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MMWR. Morbidity and Mortality Weekly Report. 2016 Feb 12; 65(5):115-9.Blood transfusion is a life-saving medical intervention; however, challenges to the recruitment of voluntary, unpaid or otherwise nonremunerated whole blood donors and insufficient funding of national blood services and programs have created obstacles to collecting adequate supplies of safe blood in developing countries (1). Since 2004, the U.S. President's Emergency Plan for AIDS Relief (PEPFAR) has provided approximately $437 million in bilateral financial support to strengthen national blood transfusion services in 14 countries in sub-Saharan Africa and the Caribbean* that have high prevalence rates of human immunodeficiency virus (HIV) infections. CDC analyzed routinely collected surveillance data on annual blood collections and HIV prevalence among donated blood units for 2011-2014. This report updates previous CDC reports (2,3) on progress made by these 14 PEPFAR-supported countries in blood safety, summarizes challenges facing countries as they strive to meet World Health Organization (WHO) targets, and documents progress toward achieving the WHO target of 100% voluntary, nonremunerated blood donors by 2020 (4). During 2011-2014, overall blood collections among the 14 countries increased by 19%; countries with 100% voluntary, nonremunerated blood donations remained stable at eight, and, despite high national HIV prevalence rates, 12 of 14 countries reported an overall decrease in donated blood units that tested positive for HIV. Achieving safe and adequate national blood supplies remains a public health priority for WHO and countries worldwide. Continued success in improving blood safety and achieving WHO targets for blood quality and adequacy will depend on national government commitments to national blood transfusion services or blood programs through increased public financing and diversified funding mechanisms for transfusion-related activities.
HIV, HCV, HBV and syphilis rate of positive donations among blood donations in Mali: lower rates among volunteer blood donors.
Transfusion Clinique Et Biologique. 2009 Nov-Dec; 16(5-6):444-7.Good data on background seroprevalence of major transfusion transmitted infections is lacking in Mali. We gathered data on the rate of positive donations of human immunodeficiency virus (HIV), hepatitis C virus (HCV), hepatitis B virus (HBV) and syphilis among blood donations in Mali for calendar year 2007. Donations with repeatedly reactive results on screening enzyme immunoassay (EIA) were considered to be seropositive. Rate of positive donations per blood unit collected was 2.6% for HIV, 3.3% for HCV, 13.9% for hepatitis B surface antigen (HBsAg) and 0.3% for syphilis. For HIV, HBsAg and syphilis, rate of positive donations was significantly (p<0.001) higher among donations from replacement donors than those from volunteer donors, while HCV rate of positive donations was similar in the two groups. Rate of positive donations was also significantly (p<0.0001) lower in blood units from regular than from first-time donors. These data reinforce WHO recommendations for increasing the number of regular, volunteer blood donors in Africa.
African Journal of AIDS Research. 2004 Nov; 3(2):145-155.Despite the underlying importance of surveillance systems for the management of HIV/AIDS prevention and control programmes, there has been limited analysis of the quality of HIV/AIDS case-detection and case-reporting systems, beginning with peripheral facilities through to those at national levels. In Mozambique, HIV cases are generally correctly detected despite some unreliable use of test kits beyond their expiry date, uneven distribution of test kits among facilities, frequent disregard for bio-safety measures and irregular external quality assessment. Furthermore, HIV/AIDS case-reporting is compromised by poor data quality, including under-reporting and discrepancies across different reporting channels and organisational levels, as well as a lack of standardised data forms, data items collected and report formats. Our analysis of HIV/AIDS surveillance systems in Mozambique leads to the following key recommendations: (1) a strengthening and standardisation of both the case-detection and case-reporting systems at all levels; (2) the regular training of staff at peripheral facilities, to allow for better testing and improved local data analysis, validation and interpretation; (3) the redesign of reporting systems for blood banks, including integration of the AIDS case-reporting subsystems into one; and (4) the use of baseline data as a foundation for more comprehensive analysis across the country, in response to UNAIDS advice regarding second-generation HIV surveillance. (author's)
Geneva, Switzerland, UNAIDS, 1997 Oct. 7 p. (UNAIDS Point of View; UNAIDS Best Practice Collection)Eighty percent of the world's population live in developing countries, but developing countries use only 20% of the world's blood supply for transfusions. The human immunodeficiency virus (HIV) which causes AIDS is easily transmitted through blood transfusions. In fact, the chances that someone who has received a transfusion with HIV-infected blood will himself or herself become infected are estimated at over 90%. While millions of lives are saved each year through blood transfusions, in countries where a safe blood supply is not guaranteed, recipients of blood run an increased risk of infection with HIV. Other diseases -- such as hepatitis B, hepatitis C, syphilis, Chagas disease and malaria -- can also easily be transmitted through blood transfusions. Worldwide, up to 4 million blood donations a year are not tested for either HIV or hepatitis B. Very few donations are tested for hepatitis C. (excerpt)
