Prevention of blood-borne HIV transmission using a decentralized approach in Shaba, Zaire
Laleman, G.; Magazani, K.; Perriëns, J.H.; Badibanga, N.; Kapila, N.; Konde, M.; Selemani, U.; Piot, P.
Aids 6(11): 1353-1358
1992
ISSN/ISBN: 0269-9370 PMID: 1472338 DOI: 10.1097/00002030-199211000-00019Document Number: 329331
Objective: To prevent blood and transfusion-acquired HIV infection with a decentralized approach to HIV screening of blood donors, using an instrument-free rapid test. Setting: Shaba province, Zaire (496 877 km-2). Methods: The program consisted of training health-care workers, distribution of a rapid HIV-antibody test (DuPont's HIVCHEK) for screening of all blood donations, and quality control of testing by a regional reference center. Results: Over a 2-year period, 11 940 rapid tests were distributed to 37 hospitals, covering 75% of all hospital beds outside the copper mine's health system in Shaba. Eighty-five per cent of the tests were used to screen blood donors (5.4% positive test rate) and 13% to test patients (39.7% positive test rate). At least 265 cases of HIV-positive blood donation were prevented, at an estimated cost of 137-279 ECU per case. Only 26% of initially positive specimens reached the central laboratory for supplemental testing, and sterile transfusion equipment and blood-grouping reagents were frequently unavailable. The lack of transport and communications and a deteriorating health system were major constraints. