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PanAfrica: U.S. Officials Discuss Blood-Safety in
Sub-Saharan Africa (Washington, DC) June 28, 2006 Posted to the web June 29, 2006 Cheryl Pellerinwashington File Staff Writer Washington, DC Unsafe blood transfusions play a role in the transmission of HIV/AIDS, malaria and viral hepatitis in developing countries, especially sub-Saharan Africa, and U.S. health and assistance agencies are working to establish sustainable blood safety programs in that region. Officials from the State Department, the U.S. Agency for International Development (USAID), the Department of Health and Human Services (HHS) and the World Health Organization (WHO) testified before the House International Relations Subcommittee on Africa, Global Human Rights and International Operations June 27. The subcommittee was examining the need for safe blood in sub-Saharan Africa and the challenges U.S. agencies and organizations face in addressing that need. The committee members also discussed strategies for providing safe, sustainable blood supplies in African health care systems, and the best way to use U.S. financial resources to accomplish that goal. With just more than 10 percent of the world's population, sub-Saharan Africa has access to only 6 percent of the global blood supply. That region is also home to more than 60 percent of all people living with HIV, and experiences a greater prevalence of transfusion-associated hepatitis virus, malaria and syphilis than industrialized nations. UNSAFE BLOOD "The two crucial issues related to blood transfusion in the developing world, particularly Africa, are blood shortages and unsafe blood," said Dr. Neelam Dhingra, coordinator for blood transfusion safety at WHO. Both these factors often lead to serious health consequences such as death from postpartum hemorrhage or the transmission of life-threatening infections such as HIV and hepatitis. WHO advocates a global strategy for blood safety, and convenes and provides the secretariat for the Global Collaboration for Blood Safety, a network of 60 international organizations, institutions, associations, agencies and experts from developing and developed countries. The U.S. government has made a major contribution to promoting universal access to safe blood, Dhingra said, mainly through the President's Emergency Plan for HIV/AIDS Relief (PEPFAR). Under PEPFAR, she added, "WHO is proud to be providing technical assistance in the strengthening of blood transfusion services in Ethiopia, Haiti and Namibia, three of the PEPFAR focus countries." PEPFAR focus countries are Botswana, Cote d' Ivoire, Ethiopia, Guyana, Haiti, Kenya, Mozambique, Namibia, Nigeria, Rwanda, South Africa, Tanzania, Uganda and Zambia. Unsafe blood transfusions have contributed to the enormous burden of HIV and other infections in sub-Saharan Africa. THE EMERGENCY PLAN "For the developing countries in which the Emergency Plan works," said Dr. Caroline Ryan, deputy director for program services in the Office of the Global AIDS Coordinator at the U.S. State Department, "there are significant challenges to developing and maintaining an adequate sustainable supply of safe blood." There are no strong health care systems, Ryan said, and a lack of basic infrastructure includes such things as inconsistent electricity and refrigeration, too few physical structures and inadequate laboratory equipment. She added there also are no administrative procedures in place for purchasing and managing blood-related commodities and no policies for governing blood safety and the clinical use of blood. To reduce the HIV/AIDS transmission risks of blood transfusions, Ryan said, the emergency plan supports national programs to improve the quality of blood supplies by improving policies, establishing laboratory facilities, buying commodities and training and managing health care workers. In fiscal year 2005, Ryan said, the emergency plan supported 600 blood safety service outlets or programs in the focus countries. In 2004, PEPFAR partners obligated a total of $24.4 million to blood safety activities in the focus countries. In 2005, that amount increased to $50 million. For fiscal year 2006, the planned amount for blood safety is $32.3 million. IMPROVING BLOOD-TRANSFUSION PRACTICES USAID works with partners to improve blood-transfusion and child delivery practices and health systems, said Dr. Robert Ferris, a medical officer in the USAID Bureau for Global Health, who has worked to create a safer blood supply in several countries, including Nigeria and Egypt. Through the Safe Blood for Africa project, USAID -- in partnership with the ExxonMobil Foundation, the Bill & Melinda Gates Foundation, Merck Pharmaceuticals, the U.S. Centers for Disease Control and Prevention (CDC) and others -- is developing a blood collection and distribution center in Abuja, Nigeria, to prevent HIV transmission through blood transfusion. In Abuja, Ferris said, blood services were understaffed and underfunded. USAID's efforts helped sustain a national blood policy and a Nigerian National Blood Transfusion Service. Through the Safe Blood for Africa project, 18 national blood transfusion services now safeguard the blood supply there. In Egypt, USAID worked with public and private partners to enhance the blood-banking enterprise. The project developed a framework to increase voluntary blood donations and includes a course in principles of safe blood collection and universal precaution guidelines, policies and procedures. USAID also promotes safe child delivery and care. Postpartum hemorrhage, for example, is a serious complication of childbirth that often requires blood transfusions. "Our programs," Ferris said, "aim to reduce the need for transfusions by developing programs to prevent postpartum hemorrhage as well as protocols to manage hemorrhage appropriately when it occurs." BLOOD SAFETY AND PREVENTION As part of PEPFAR, said Jerry Holmberg, senior adviser for blood policy at HHS, HHS/CDC supports the development of integrated strategies for blood safety in 14 of the 15 focus countries,12 of which are in sub-Saharan Africa. HHS/CDC's emergency plan-funded initiative pairs the National Blood Transfusion Services with one of five nongovernmental organizationsthat are recognized leaders in blood safety. The approach has four elements: -Enhances local laboratories' capacity to test all donated blood for transfusion-transmitted infections, with a focus on quality-assured screening of all donated blood for HIV. -Promotes voluntary nonpaid blood donations - the collection of blood from regular, unpaid blood donors from low-risk populations. -Provides training and education for local medical personnel to reduce unneeded transfusions, promote safe blood use and increase the use of alternatives to transfusions. -Identifies the amount of blood needed each year to ensure a sufficient supply in each country. The National Heart, Lung and Blood Institute (NHLBI) at the National Institutes of Health supports epidemiological studies at international demonstration sites addressing important blood safety and availability issues to ensure a safe and adequate blood supply. (The Washington File is a product of the Bureau of International Information Programs, U.S. Department of State. Web site: http://usinfo.state.gov) |
