USAID Ghana's strengthening the care continuum project: midterm assessment

This project is designed to provide and scale up accessible, high-quality HIV services to Ghana’s key populations (KPs)—men who have sex with men, female sex workers, and transgender people—and promote transition of service provision to the Government of Ghana. The study used primary and secondary data collection: reviews of program data, client and provider surveys, focus group discussions with service providers, and key informant interviews with stakeholders at the national and local service-delivery levels. It also drew on chart abstraction data for KPs enrolled in case management services, as well as costing data for the service delivery modalities undertaken by the Care Continuum project. The study found that the Care Continuum project is well regarded by clients, providers, and stakeholders for the services it provides. The study also noted the project’s contributions to a policy environment more favorable to high-quality HIV service delivery for KPs. Chart abstraction and program data reveal that retention of KPs in care and treatment programs is a challenge in Ghana. Gender could be better integrated in services for KPs, who are highly vulnerable to gender-based violence. Finally, costs per beneficiary of the “new” intervention modalities, case management, and the healthy living platform are high, in part, because of the recent rollout of these interventions. As these modalities scale up and serve more people, costs per beneficiary should decrease—a clear benefit, especially if scale-up brings improvements in retention in care and treatment of HIV-positive KPs.