This is the 7th blog in a series of blogs from the Office of the Global AIDS Coordinator in recognition of the 10th anniversary of PEPFAR. Previous blogs in the series can be found on the PEPFAR blog site.
“Children are our future, and their mothers are its guardians.”– Former United Nations Secretary-General Kofi Annan
Having just celebrated Mother’s Day, it is fitting to reflect on the significant strides the global community has made in improving and protecting the health of women around the world, particularly in countries with a high burden of HIV and AIDS.
One of the principal ways the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) improves the health and lives of mothers—and their children—is by helping to ensure the safety of blood transfusions. Lack of safe blood directly contributes to poor health outcomes, including high rates of maternal, infant, and under-five mortality. In many parts of sub-Saharan Africa, women and children are often at greatest risk of requiring blood transfusions. This is often due to post-partum hemorrhage and other complications of childbirth, childhood anemia associated with malaria, and trauma. In malaria endemic areas of sub-Saharan Africa, severe anemia in children due to malaria is estimated to account for at least half of all transfusions while obstetric complications are responsible for up to a quarter.
Through the U.S. Centers for Disease Control (CDC), PEPFAR works with Ministries of Health in foreign countries to develop and strengthen national blood transfusion services (NBTS), with a particular focus on countries with a high burden of HIV. Since 2004, PEPFAR has provided ongoing financial and technical support to more than 14 countries with NBTS programs, with the goal of ensuring an adequate supply of safe blood from voluntary non-remunerated donors through screening for transfusion-transmissible infections, such as HIV, syphilis, Hepatitis B, and Hepatitis C.
PEPFAR, through CDC, also supports infrastructure and laboratory development, technical assistance and training, universal testing of blood units for HIV with other transfusion-transmissible infections, development of safe injection policies, and expansion of safe disposal among healthcare workers and community members.
The results have been dramatic. In 10 out of 14 countries, the NBTS reported a significant decline in the percentage of collected blood units reactive for HIV between 2008 and 2010. For example, in Botswana the percentage of collected blood units reactive for HIV decreased from 7.5 percent in 2003 to 1.0 percent in 2010. In Zambia, PEPFAR has supported the shift from a fragmented hospital-based system to a regionalized system under the control of the country’s NBTS. The program has nearly tripled the number of donations from voluntary non-remunerated donors, who are at lower risk for HIV infection, and has eliminated collections from higher-risk family replacement donors. In 2012, the Zambia NBTS collected 108,000 units of blood – of which over 33,000 units were used to save the lives of new mothers or pregnant women. Zambia has also eliminated risky family replacement donations.
This robust platform has been leveraged to build a more sustainable and integrated response. By 2010, more than 80 percent of PEPFAR funds for blood safety had been shifted directly to each country, allowing country programs to more closely monitor and manage the transition of blood safety programs.
These programs are having a tangible impact on the communities they serve. In Rwanda, the NBTS instituted a cross-cutting incentive system to attract and retain voluntary blood donors with repeat donors qualifying for items such as insecticide-treated bed nets to combat malaria. And in Kenya, blood donations from volunteer donors nearly tripled in two years, from 43,000 units to 117,482 units; the NBTS now supplies 125 health care facilities with at least 80 percent of their blood needs, up from only 8 sites in 2004.
Despite these remarkable results, much more remains to be done. CDC and PEPFAR are committed to continued support of blood safety activities. Going forward, we will maintain our support in 14 countries and add 13 more countries through financial support to Ministries of Health and NTBS units, and the provision of technical assistance by CDC and other international experts in blood transfusion and the administration of blood services. Ensuring blood safety is a crucial component to maternal and child health, and critical to achieving an AIDS-free generation. We will not back down from this challenge; the stakes are too high—for mothers, children, and the millions of patients that PEPFAR helps to serve.