Current screening strategies for blood donor screening in developing countries

Abstract

Background The entire African continents counties are classified as developing countries according to the World Bank criteria. It is ironic that poverty is a cause of endemic disease which in turn is a cause of poverty. It has been described in the 2008 UNAIDS report that sub‐Saharan Africa remains the region most heavily affected by HIV, accounting for 67% of all people living with HIV and 75% of all AIDS deaths in 2007 and in this environment millions of units of blood are collected. Aims The aim of this review is to discuss the various different screening strategies of blood donations used in developing countries and to highlight some of the advantages and disadvantages. Material & Methods This paper is based on a review of the literature as well as information provided by various transfusion services in Africa. Results There are various systems for the provision of blood, the hospital based systems which consist mainly of transfusion units attached to laboratories at the hospital, most of which use donor replacement schemes or the more centralized transfusion centers that usually have a system for voluntary non remunerated altruistic donors. Currently most countries have a hybrid of these two systems with 70% of the blood coming from donor replacement schemes. A range of screening strategies are used in Africa and it was estimated in 2004 that only 80% of the blood was screened for Transfusion Transmissible infections (TTI’s). One hundred and fifty five countries reported to the WHO global database that 100% screening was performed but of these only 71 were performed in a quality assured manner. Various assay systems with differing sensitivities and specificities are used. A rapid assay is performed prior to donation in some settings which has advantages and disadvantages. Studies have shown that performing two different rapid assays in serial or parallel is more sensitive than as a single test but may not be feasible in resource limited settings. The majority of African countries test using an ELISA method which is the recommendation of the WHO. Many creative studies have been performed to try and make the screening as cost effective as possible without too much loss in sensitivity. One such study showed that if a serial testing algorithm was used that tested HBsAg first and then HIV on the seronegative donations and then syphilis on the subsequent seronegative donations and finally HCV the costs per annum in screening could be reduced by €90 860 per annum in Ghana. The final screening strategy that is used in some developing countries is Nucleic acid testing (NAT), this strategy is used in South Africa, Namibia, Egypt and Ghana. Although this strategy increases the safety of the blood supply it has been shown that in some settings it is not cost effective and should be clearly investigated prior to implementation Conclusion There are various screening strategies in Africa and due to a large amount of work performed by different organizations the plan is to have 100% voluntary blood donors and 100% screening by 2012. To do this a National blood screening programme and budgeting nationally for blood will be required.

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