Making Strategic Choices: Prioritizing HIV Interventions in a Resource-Limited Setting Options for Ghana’s Next HIV National Strategic Plan

The analysis examined the impact of various levels of funding on the scale-up and health impact of key HIV interventions, including prevention and treatment for key populations. The country's NSP 2011-2015 identified strategic areas beyond these key interventions that play a significant role in the overall program response. The expanded investment case analysis was done in two parts: a cascade analysis and a modeling analysis. The cascade analysis used existing quantitative data to assess the success of current key interventions and to develop theoretical prevention and treatment cascades. Qualitative interviews were also conducted with key informants in Ghana to identify gaps in these cascades and in the existing HIV program. The key informants ranked current efforts along the HIV prevention and treatment cascades and completed a budgeting exercise to allocate theoretical budget dollars to direct and indirect interventions. The modeling analysis used the Goals model to project the impact of three coverage scenarios. Scenario 1, the NSP Target scenario, serves as a baseline, in which coverage rates are set for both prevention and treatment efforts to achieve the targets likely to be set in the upcoming NSP (2016-2020). Scenario 2, the Cascade-Constrained scenario, models a "realistic scale-up" where coverage rates are set given the existing limitations of the health system and the policy environment. Fiscal constraints are not included in this scenario, reflecting the priority and political support for specific supporting activities and the limitations of resource mobilization to achieve country targets when constraints in health systems and policy environments are not addressed. Scenario 3, the Fiscally-Constrained scenario, set coverage rates given the limited financial resources available for national HIV efforts, prioritizing allocation of funds first to high-impact interventions. The analysis examined the population flows through prevention and treatment programs, including female sex workers, men who have sex with men, prevention of mother-to-child transmission, sero-discordant couples, people who inject drugs, and the general population in Ghana. The results of the cascade analysis were used to feed into the modeling analysis to assess the impact of prioritized programs. The analysis also considered the impact of supporting interventions that contribute indirectly to the response, such as those that directly impact prevention and treatment. The Ghana AIDS Commission, Ghana Health Services/National AIDS Control Program, UNAIDS, and other major stakeholders involved in Ghana's national HIV & AIDS response collaborated with the Health Policy Project to conduct the analysis. The authors acknowledge the support provided by multiple stakeholders in Ghana who supplied data, comments, and suggestions during the analysis. The analysis aimed to inform the development of the new National HIV & AIDS Strategic Plan (NSP) 2016-2020 in Ghana, taking into account the current epidemic and funding context.