Vox Sanguinis. 2002; 83 Suppl 1:173-177.A safe blood supply is a critical component in improving health care and in preventing the spread of infectious diseases globally. Millions of lives are saved each year through blood transfusions. Safe blood transfusion is an extremely cost-effective measure in developed countries such as the USA, where 2% of the health care budget which is spent on Blood Transfusion Services benefits 50% of the health services. Yet the quality and safety of blood transfusion therapy is of continuing concern, particularly in developing countries where 80% of the world's population lives. This concern is related to the risk of transfusion-transmissible infections (TTIs) due to unsafe transfusions. This results from blood collected from unsafe donors, the lack of quality systems in blood transfusion services, poor laboratory procedures in blood group serology and inadequate testing of donated blood for TTIs, errors in the administration of blood, and a lack of access and appropriate clinical use of blood and blood products for patients requiring transfusion. (excerpt)
New York Times on the Web. 2002 Jun 28;  p..The United Nations today issued a stinging public criticism of China's lackluster efforts to face its rapidly accelerating epidemic of H.I.V. infection and AIDS, saying the country is "on the verge of a catastrophe." In a new report, "H.I.V./AIDS: China's Titanic Peril," the Joint United Nations Program on H.I.V./AIDS criticized Chinese officials on many fronts, from the lack of adequate education programs to the absence of treatment for people infected with H.I.V. "We are now witnessing the unfolding of an H.I.V./AIDS epidemic of proportions beyond belief, an epidemic that calls for an urgent and proper but as yet unanswered quintessential response," the report said, noting that the lack of action meant China could have the largest number of people infected with H.I.V. in the world within a few years. While much of the report circulated as an internal document among United Nations agencies late last year, its very public release today at a large news conference in Beijing signaled a new willingness by the United Nations to press China into action. (excerpt)
VOX SANGUINIS. 1994; 67(4):377-81.As part of an effort to monitor the safety of global blood transfusion services, the World Health Organization circulates a questionnaire for use in a database on blood safety. In 1992, 67% of countries responding to the survey (100% of developed, 66% of developing, and 46% of less developed countries) were screening all blood donations for HIV antibodies and 87% of these countries (100% of developed, 92% of developing, and 63% of less developed countries) carried out supplementary testing to confirm positive results. All developed countries, 72% of developing, and 35% of less developed countries screen blood for hepatitis B surface antigen and 94%, 71%, and 48%, respectively, screen for syphilis. The primary reasons for inadequate blood testing are the cost of test kits and reagents and the unreliability of supplies. The proportion of safe donors is highest in systems where all donors are voluntary and nonremunerated--conditions that exist in 85% of developed countries but only 15% of developing and 7% of less developed countries. Blood safety would also be improved by more appropriate use of transfusions and the provision of alternatives such as saline and colloids. Other problems include insufficient blood supply (e.g., none of the less developed and only 9% of developing countries collect 30 units or more per 1000 population per year) and inadequate quality assurance in all aspects of preparatory testing.
In: Health and disease in developing countries, edited by Kari S. Lankinen, Staffan Bergstrom, P. Helena Makela, Miikka Peltomaa. London, England, Macmillan Press, 1994. 503-11.Blood transfusion is a routine hospital function. Whole blood and red cell concentrates are needed for managing anemia and hemorrhage, while plasma, coagulation factors, white cell and platelet concentrates are used for the management of burns, hemophilia, and hematological disorders. The blood transfusion services (BTS) should be part of the national health plan. Transfusion medicine consists of donor recruitment and retention, collection, testing, processing, storage of blood, and training of physicians in appropriate use of blood. Estimation of the need of blood and blood components is usually difficult to make. An annual collection of 5 units of blood per hospital and in acute care is sufficient. Formulation of a national blood policy is necessary for every country. The policy should define: 1) the responsible organization for implementation of the blood program, 2) the method of funding the BTS, 3) the concept of blood donation, and 4) the regulations of blood donation and transfusion. Already 61% of developing and 32% of the least developed countries have adopted such a policy. Responsibility for the organization of transfusion services lies with the ministries of health, which may delegated it to a governmental or nongovernmental organization. The Red Cross is most often associated with BTS. Provision of funding is effected by an annual allocation or on a cost recovery basis. Processing and storage requires refrigeration. Costing of blood transfusion services must include the capital and overhead costs. Other topics included in this report are: national blood transfusion service; recruitment and selection of blood donors (voluntary unpaid blood donation and donor recruitment utilizes the importance of this service to society); collection and processing of blood (testing ABO and Rh groups, HIV, hepatitis B and C, syphilis, Chagas disease, and malaria); blood transfusion service in a small hospital; recruitment and training of personnel; and international organizations dealing with blood transfusion.
