Dr. Michael Boah

Background Antiretroviral therapy (ART) has helped reduce the burden of human immunodeficiency virus (HIV) and acquired immune deficiency syndrome (AIDS) in the majority of countries. Its contribution to the HIV/AIDS burden in Ghana is still understudied. This study examined HIV/AIDS trends in Ghana before (1990–2004) and after (2004–2020) the implementation and expansion of ART. Methods We obtained HIV/AIDS epidemiology and treatment data for the years 1990–2020 from the United Nations Programme on HIV/AIDS. We investigated the impact of the ART rollout on HIV/AIDS in Ghana using Joinpoint regression models. Results The HIV incidence, prevalence, and AIDS-related deaths decreased significantly after 2004, as ART coverage increased from 1% to 2004 to 60% in 2020. The HIV incidence decreased by approximately 3% (AAPC = -2.6%; 95% CI: -3.2, -1.9) per year from 1990 to 2004 and approximately 5% (AAPC = -4.5%; 95% CI: -4.9, -4.2) per year from 2004 to 2020. Between 1990 and 2004, the HIV prevalence increased by approximately 5% (AAPC = 4.7%; 95% CI: 3.6, 5.8) per year but decreased by 2% (AAPC = -1.9%; 95% CI: -2.1, -1.6) per year between 2004 and 2020. Between 1990 and 2004, the annual increase in AIDS-related mortality was 14% (AAPC = 13.8%; 95% CI: 12.6, 15.0), but between 2004 and 2020, it decreased at nearly a 4% (AAPC= -3.6%; 95% CI: -4.7, -2.5) annual rate. Conclusions We found trends indicating progress in Ghana’s fight against HIV/AIDS. However, the most significant declines occurred after the introduction of ART, suggesting that the scale-up of ART may have contributed to the decline in HIV/AIDS in Ghana. We advocate for the rapid expansion of ART in Ghana.

Objectives Antiretroviral therapy (ART) reduces the risk of tuberculosis (TB). We aimed to examine the association between ART coverage scale-up on the changes in TB incidence in Africa from 2000 to 2018. Study design The design of the study is a retrospective ecological study. Methods Data for 54 countries were obtained from several institutional-based sources, including the World Health Organization, the Joint United Nations Programme on HIV/AIDS, and the World Bank. A fixed-effects regression method of longitudinal data analysis was used to estimate the association between ART coverage and changes in TB incidence rate during 2000–2018. Statistical analyses were conducted using STATA 15.0/IC. Results The TB incidence declined significantly, by an average of 2.3% per year during 2000–2018. The highest significant declines occurred in eastern and southern Africa. In adjusted analysis, each 1% increase in ART coverage was associated with a 3.97 per 100,000 decline of TB incidence. However, the marginal effects of ART on overall population TB incidence was dependent on the prevalence of human immunodeficiency virus infection. Conclusions Investment in the widespread scale-up of ART may contribute to the control of the TB epidemic in Africa. However, interventions are also needed to augment the effect of ART on population TB incidence.