Benefits of HIV screening of blood transfusions in Zambia
Foster, S.; Buvé, A.
Lancet 346(8969): 225-227
1995
ISSN/ISBN: 0140-6736 PMID: 7616804 DOI: 10.1016/s0140-6736(95)91272-xDocument Number: 292157
Monze Hospital is a 250-bed hospital located in the southern province of Zambia. In 1991 overall seroprevalence of HIV was about 15.9% among the hospital's blood donors. The usual procedure was to interview and weigh the donor, measure his or her hemoglobin concentration, and then to collect the blood. Blood was tested for HIV with HIVChek or another rapid test or by ELISA. The cost of testing was dependent on which HIV test was available at the time. A rapid test such as HIVChek was preferred but the price was high. The alternative was an ELISA such as the Wellcozyme ELISA. The total cost of collection of 1 unit of blood was about $11.76 when HIVChek was used, when ELISA was used, the cost of 1 unit was $9.69. For the 1073 units transfused in 1991, 1276 units had to be tested and 203 were rejected. About 2/3 of units were screened by HIVChek and 1/3 by ELISA. The approximate cost of blood collection was $14,128, of which HIV tests accounted for $4745, 33.6% of the total. About 16% of units were discarded because of HIV positivity, and the costs of this wastage brought the total cost per usable unit to an average of $12.82. A minimum of 11.4 of the 1073 units transfused were probably infected but were not detected by screening. Of these about 8 units would have caused new infections. Therefore, 150 infections were prevented by screening and the cost of HIV screening per infection prevented was $31.62. About 59% of infections prevented would have been in children no more than 5 years old and 31% in women. The cost of HIV screening was $4745, an annual expenditure of $0.03 per person. The cost of HIV screening per year of healthy life saved was $1.32. The cost to the health services of treating HIV disease in the 2 years before death was about $110.60 per person. The cost of screening blood in 1991 was estimated at $4745. Thus, the benefit/cost ratio was 3.5/1.