Using programmatic data to assess pediatric service coverage and HIV treatment cascades in Western region, Ghana

BACKGROUND: In 2019, 2,972 (15%) of new 20,068 HIV infections in Ghana were in children under the age of 14. Out of the estimated number of 13,616 annual deaths, 2,441 (18%) were children. To address this critical issue, opportunities for identifying and supporting infants and young children living with HIV early cannot be missed. There is need to review program data to inform innovative strategies for testing and putting pediatrics and adolescents left behind on HIV treatment.
METHODS: The USAID Strengthening the Care Continuum project (Care Continuum), implemented by JSI Research & Training Institute, Inc. reviewed program data of pediatric clients on ART from January 2019 to December 2021. Within the period we analyzed the number of: pediatric HIV testing for males and females, positivity rates, linkage and yield; ART facilities and the number offering pediatric ARVs; pediatrics who received VL results; and suppressed and unsuppressed clients.
RESULTS: We assessed service utilization in 58 ART pediatric service facilities out of 76 ART sites (76%), testing 8,539 females and 7,601 males. The data for females and males were as follows, respectively: positivity rates of 1.98% (n=169) and 2.26% (n=172); initiation rates of 2.1% (n=179) and 2.49% (n=189); HIV yield of 28% and 26%; average linkage rate of 193.5% and 218.4%; VL suppression rates of 91% (n=597) and 88% (n=304); and pediatric client unsuppressed VL of 26% and 42%. Data were collected through the District Health Information Management System (DHMIS), which aggregates clients who were identified as positive, plus new positive clients. This accounts for higher percentage of initiated clients than new positive clients.
CONCLUSIONS: Early initiation of antiretroviral drugs in infants with HIV can save lives. However, coverage of essential interventions remains low. This study illuminates that late VL sample receipt of VL results due to faulty PCR machines and sample transport delays VL result entry, leading to inflated linkage rates and skewed VL coverage data. This impacts decision-making. ANC units can address this by sending client folders to RCH when mothers transition to RCH for services.

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