivery and HIV-related care.
Key Role Players:
– National AIDS/STI Control Programme (NACP)
– Regional health authorities
– Antenatal clinic staff
– HIV testing and counseling providers
– Maternal and child health service providers
– Policy makers and government officials
Cost Items for Planning Recommendations:
– Training and capacity building for healthcare providers on HIV testing and counseling
– Procurement and distribution of HIV testing kits
– Provision of antiretroviral therapy for HIV positive pregnant women
– Strengthening of primary care systems for maternal and child health
– Monitoring and evaluation of program implementation
– Public awareness campaigns and community engagement activities

The strength of evidence for this abstract is 7 out of 10.
The evidence in the abstract is moderately strong. The study provides a comprehensive analysis of national program data in Ghana to describe regional disparities and national trends in key PMTCT indicators. The data covers a period of 3 years and includes information on ANC registrants, utilization of HIV testing and counseling, number of HIV positive pregnant women, and number of HIV positive pregnant women initiated on ARVs. Descriptive statistics are used to determine gaps in the utilization of PMTCT services. However, the abstract does not provide information on the sample size or the methodology used to collect the data. To improve the strength of the evidence, the authors could provide more details on the study design, sample size, and data collection methods.

Background: Despite 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. Methods: Data 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. Results: Although 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. Conclusions: Missed 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 paramount for ensuring equitable access across the country.

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Innovation 1: Mobile HIV Testing Units

Description: Implement mobile HIV testing units that can travel to regions with high percentages of untested ANC clients. These units can provide on-site HIV testing and counseling services, making it more convenient for pregnant women to access testing. The units can be equipped with trained healthcare providers, testing kits, and counseling materials. This innovation aims to increase the uptake of HIV testing among pregnant women in regions with limited access to healthcare facilities.

Innovation 2: Task Shifting and Training

Description: Implement task shifting strategies to address the shortage of healthcare providers trained in HIV testing and counseling. This can involve training and empowering nurses, midwives, and community health workers to provide HIV testing and counseling services. By expanding the pool of healthcare providers who can offer these services, more pregnant women can be reached and tested for HIV. Training programs can be developed and implemented to ensure that healthcare providers have the necessary skills and knowledge to conduct HIV testing and counseling effectively.

Innovation 3: Peer Support Programs

Description: Establish peer support programs for pregnant women living with HIV. These programs can provide emotional support, education, and guidance to HIV-positive pregnant women, helping them navigate the challenges of living with HIV during pregnancy and motherhood. Peer support can be provided through support groups, one-on-one mentoring, or online platforms. By connecting HIV-positive pregnant women with peers who have similar experiences, these programs can help reduce stigma, improve adherence to ARV treatment, and promote overall well-being.

Innovation 4: Strengthening Referral Systems

Description: Strengthen referral systems between antenatal clinics and HIV treatment centers. This can involve establishing clear protocols and communication channels to ensure that pregnant women who test positive for HIV are promptly referred to treatment centers for initiation on ARVs. Training healthcare providers on the importance of timely referrals and establishing mechanisms for tracking referrals can help ensure that HIV-positive pregnant women receive the necessary treatment and care.

These innovations aim to address the regional disparities and missed opportunities for testing pregnant women and treating those who are HIV positive, ultimately improving access to maternal health and reducing mother-to-child transmission of HIV in Ghana.
AI Innovations Description
Based on the information provided, here is a recommendation that can be developed into an innovation to improve access to maternal health:

Recommendation: Implement targeted interventions to address regional disparities and missed opportunities for testing pregnant women and treating those who are HIV positive.

Explanation: The study highlights regional disparities and missed opportunities for testing pregnant women and providing antiretroviral treatment (ARVs) to HIV-positive pregnant women in Ghana. To improve access to maternal health, it is recommended to implement targeted interventions that specifically address these issues. This can include:

1. Regional-specific strategies: Develop and implement strategies tailored to each region to address the varying levels of missed opportunities for testing pregnant women. This can involve increasing awareness and education about the importance of HIV testing during antenatal care visits, training healthcare providers on HIV testing and counseling, and improving access to testing facilities in regions with high percentages of untested ANC clients.

2. Strengthening healthcare systems: Invest in strengthening the healthcare system, particularly in regions with high percentages of untested ANC clients and HIV-positive pregnant women not receiving ARVs. This can involve improving infrastructure, ensuring an adequate supply of HIV testing kits and ARVs, and training healthcare providers on PMTCT services.

3. Community engagement: Engage communities in promoting HIV testing and PMTCT services. This can involve community outreach programs, involving community leaders and influencers in spreading awareness about the importance of HIV testing and treatment, and addressing cultural and social barriers that may hinder access to maternal health services.

4. Monitoring and evaluation: Establish a robust monitoring and evaluation system to track the progress of interventions and identify areas that require further improvement. This can involve regular data collection and analysis, feedback mechanisms, and accountability measures to ensure the effectiveness of the implemented interventions.

By implementing these targeted interventions, it is expected that access to maternal health, particularly in relation to HIV testing and treatment, will be improved, leading to a reduction in mother-to-child transmission of HIV in Ghana.
AI Innovations Methodology
To simulate the impact of the main recommendations on improving access to maternal health, the following methodology can be used:

1. Data collection: Gather data on key indicators related to maternal health and HIV testing and treatment from the National AIDS/STI Control Programme (NACP) regional disaggregated records. This includes the 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. The data should cover a period of at least three years to capture trends over time (e.g., 2011-2013).

2. Data analysis: Analyze the collected data using statistical software such as Microsoft Excel. Calculate simple frequencies, proportions, and percentages to determine the gaps in the utilization of PMTCT services and identify regional disparities and missed opportunities for testing and treatment.

3. Baseline assessment: Establish a baseline by comparing the indicators across the ten administrative regions in Ghana. This will help identify regions with the highest percentages of untested ANC clients and HIV-positive pregnant women not receiving ARVs.

4. Intervention implementation: Implement the recommended targeted interventions in regions with the highest percentages of untested ANC clients and HIV-positive pregnant women not receiving ARVs. This can involve regional-specific strategies, strengthening healthcare systems, community engagement, and monitoring and evaluation.

5. Monitoring and evaluation: Establish a monitoring and evaluation system to track the progress of the implemented interventions. Regularly collect and analyze data on key indicators to assess the impact of the interventions on improving access to maternal health. This can involve comparing the indicators before and after the implementation of the interventions and assessing the changes in regional disparities and missed opportunities for testing and treatment.

6. Analysis of results: Analyze the data collected after the implementation of the interventions to determine the impact on improving access to maternal health. Calculate the changes in the percentages of untested ANC clients and HIV-positive pregnant women not receiving ARVs. Assess if the targeted interventions have reduced regional disparities and missed opportunities for testing and treatment.

7. Reporting and dissemination: Prepare a report summarizing the findings of the simulation and the impact of the recommended interventions. Share the results with relevant stakeholders, including policymakers, healthcare providers, and community leaders, to inform decision-making and further actions to improve access to maternal health.

By following this methodology, it will be possible to simulate the impact of the main recommendations on improving access to maternal health and assess the effectiveness of the interventions in reducing regional disparities and missed opportunities for testing and treatment.

Statistics:
Citations: 11
Authors: 6
Identifiers:
DOI: 10.1186/s12939-016-0300-5
Research Areas:
Community Interventions, Disparities, Health System and Policy, Infectious Diseases, Maternal and Child Health, Quality of Care, Sexual and Reproductive Health
Study Countries:
Ghana
Study Design:
Cross Sectional Study
Study Approach:
Quantitative
Participants Gender:
Female
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