Treat All Policy, The Burden of The Blessing

Treat All

The Ghana Aids Commission in 2016 launched the ambitious 90-90-90 targets to end AIDS by the year 2030.

What this means is that, by the year 2030 people will be living with HIV in Ghana, but will not be graduating to AIDS status.

The 90-90-90 is a strategy to ensure that by the year 2020, 90% of people living with HIV should be aware of their HIV infection.

90% of all people living with HIV should be receiving anti-retroviral drugs.

Lastly, 90% of people on anti-retroviral drugs should receive viral suppression.

The suppression should be such that, they wouldn’t be able to infect others with the virus.

It is in the light of the second 90, that the treat all policy has been adopted.

In a press release, signed by Dr Anthony Nsiah-Asare, Director General of the Ghana Health Service, the Treat All Policy has received full support.

The release says, “effective Monday 11, September 2017, HIV testing should be routinely offered to all out-patients, in-patients, emergency room patients, mothers and their infants attending CWC and at special clinics like nutritional rehabilitation.”

Treat All policy requires that viral load measurement is used in monitoring HIV clients on treatment.

Therefore facilities should engage the District Health Administration through the District HIV focal person for sample transport to the regional testing site.

Speaking to a member of the MJA-G, Golda Asante, a Technical Coordinator at the Ghana Aids Commission in the Eastern Region, she explained the treat all policy.

According to her “This policy links directly to the second 90.”

This in her opinion is going to burden some of the facilities where the ARTs are administered because, up till now, it is the CD4 count of the infected person that would determine whether the person should be placed on treatment or not.

“But now, with the treat all policy, all that is going to change” she says.

The CD 4

The CD4 cells are a type of blood cell that is part of the immune system.

They are a type of white blood cell (lymphocyte). CD4 cells are sometimes called T-helper cells or T-cells.

The normal ranges for CD4 counts vary depending on the lab and test.

A test for CD 4 is a test to find out the strength of ones immunity.

Before the treat all policy, there were people living with HIV who were not on full treatment.

These people were on “clinical care.

Clinical care means they “were on prophylaxis”

A person living with HIV before the policy will be put on anti-retroviral treatment if their CD 4 count fell < 250 (below 250)

This number was increased to 500.

The Treat All Policy Per the National HIV and AIDS Strategic Plan 2016 – 2020, pg 24, “Ghana adopted the Test and Treat Policy for all people who test positive for HIV for full implementation beginning 2017.

The “Treat all policy” is a key strategy for the 90-90-90;”

In the treat all policy, Golda Asante postulates that “In the teat all policy, we don’t care weather your CD 4 is 10,000 or the strength of your immunity is 2million.

Once you are HIV positive, we have to put you on treatment, and it is when we do that, that we can achieve viral suppression.

She emphasized, “We don’t have to wait till you are lean or wait till you have opportunistic infection.”

“Before treat all, there were so many people living with HIV who were not on treatment because of CD 4 issues.”

The Burden

With treat all, all those who are living with HIV have been brought on board the full anti-retroviral treatment.

Golda explains that, with the many people who have all been roped into the treatment, “it is a burden on facility”

Accordingly, the commission has inspected the various facilities to assess their ability to contain the imminent pressure.

For some facilities, about 2500 of their clients are already on treatment. The treat all has therefore not added anything.

For some other facilities, there were about 1,900 people living with HIV who access their services, and only 300 are on the full treatment.

For such facilities, the other 1,600 have to now be brought on board.

The Ghana Aids Commission also provides money for Health Insurance for the people living with HIV.

With the treat all policy now, all those who are going to be enrolled into treatment.

With the release of the Director General of the Ghana Health Service, it is expected that the commission will receive the needed support in facilities and funds to have an effective treat all policy.

Considering the fact that now, the Ghana AIDS Commission does not receive the same quantum of funds it used to in time passed, it is only a matter of time before Ghana feels the real burden of the blessing of Treat All.

Currently, the commission estimates that, roughly 276,000 people are estimated to be living with the virus in Ghana