HIV Prevention Knowledge Base
Biomedical Interventions: Blood Safety and Availability
Blood Donors and Blood Collection: Status of Blood Banking and Blood Supply in Afghanistan
This paper describes the extremely challenging conditions under which Afghanistan’s blood supply system health professionals operate. The country has a nationalized blood banking system comprising the Central Blood Bank of Kabul as well as 18 other branches in Kabul and throughout the country. However, over two decades of armed conflict have severely disrupted the system. Staff lack training in blood banking and transfusion medicine and face shortages of basic equipment and supplies, even water and electricity. The study makes recommendations to build on the existing basic infrastructure and dedicated staff by improving facilities and equipment, promoting voluntary blood donation, enhancing blood collection and processing procedures, and boosting training and education.
Donor Counseling Can Provide Valuable Information to Improve Blood Safety
This study looks at blood donors with a confirmed positive HIV result who were invited for postdonation counseling. The information obtained during the session was then compared with that collected from the donors’ answers to the predonation questionnaire and in the face-to-face interview. The postdonation interview revealed useful additional information about donor behavior and provided feedback on the efficacy of the predonation interview and questionnaire. Interviewees often lacked an understanding of the window period for HIV infection, evaded questions about concurrent partners, and were inconsistent in condom use. The open-ended nature of the questions in a postdonation interview highlights the need for counseling skills training for donor staff.
Strategies to Maintain Effective Donor Recruitment and Retention in a Harsh Operating Environment—Lessons from Zimbabwe
National Blood Service Zimbabwe has grappled with a host of difficulties caused by political instability, record levels of inflation, and shortages of funds, basic commodities and fuel, according to this paper. In the decade to 2008, blood collections fell and HIV seroprevalence among donors rose, but the system was able to maintain its record of 100 percent blood collection from voluntary, non-remunerated donors and 100 percent testing of donated blood. The service also improved its quality management system.
Maternal Mortality: A Consideration for Developing Countries and Emergency Preparedness Blood Safety Plan
This article provides an overview of blood safety in developing countries and uses data from Tanzania to illustrate the increased risk of transfusion-transmitted infections (TTIs) from voluntary non-remunerated blood donors (VNRD) versus relative blood donors. It argues that a safe blood supply is an essential element of safe motherhood, as pregnancy-related bleeding complications are a significant cause of sudden death among women in developing countries. Safe blood can also reduce infant mortality associated with malnutrition, malaria, and worm infestation, as well as the transmission of HIV and other diseases, the authors write, but only within a wider context of political commitment and adequately trained health care workers.
Blood Safety in Sub-Saharan Africa: a Multi-Factorial Problem
This paper examines the paradox of sub-Saharan Africa’s great need for blood transfusion (anemia is common, especially among women and children) and lack of access to a safe and reliable supply, given that blood-borne diseases such as HIV and hepatitis are prevalent. While most countries in the region have a transfusion policy, less than half consistently apply it, and the World Health Organization (WHO)-recommended strategy of promoting voluntary, non-remunerated blood donation has failed the thrive in many countries. The lack of testing, preparation of blood components, and inappropriate clinical use of blood all contribute to blood safety remaining a serious issue for sub-Saharan Africa.
Pathogen Inactivation: A New Paradigm for Blood Safety
The development of pathogen inactivation represents a paradigm shift for blood safety, the author of this editorial argues. Although current practice effectively screens for a number of diseases, it does not prevent all transfusion-transmitted infections (TTIs), nor does it entirely prevent transfusion-related sepsis. Pathogen inactivation addresses these issues and eliminates the need for irradiation of blood components, thus removing the risk of graft-versus-host disease. Pathogen inactivation should be more widely adopted, with the additional costs weighed against improvements in blood safety, the author writes. However, current interest in this technology does not address noninfectious blood transfusion hazards and focuses on use in developed countries.
Prevalence of HIV-1 in Blood Donations Following Implementation of a Structured Blood Safety Policy in South Africa
As the HIV epidemic in South Africa escalated in the late 1990s, so did HIV infections in the nation’s blood supply, which was an indication of a significant number of new infections undetected by an antibody test (window-period infections). In response, in 1999 the National Blood Service closed blood donation sites in high-prevalence areas, implemented an oral questionnaire about HIV risk behaviors for donors, and began triaging donated products based on risk profiling, issuing the safest products first. As a result, HIV prevalence in blood donations fell from a peak of 0.26 percent in 1998 to 0.05 percent in 2003. First-time donors were significantly more likely to have HIV than repeat donors. After the new screening protocol was implemented, the proportion of first-time donors decreased significantly between 1999 and 2000 and 2001 and 2002. Furthermore, the prevalence of HIV among these donors decreased significantly, from 1.08 percent in 1999 to 2000 to 0.59 percent in 2001 to 2002. The authors estimate a 24 percent reduction from 1999 to 2001/2002 in risk of collecting a unit of blood infected with HIV from a donor in the window period. Collection policies will continue to be adjusted over time to ensure the continued safety of the South African blood supply.
Predonation Screening of Blood Donors with Rapid Tests: Implementation and Efficacy of a Novel Approach to Blood Safety in Resource-Poor Settings
The equipment-dependent western model of safe blood procurement is inefficient and unaffordable in small-scale settings in Africa. This paper proposes predonation screening for hepatitis B, hepatitis C, and HIV by rapid testing, followed by nucleic acid testing (NAT) on batches of donated samples, as an affordable means of improving blood safety. As well as being cheaper than traditional screening of donated blood, this method also enables infected donors to be referred for further care, in itself a public health benefit. A study in Ghana found that in high endemic areas, such testing is effective and may reduce the cost of ensuring safe blood supply.
Improving Blood Safety in Resource-Poor Settings
This paper highlights the disparity between developed countries that can rely on high-performance technology to guarantee safe supplies of donated blood and resource-poor countries facing many obstacles to safe blood provision. Namely those obstacles include limited budget; the high prevalence of HIV, hepatitis B, and hepatitis C; and factors adversely affecting retention of voluntary donors. Developing countries should use rapid tests before blood donation rather than striving for a technology-heavy solution. However, developing countries have special requirements of such tests in terms of reagent formulation and test design to compensate for the lack of sensitivity of dipstick tests compared to enzyme immunoassay screening.
Risk of Human Immunodeficiency Virus (HIV) Transmission by Blood Transfusions Before the Implementation of HIV-1 Antibody Screening
This paper describes a novel model to estimate the proportion and number of people infected with HIV through blood transfusion in the San Francisco Bay area before the introduction of HIV antibody screening in 1985. The model relied on data on identified HIV-positive blood donations, the prevalence of HIV among homosexual and bisexual men in San Francisco from 1978 to 1984, donation rates to a blood center over the same period, and the outcome from the tracing of recipients of seropositive transfusions. The authors found the risk of infection was higher than previously estimated, and they underline the importance of donor education and self-exclusion to protect blood supply.