SUAD0208 | ASSESSING THE EFFECT OF CONFLICT ON HIV SERVICE DELIVERY: CASE STUDY OF BAWKU MUNICIPALITY, GHANA

William Ansah | Local Government Service-Office of Bawku Municipal Assembly, Bawku, Ghana

Bawku Municipality in Ghana’s Upper East Region has experienced periodic conflict, with a major resurgence of violence beginning in December 2021. This situation has disrupted essential health services, including HIV prevention and treatment (Yaro et al. 2023). Most notably, the closure of the ART center at Bawku Presbyterian Hospital since 2022 significantly affected service access for persons living with HIV (PLHIV). This study examines the effect of the conflict on HIV service delivery, specifically ART attendance and HIV testing rates between 2020 and 2024. A comparative analysis of key HIV-related indicators, ART attendance, and HIV testing rates of pre-conflict years (2020–2021) and post-conflict years (2022–2024) was conducted. Quantitative data was drawn from records in the District Health Management Information System (DHMIS). Qualitative data were collected through focus group discussions and key informant interviews with PLHIV and health workers from the facilities. Thematic analysis was used to assess perceived barriers to service access in the context of ongoing conflict. ART attendance declined from 2,366 in 2021 to 1,073 in 2022, 1,100 in 2023, and 1,084 in 2024. HIV testing rates followed a similar downward trend, dropping from 411 in 2021 to 192 in 2022, 319 in 2023, and 210 in 2024. These were compared to a baseline of 1,679 ART clients and 212 tests recorded in 2020. The data reveal a clear decline in HIV service uptake following the onset of the conflict. ART attendance declined by over 50% from its 2021 peak, while testing rates also declined by 53%. Interviews pointed to persistent insecurity, facility closures, fear of travel, and service disruptions as major perceived barriers. The closure of the main ART center and absence of mobile or decentralized alternatives further compounded service gaps. The Bawku conflict has affected HIV prevention and treatment services. The marked decline in ART attendance and testing uptake highlights the vulnerability of public health systems in conflict-affected areas. Strengthening decentralized care models, enhancing community-based outreach, and integrating HIV services into emergency health strategies are critical to sustaining care for PLHIV in such fragile contexts especially for hard-to-reach populations.