. 2017 Oct 11;33(1):17–33. doi: 10.1093/heapol/czx132

Table 4.

Review of documents for the national HIV response in Ghana and Uganda to assess influence of UNAIDS’ 90–90–90 targets

No.	Document title (author)	Date document published	Document type	Number of mentions/ number of pages	Rhetoric	Policy or programme changes	Budgetary changes
Ghana
1	The costs and impact of investing in the HIV response in Ghana (Health Policy Project, USAID, PEPFAR)	April 2015	Strategic	8/42	–	X	X
1		April 2015	Strategic	8/42	Pre-adoption of 90–90–90 by Ghana—modelling to consider feasibility of adopting targets^a	Proposed/scenario analysis for 90–90–90	Modelled estimates of resource needs for 90–90–90 Total cost of 450 million for NSP scenario including attainment of 90–90–90
2	Ghana Country Operational Plan 2015 (PEPFAR)	August 2015	Operational	22/74	X	X	X
2	Ghana Country Operational Plan 2015 (PEPFAR)	August 2015	Operational	22/74	Adopted 90–90–90 for key populations The PEPFAR Ghana targets are to achieve 90–90–90 among 60% of key populations in in high burden regions/districts in southern Ghana by the end of 2017. Not on track to meet 90–90–90 for whole population, only sufficient ART for 50% of PLHIV	Core plans for 90–90–90 for key populations onlyPredominantly first 90 (HIV counselling and testing for key populations in 5 scale up regions and in Cape Coast) but support for lab services for testing and viral load monitoring and retention with ‘Models of Hope’ programme	For key populations only Resources allocated for programme activities (for example, lab, HIV counselling and testing)
3	Making strategic choices: Prioritizing HIV interventions in a resource limited setting. Options for Ghana's next National Strategic Plan (USAID, PEPFAR, Health Policy Plus)	September 2015	Strategic	19/59	–	X	X
3		September 2015	Strategic	19/59	Pre-adoption of 90–90–90 by Ghana—modelling to consider feasibility finds: ‘Even if such significant resource mobilization was successful, unless the country addresses the health systems and policy gaps identified in this study, it will not achieve its ultimate goal of getting 90 percent of PLHIVs to know their status, 90 percent of them to be on treatment, and 90 percent of those on treatment to be virally suppressed’^a	Proposed/scenario analysis for 90–90–90 Need to focus on indirect (reducing stigma, health systems strengthening) as well as direct interventions otherwise will not achieve 90–90–90	Modelled estimates of resource needs for 90–90–90 80 million USD for treatment alone pa and 2015 NSP budget for treatment was US$19 million—therefore massive resource scale up required
4	Ghana Country Operational Plan 2016 (PEPFAR)	June 2016	Operational	22/70	X	X	X
4	Ghana Country Operational Plan 2016 (PEPFAR)	June 2016	Operational	22/70	Does not specifically say that Ghana has adopted the targets	Plans for achieving first and second 90, with systems strengthening to assist in preparation for meeting third 90	Allocations for some activities relating to 90–90–90 but not all
5	90–90–90 Roadmap to Treat All (National AIDS Control Program)	July 2016	Operational, presentation	4	X	X	–
5		July 2016	Operational, presentation	4	Adopted 90–90–90 and Fast Track strategy	Plans for second 90
6	Locate, test, treat, and retain (L2TR) 90–90–90 Ghana Campaign (National AIDS Control Program)	July 2016	Operational	61/20	X	X	–
6		July 2016	Operational	61/20	Adopted 90–90–90 and Fast Track strategy	Plans for 90–90–90, in particular the ‘one million community health workers project’
7	Guidelines for antiretroviral therapy in Ghana (Ministry of Health, NACP, Ghana Health Service)	September 2016	Policy/guideline	2/134	X	–	–
7		September 2016	Policy/guideline	2/134	Adopted 90–90–90
8	National HIV/AIDS Strategic Plan 2016–20 (Ghana AIDS Commission)	September 2016	Strategic	55/131	X	X	X
8		September 2016	Strategic	55/131	Adopted 90–90–90 and Fast Track strategy	Plans for achieving first and second 90, with systems strengthening to assist in preparation for meeting third 90
9	Ghana AIDS Commission launches the national HIV and AIDS strategic plan & ‘treat all’ policy (Ghana AIDS Commission)	2016	Press release	1/2	X	–	–
9		2016	Press release	1/2	Informed by 90–90–90 and inline with SDGs
10	Treat All Implementation Update (NACP)	October 2016	Operational— presentation	2/29	–	X	X
10	Treat All Implementation Update (NACP)	October 2016	Operational— presentation	2/29		Actual activities for second 90	Need for reprogramming/reallocation of funds for 90–90–90
11	Guidance on the CCM Approach to develop the funding request 2018–20 (The Global Fund)	October 2016	Funding request	1/12	–	–	X
11		October 2016	Funding request	1/12			NACP to consider modelling from USAID/Health Policy Plus for resource needs for 90–90–90
12	HIV/TB Funding Request 2018–20 (Ghana CCM)	December 2016	Funding request	10/33	X	X	X
					Adopted 90–90–90	Plans for first 90 and actual for second 90 Want to focus on PMTCT and early infant diagnosis as main way to increase diagnosis and coverage of ART	Planned and actual re-allocation/re-programming of TGF budget allocation, efforts to seek efficiency gains and prioritize programme activities to geography and populations in need, donor and domestic resource mobilization
