A 1994 study which highlighted the problem of HIV-1 transmission from blood-transfusion programmes in Kenya-and resulted in positive government action-could help other African countries develop safer blood-transfusion strategies.
Little support for blood-safety programmes has been provided to less-developed countries over the past decade. The Kenya Ministry of Health did a collaborative multicentre assessment with Robert Janssen and colleagues from the Centres for Disease Control, Atlanta, USA. The aims of this study were to establish the risk of HIV transmission by transfusion in Kenya, to promote awareness of blood safety issues in a country with a mature HIV epidemic, and to identify methods to reduce the risk of HIV transmission by blood transfusion.
The investigators collected information and blood samples from all blood donors and pretransfusion samples from all recipients in six government hospitals in Kenya. Blood donations were screened for HIV according to standard practice in the hospital laboratories. Test results at a reference laboratory at the US Centres for Disease Control were compared with those of the hospital laboratories and risk of transfusion-associated HIV transmission was calculated.
The prevalence of HIV among blood donors was 6.4% and varied by hospital (range 2%-20%). HIV-test results were available for 1290 donor-recipient pairs. Of these, 26 HIV-positive donations were given to HIV-negative patients. The investigators estimated that 2% of transfusions transmitted HIV. Problems in the hospitals that contributed to transfusion risk included inconsistent refrigeration, data-entry errors, equipment failure, and lack of a quality-assurance programme.
Robert Janssen comments: “This rapid assessment provided important information for the development and implementation of programmes aimed at improving blood safety. Based on these results, the Kenya Ministry of Health identified support for the purchase and distribution of rapid HIV test kits and developed a national training programme to improve laboratory practices. Universal screening of all blood donations was emphasised at all hospitals. With an accurate assessment completed, and a national response planned, international aid funding was secured to implement training programmes, to improve recruitment of volunteer donors, to develop regional transfusion centres, and to develop a standardised quality-assurance programme. In these ways, this assessment helped to specify the areas that needed improvement and mobilise the resources and political commitment needed to address them. This rapid assessment may serve as an example other countries could use to assess the safety of their blood supply and to identify procedures to improve blood safety.”
Contact: Dr Robert S Janssen,Division of HIV/AIDS Prevention-Surveillance and Epidemiology,Centers for Disease Control and Prevention,1600 Clifton Road (Mail-stop D-21),Atlanta, GA 30333,USA,T) 1-404-639-0900;F) 1-404-639-0910;E) rjanssen@cdc.gov
Journal
The Lancet