Effect of antiretroviral therapy on all-cause mortality among people living with HIV/AIDS in Ghana using Mahalanobis distant metric matching within propensity score caliper analysis: A retrospective cohort study.

Several health interventions have been put in place to improve health outcomes of people living with HIV/AIDS (PLHIV) in Ghana. We evaluated the impact of Antiretroviral Therapy (ART) on all-cause mortality in Ghana using matching procedures. This was a retrospective cohort study of 12,881 HIV/AIDS patients initiated on ART at 40 sentinel sites and 199 treatment centers between 2013 and 2016 countrywide. Patients were included if they had date of ART initiation and if they had mortality outcome recorded. Mahalanobis distant metric matching within propensity score caliper and other matching procedures were used to evaluate the effectiveness of ART in reducing the risk of all-cause mortality among PLHIV in Ghana. We performed sensitivity analysis using different matching procedures including Kernel weighting adjustment and Mahalanobis distance metric matching with nearest neighbour to ascertain the robustness of our results in the presence of unmeasured covariates. The proportion of patients on ART was 60.3% (95% CI: 59.5-61.1). The total number of mortalities reported was only 734 representing 4.6% (95% CI: 4.2-4.9) of the studied population. The risk of all-cause mortality has reduced by 11.6 percentage point among HIV/AIDS patients who were on ART compared to those who were not on ART (95% CI: 9.6-13.4). ART was associated with a decreased risk of all-cause mortality. Effort being made by Government and non-Governmental organizations in support of ART treatment in Ghana should continue unabated to help reduce mortality rate and improve health outcomes among HIV/AIDS. To reduce bias to the barest minimum between treatment and intervention group when evaluating the effectiveness of health interventions, it is recommended to use matching procedures especially when the study design is not a randomized control trial

Availability of HIV services along the continuum of HIV testing, care and treatment in Ghana

Abstract Background Ghana has been providing HIV and AIDS services since the identification of the first case in 1986 and added highly active antiretroviral therapy to its comprehensive care in 2003.This study aimed at assessing availability of HIV services along the continuum of HIV care in Ghana. Method A cross sectional study was conducted among 172 (87%) of the total 197 ART canters in Ghana. Data was collected by self-administered questionnaire and analysed using STATA version 13. Results Of the 172 health facilities surveyed, 165 (96%) were offering HIV testing Services (HTS) during the survey period. More than 90% of the surveyed facilities reported to offer Anti-Retroviral Treatment (ART), patient counselling, TB screening and Prevention of Mother to Child Transmission (PMTCT) services. Viral load and Early Infant Diagnosis (EID) and laboratory testing services were reported at 10 (5.8%) and 23 (13.4%) respectively. HIV testing services (HTS), PMTCT, ART, patient counselling and opportunistic infections (OI) prophylaxis services were offered at all Tertiary and Regional hospitals surveyed. EID sample collection and testing services was reported at 2 out of 27 (7.4%) of the Health Centre and/or clinics in Ghana. The common adherence assessment methodology being implemented varied by facilities which included: asking patients if they took their drugs 154 (89.5%), pill counting 131 (76.2%), use of follow-up visit 79(45.9%) and use of CD4 counts, viral loads and clinical manifestation 76 (44.2%). Challenges encountered by facilities included shortage of test reagents and drugs 122 (71%), 111 (65%) respectively and patient compliance 101 (59%). Conclusion This study showed ART services to be available in most facilities. Methods used to assess patients adherence varied across facilities. Shortage of test reagents and drugs, EID sample collection and testing were major challenges. A standardised approach to assessing patient’s adherence is recommended. Measures should be put in place to ensure availability of HIV commodities at all levels