					Adopted 90–90–90	Plans for three 90s for key populations
13	Prioritized above allocation request (Ghana CCM)	December 2016	Funding request	2/5	–	X	X
13	Prioritized above allocation request (Ghana CCM)	December 2016	Funding request	2/5		To support planned and already ongoing activities	Funding request for Models of Hope and viral load monitoring
14	Ghana Global Fund 2017–19 Allocation Letter (The Global Fund)	December 2016	Funding letter	0/12	–	–	–
14		December 2016	Funding letter	0/12	Does state need to strengthen the cascade to meet the Fast Track targets but no mention of 90–90–90 specifically^a
Uganda
1	Uganda Country Operational Plan 2015 (PEPFAR)	September 2015	Operational	7/104	X	X	X
1	Uganda Country Operational Plan 2015 (PEPFAR)	September 2015	Operational	7/104	Adopted and on track ‘15 districts have already met the first two 90s’	Plans to focus on first two 90s for scale up districts and plans for nationwide scale up of VL	‘PEPFAR Uganda is able to make these shifts through an additional $30 million for treatment scale-up, further streamlining of the Country Operational Plan 12 core package of services, transitioning out of low burden/low yield districts and sites, rationalization of implementing partners, and exploration of more efficient service delivery models’.
2	National HIV/AIDS Strategic Plan 2015/16–19/20 (Uganda AIDS Commission)	August 2016	Strategic	1/87	X	–	–
2		August 2016	Strategic	1/87	Strategy is ‘cognizant of the global and national commitment to end AIDS by 2030’ and aligned to the Fast Track Strategy and 90–90–90	Programme activities are not directly attributed to attainment of 90–90–90 goals in the NSP^a	Estimated cost of implementing NSP goals is 3647.9 billion USD for 5-year period^a
3	National HIV/AIDS Monitoring and Evaluation Plan 2015/16–19/20 (Uganda AIDS Commission)	August 2016	Operational	0/113	–	–	–
3		August 2016	Operational	0/113	Aligned to ‘end of AIDS by 2030’ but no mention of 90–90–90 specifically^a
4	National HIV/AIDS Indicator Handbook 2015/16–19/20 (Uganda AIDS Commission)	August 2016	Operational	0/97	–	–	–
5	National HIV/AIDS Priority Action Plan (Uganda AIDS Commission)	August 2016	Strategic	0/72	–	–	–
6	2015/16 Country Progress Report (Uganda AIDS Commission)	November 2016	Evaluation	25/82	X	X	–
6	2015/16 Country Progress Report (Uganda AIDS Commission)	November 2016	Evaluation	25/82	Adopted and on track	Actual changes for first year and planned up until 2020
7	Consolidated HIV Prevention and Treatment Guidelines (Ministry of Health Uganda)	December 2016	Guideline	7/152	X	X	–
7		December 2016	Guideline	7/152	Adopted 90–90–90	Actual policy change for all three 90s—treat all irrespective of CD4 cell count, differentiated service delivery, improved retention strategies
8	Uganda Country Operational Plan 2016 (PEPFAR)	January 2017	Operational	32/65	X	X	X
8	Uganda Country Operational Plan 2016 (PEPFAR)	January 2017	Operational	32/65	Adopted, and on track pending implementation of test and treat and new service delivery models to reduce issues with commodities for rapid scale up	Plans and actual ongoing activities for 90–90–90	Plans for efficiency gains through new service delivery models and prioritization of testing, treatment and care services by geography and location
9	National Multi-Sectorial HIV/AIDS Resource Mobilization Strategy 2015/16–19/20 (Uganda AIDS Commission)	April 2017	Strategic	3/89	X	–	X
9		April 2017	Strategic	3/89	States national response is aligned to 90–90–90		Implementation of the strategy aims to raise 69 million USD toward the 3647 million USD needed for the NSP.90–90–90 is cited as a reason for increasing mobilization efforts, but the amount from these efforts targeted to meeting 90–90–90 is unclear.

Information detailed is considered relevant although does not necessarily provide evidence of the transfer of 90–90–90.

Key:

Number of mentions:

One count given to a mention of ‘90–90–90’ and each of the sub goals, for example, ′first 90′ or the equivalent percentage for each category, i.e. 90%, 81% or 73%. Count only once per sentence, or a figure, and only once in table unless 90–90–90 is the content of cells in a table, in which case count each mention.

Standardized data extraction form used for reviewing each document:

1. Rhetoric: Statement of the nation’s adoption, commitment or alignment to the 90–90–90 treatment targets or Fast Track strategy, including statements about the country being ′on track′ to any or all three of the targets. Including problem statements and magnitude of the problem.

2. Policy orprogrammechange: Statements about 90–90–90 are supported by recommended, planned or implemented policy or program change intended to achieve 90–90–90 or each of its sub-goals.

3. Budgetary changes: Statements about 90–90–90 that are supported by recommended, planned or actual reallocation of resources, resource mobilization, and efforts to seek efficiencies (includes modelled estimates of resource needs and resource allocation).