PUBLIC HEALTH. 1994 May; 108(3):219-26.The World Health Organization Global Programme on AIDS (WHO/GPA) and the International Federation of Red Cross and Red Crescent Societies collaborated on a project to conduct a series of studies on blood transfusion activities in selected developing countries to identify the needs and shortcomings of blood donor counseling for HIV and other infectious agents in the blood transfusion setting. In Uganda, Zimbabwe, Botswana, Rwanda, India (Maharashtra State), and Thailand, the national blood transfusion service (BTS) and Red Cross facilities generate safe blood supplies screening blood for HIV, and significant levels of HIV infection were identified. Uganda was the only country doing BTS-initiated blood donor counseling with good links to external counseling agencies. Based on the WHO/GPA definition of counseling, blood donor counseling is feasible in Uganda, Zimbabwe, and Botswana. Blood donor counseling could be feasible in Rwanda, India (Maharashtra), and Thailand if initiated by the Red Cross; if a major shift in resources occurred; and if referral links and staff training existed. A variety of incentives for blood donors were noted: saving lives; helping relatives and friends; getting food and drink; and receiving HIV test results. In Uganda, Zimbabwe, and Botswana, the BTS was a place where one could receive HIV test results. In Zimbabwe blood donors were required to nominate a medical officer to whom they would go to receive their HIV test results. The obstacles to donor counseling included lack of trained staff for counseling, few links with alternative counseling and testing sites, and lack of access for donor referral and donor understanding. Management-based obstacles included the lack of policies on donor counseling and the general lack of awareness about HIV counseling and potential benefits. Policies about donor care within BTS should include standards for information giving and management, confidentiality, and donor referral.
[Status of the human immunodeficiency virus (HIV) epidemic in Cambodia (letter)] Situation de l'epidemie par le virus de l'immunodeficience humaine au Cambodge.
ANNALES DE MEDECINE INTERNE. 1994; 145(3):200-1.Pharmacists Without Borders conducted the first HIV seroprevalence study in Cambodia in May 1992. It found an HIV seropositive rate of 9.09% among 55 prostitutes. WHO conducted the most important study in Cambodia in June 1992 among 1017 subjects. HIV seroprevalence was 9.2% among 207 prostitutes and 4.2% among 72 sexually transmitted disease (STD) patients. No pregnant woman, police officer, military person, or tuberculosis patient tested HIV seropositive. The third study occurred during June-December 1992. It found that 4.5% of the 733 STD patients tested HIV seropositive. An August 1993 study conducted by the Pasteur Institute and Physicians of the World found that 3.1% of the 65 inmates in a prison in the periphery of Phnom-Penh tested HIV seropositive. The National Blood Transfusion Center of Phnom-Penh shows an increase in HIV seropositivity among blood donors (0.06% in 1991, 0.87% in the third trimester of 1992, and 2.11% in the third trimester of 1993), suggesting that HIV is spreading to the general public. Since HIV infection is progressing in Cambodia at the same rate as it is in neighboring countries and since HIV existed before the arrival of the UN, the UN Provisional Authority in Cambodia cannot be blamed for introducing HIV into the country. Yet, UN military personnel have played a role in spreading HIV, particularly through the sex industry. The main mode of HIV transmission in Cambodia is female prostitutes. An ancient tradition and cultural acceptance of male infidelity and prostitution exist in Cambodia, which allows clients to transmit HIV to their spouses. Young Cambodians entrusted to sex merchants in Bangkok who are returning to Cambodia are another source of HIV. Cambodia needs urgent measures to stem HIV infection, such as HIV information and education for the public. Nongovernmental organizations are leading the way. An AIDS division in the Ministry of Health has been created.