Evaluating 2009 HIV Sentinel Survey

The National HIV Sentinel Survey (HSS), conducted annually, is a useful tool to observe trends, reinforce or increase the commitment to accelerate implementation and provide feedback for health workers, as well as local and international groups involved in AIDS prevention programmes.
In the last five years, HSS data have been used as the primary data source for the national HIV and AIDS estimate in Ghana.
The sentinel survey is a cross-sectional survey targeting pregnant women attending antenatal clinics (ANC) in selected ANC sites in Ghana. The surveillance system was initiated based on the premise that prevalence of HIV among pregnant women was a good proxy indicator of the spread of the infection among the populace.
At a day’s workshop to disseminate the 2009 HSS in Accra, on Monday March 15, it came out that the estimated percentage of new HIV cases in Ghana increased to 1.9 per cent in 2009 from 1.7 per cent in 2008.
Also the HIV prevalence among pregnant women attending antenatal clinics was 2.9 per cent representing a 31 per cent increase of 2.2 per cent in 2008.
Addressing participants in the dissemination workshop where facts and figures of the 2009 HIV Sentinel Survey and National HIV and AIDS Prevalence Estimates were released, the Programme Manager of the National AIDS/STI Control Programme, Dr Nii Akwei Addo, maintained that despite the increase in prevalence of HIV in 2009, Ghana’s epidemic was still on the low side.
He was, however, quick to add that more effort was required by all stakeholders to keep the HIV prevalence on further decline, since complacency would erode the progress made so far.
For the survey, a total of 18,833 samples were collected from 69 antenatal clinics (ANCs) located in 40 sentinel sites (23 urban and 17 rural) across the country and records on 18,809 were analysed.
Dr Addo said there were an estimated 267,069 persons comprising 112,457 males and 154,612 females living with HIV and AIDS in Ghana and 25,666 of that were children; 12,579 being females.
Additionally, there were 22,177 new infections and 20,313 AIDS deaths with 2,566 being children.
The HIV site prevalence ranged from 0.7 per cent in North Tongu (rural) to 5.8 per cent in Koforidua and Agomanya (urban).
Dr Addo pointed out that interestingly, Agomanya saw a drop in prevalence from 2008’s figure of eight per cent to 5.8 per cent but still maintained its position as the site with the highest prevalence with Koforidua. Again, although Fanteakwa’s prevalence dropped to four per cent, it still remained the rural site with highest prevalence.
It also came out that all the regions with the exception of the Eastern Region recorded an increase in prevalence over 2008, Upper West Region recorded the highest increase of 3.1 per cent from 1.6 per cent. However, Eastern Region continues to be the region with the highest prevalence level.
For the age group, 40 to 44 years recorded the highest prevalence of four per cent while the 15-19 year group had the least prevalence of 1.9 per cent. Prevalence among the youth of age group 15-24 years which is used as a marker for new infections was 2.1 per cent.
According to the report, 91.8 per cent of the HIV positive samples were HIV type I; HIV type II was 5.2 per cent while HIV types I and II was three per cent.
Dr Addo said the country was gradually getting more HIV type II and HIV types I and II and considerations for a review of national antiretrovirals (ART) guidelines must take this trend into account given the limited regimens available for managing HIV type II.
For syphilis, the survey came out that the Central Region remained the region with the highest syphilis prevalence and Asikuma Odoben Brakwa (rural) the site with the highest prevalence.
The report indicated that rural areas continued to have higher syphilis prevalence than urban areas.
HIV prevalence among Sexually Transmitted Infections (STI) clients was almost halved from 10.5 per cent in 2008 to 5.5 per cent in 2009 due to decreases at both the Adabraka and Kumasi sites.
Dr Addo stated that while the number of AIDS deaths was expected to decline, the number of people living with HIV was expected to increase gradually with improved access to ART taking into consideration the emergence of new infections.
He said more persons living with HIV would need ART and co-trimoxazole prophylaxis but the demand for these medications in children was expected to decline as the risk of Mother-to-Child transmission of HIV was reduced through PMTCT intervention.
For his part, the Deputy Minister of Health, Mr Rojo Mettle-Nunoo, said the results of the survey remained an important indicator for monitoring the trend of the disease in the country and provide useful information for policy intervention.
He cautioned against complacency in order not to erode the gains made so far, saying “the more we reduce the prevalence, the more we must work hard to keep it low”.