"HIV is a disaster of enormous proportions in many developing nations including those in Africa," said Christopher D. Hillyer, MD, director of Emory's Transfusion Medicine Program, professor of pathology and laboratory medicine at Emory University School of Medicine, vice president of the AABB and co-principal investigator of the grant, which will provide $12 million over five years. . "Blood transfusion plays a significant part in transmission of HIV in those countries."
UNAIDS estimates 40 million individuals in sub-Saharan Africa are infected with HIV, and that 2.5 million of those are children. Five million new individuals in that region were infected with HIV in the year 2003. The World Health Organization (WHO) estimates that 5% to 10% of global HIV infections worldwide are caused by transfusion of unsafe blood and blood products. In Africa, that percentage is likely much higher, however, because few hospitals regularly test blood products for HIV and fewer than one-third of African countries have transfusion policies, procedures or guidelines to limit HIV transmission.
Karen Shoos Lipton, JD, chief executive officer of AABB, is principal investigator of the grant, and Roger Y. Dodd, PhD, executive director of biomedical safety and head of the Transmissible Diseases Department at the ARC's Jerome H. Holland Laboratory for the Biomedical Sciences, is senior co-investigator. All three primary investigators are recognized authorities in national and international transfusion medicine. Dr. Hillyer is slated to become president-elect and then president of the AABB in 2004 and 2005.
While the risk of HIV transmission due to blood transfusion in the U.S. is approximately 1 in 5 million, this ratio approaches 1 in 500 in some developing countries, according to Dr. Hillyer. In the U.S. virtually all blood donations are voluntary, and extensive testing programs are in place to detect HIV and hepatitis C virus. Developing countries, however, often lack basic services necessary for a safe blood supply, including reliable electricity, safe water and passable roads. These factors are essential for testing donors and donated blood, storing blood and rapidly transporting blood for transfusion.
Although the majority of U.S. blood transfusions are performed in adults, in developing nations more than half of transfused blood is given to children. The primary reasons for maternal and pediatric transfusions in developing countries are anemia in early childhood or pregnancy, trauma, malaria, sickle cell disease and thalassemia. Cultural and social pressures contribute to a shortage of volunteer donors, and transfused blood often is not tested due to lack of resources, untrained workers or a cultural stigma against HIV awareness.
"Our first step with this new PEPFAR grant will be to send immediate response teams of blood banking professionals to the four countries to conduct assessments and hold high-level meetings with the ministries of health," Dr. Hillyer said. "We will develop a plan, create standards and conduct training programs that incorporate all elements of transfusion medicine, including basic techniques, testing, record keeping, transportation and the creation of geographic transfusion centers."
In addition to the grants given to U.S. institutions for improving transfusion safety, PEPFAR simultaneously awarded grants to ministries of health and national transfusion services in each of the four countries selected for the AIDS relief program. Together the U.S. teams and the ministries of health plan to achieve either substantial improvement in national blood transfusion services and their infrastructure, or to establish new transfusion services. Using model standards developed by the AABB, the U.S. teams will provide expert guidance and technical assistance to the ministries of health or the national transfusion services as they develop and implement safe blood programs. The model standards encompass every aspect of blood donor recruitment, blood collection, processing, testing, storage (handling) and distribution, including record keeping and quality assurance activities.
"This grant makes it possible for Emory and its colleagues at the AABB and the American Red Cross to undertake a tremendous humanitarian effort," said Tristram Parslow, MD, PhD, chair of the Department of Pathology and Laboratory Medicine at Emory University School of Medicine. "Our program in transfusion medicine already serves as a model for best practices, and our successful training programs for physicians from Kenya and Tanzania have given our transfusion medicine specialists excellent experience in transferring their expertise to transfusion medicine physicians in other nations. Working with our partners at AABB and ARC, we welcome this chance to promote blood safety in the developing world and to help stem the global HIV/AIDS epidemic."
Emory's Transfusion Medicine Program maintains one of the largest blood banks in the U.S., and the program's faculty and physicians are responsible for research, teaching and clinical endeavors for all transfusion medicine-related activities within Emory Healthcare, at Grady Memorial Hospital and Children's Healthcare of Atlanta. The AABB has been the international leader in developing standards for voluntary compliance in blood collection, processing, testing and transfusion for more than 45 years. The ARC, through its Blood Services Program, provides almost half of the blood and blood components used for transfusion in the U.S. The ARC also supports numerous humanitarian programs throughout the world, many of which have enhanced blood safety.