Inconsistencies Found in Kenyan Blood Safety Procedures; Assessment Could Serve as Model in Developing Countries
A 1994 assessment of Kenyan blood safety practices found that HIV-positive blood was transfused 2% of the time due to inconsistent screening practices at Kenyan government hospitals, according to a research summary in the Aug. 25 issue of the Lancet. Researchers from the CDC collected information and blood samples from 1,290 donor-recipient pairs for 12 weeks from April to July 1994 at six government hospitals in Kenya. The blood samples were screened for HIV using each hospital's "standard practice[s]" and were then later screened by a reference laboratory at the CDC in order to make a comparison. Overall, HIV was found among 6.4% of the blood donors, with prevalence varying from 2% to 20% by hospital. Thirty-one of the 1,482 units of blood (2.1%) used in transfusions contained HIV, and of the 1,290 transfusions that were performed using the screened blood, 26 contained HIV-positive blood. Blood was not regularly screened in the hospitals due primarily to a shortage of testing kits. For four weeks during the study period "no HIV test kits were available nationwide," so the researchers supplied the hospitals with kits "with which hospital laboratory personnel were familiar." Data entry errors were also to blame for some of the disparities between screenings. Results for 99 blood samples were not found in hospital log books, but had been written down on the testing laboratory logsheets. "Inconsistent" refrigeration was also a problem, with blood being kept in household refrigerators that often had "limited space" and HIV-positive and HIV-negative blood sometimes being stored together "without clear labels." Equipment problems such as a period of no electricity and malfunctions with one hospital's antibody test reader also compromised the safety of the blood supply. A "lack of quality-assurance programs" and an inconsistency between what types of donations hospitals screened was also found, according to the researchers. One hospital did not "routine[ly]" test the blood of infants born to HIV-positive mothers because "hospital personnel assumed that children of HIV-infected mothers were also HIV-infected." The authors concluded, "Although blood screening removed two-thirds of infected donations, increased attention to blood safety is needed to prevent this unacceptable risk of HIV transmission by transfusion."
Developing a Model
Although the risk of contracting HIV from tainted blood donations has been negligible in most Western nations for years, blood screening programs have been "difficult to implement and sustain" in developing countries because of limited resources for donor recruitment and staff training, improper distribution of the needed testing reagents and "waning support" from international agencies. Based on their findings, the CDC team recommended that the government pay "increased attention to training, supervision, quality assurance, enforced regulation and accountability" to improve blood supply safety. Using those recommendations, the Kenyan Ministry of Health was able to procure financial support to purchase and distribute rapid HIV test kits and develop a national training program to improve laboratory practices. Funding was also found to recruit volunteer donors and to develop "regional transfusion centers" and a "standardized quality assurance program" for the government's hospitals. These "[p]ractical and feasible interventions could dramatically improve blood safety in many resource-poor countries," the researchers concluded, adding, "Given the burden of HIV throughout sub-Saharan African countries, it is time to bring increased attention and resources to eliminate this preventable mode of HIV transmission" (Moore et al., Lancet, 8/25).