Treatment Acceleration Program - TAP

Focal point - Dr Sally Ann Ohene

As part of the national effort to increase access to treatment and care, the World Bank in collaboration with the Ministry of Health/Ghana Health Service (GHS/MOH) is supporting the TAP. Operating within the context of the WHO’s ‘3 by 5’ initiative, TAP makes use of private/public partnerships in contributing to the national scale up of comprehensive HIV care service.

Collaboration is between the National AIDS/STI Control Program (NACP) of the GHS/MOH which is the public sector partner and private sector Implementing Partners (IP) Family Health International (FHI), the National Catholic Health Service (NCHS) and Private Enterprise Foundation (PEF). Uniquely, TAP also presents an opportunity to learn from this collaboration for the benefit of other countries. The TAP initiative is also being piloted in Mozambique and Burkina Faso. The World Health Organization (WHO) is providing technical support while United Nations Economic Commission for Africa (UNECA) is facilitating cross-country consultation and learning.

Goal of the Programme

The primary goal of the TAP is to pilot strategies for strengthening the country's capacity to scale up comprehensive HIV care programs for PLHIV which is effective, affordable, and equitable.

The objectives of the programme in Ghana are to:

• Scale-up service delivery for HIV/AIDS care and treatment;
• Strengthen the institutional capacity of MOH for national scale up of HIV/AIDS care and treatment; and
• Facilitate regional learning from TAP country experiences

Key Activities so far

I. Scale up Comprehensive Care

Group discussion during IMAI adaptation

Family Health International (FHI)
FHI, the first IP to come on board in May 2005 has 4 protégé private health facilities in the Ashanti and Greater Accra region. In addition to support for infrastructural refurbishment support and good laboratory practice, capacity has been built in these facilities to provide comprehensive HIV care including Counseling and Testing (CT), Prevention of Mother to Child Transmission (PMTCT) and Anti-retroviral Therapy (ART).

Cumulatively these 4 sites have enrolled 746 HIV positive clients into care including 599 on Opportunistic Infection (OI) management and 356 on Anti-retroviral Therapy (ART) as at September 2007.

National Catholic Health Services (NCHS)
Under TAP 6 NCHS hospitals in Eastern, Ashanti and Western have benefited from support similar to the FHI sites. More than 1300 persons living with HIV (PLHIV) are on OI treatment and 514 clients are on ART. A major strength of the NCHS sites is their Home Based Care (HBC) and community outreach programmes.

Private Enterprise Foundation (PEF)
TPEF has the role of galvanizing private sector enterprises’ support for HIV activities. So far PEF has undertaken two surveys of enterprises to assess progress towards achieving the above.

In between these surveys the following interventions have been carried out:

• Advocacy with management to develop Workplace HIV policies;
• HIV sensitization programs for employees;
• Training of HIV peer educators in work places.

II. Strengthening institutional capacity

Odorna Clinic, an FHI-supported TAP site

The World Health Organisation, through the Country Office and the 3 TAP Technical Officers, provides technical assistance for the implementation of the MOH/GHS component of the TAP program as well as processes involved in the national scale up of comprehensive HIV care including capacity building, review of guidelines and monitoring.

TAP supports the Technical Working Group (TWG) for ART established to support to the NACP Program manager on matters relating to treatment and care of PLHIV including:

• Accreditation and monitoring visits to prospective and operating ART sites
• Training of health workers in ART/OI management and
• Revision/updating of the HIV care guidelines
• Ten CD4 machines designated for ART facilities were procured courtesy of TAP.
• TAP supports HIV drug resistance surveillance. A Sequencer was acquired and is in use for monitoring resistance of HIV strains to current treatment regimes.

III. Regional learning from TAP country experiences

RAP meeting in Burkina Faso

In line with TAP’s third objective, the Regional Advisory Panel (RAP) provides a forum for TAP stakeholders to meet and discuss the progress and challenges in the implementation of TAP and learn lessons from others. It is also an opportunity for experts from WHO and other organizations to share ideas on related topical issues such as TB and HIV drug resistance, PMTCT and long term financing of HIV care.

The last two RAP meetings were held in Burkina Faso and Kenya. Key on the agenda at the 5th and 6th RAP meetings (Ouagadougou, Burkina Faso; 1-7th July 2007 and Nairobi, Kenya; 6-7th December 2007) were sustaining and building on the gains achieved under TAP.

One of the key benefits of TAP has been the successful kick starting of the provision of comprehensive care in the private sector using private public partnerships. There is a lot to be learnt from this experience.

Other ongoing TAP research and activities present other opportunities for learning and include:

• The impact of the availability of ART on the socio-economic status of Ghanaians (TAP Household Survey);
• Research on treatment outcomes for clients on ART, HIV drug resistance and affordability of HIV care;
• Documentation of best practices in PMTCT and HBC.

Key activities for 2008

• Finalize a concrete sustainability plan to consolidate the gains made under TAP.
• Active pursuit of the research agenda and documentation of best practices to facilitate dissemination of lessons under TAP.
• Plan for the final RAP meeting scheduled for June 2008 in Addis Ababa, Ethiopia.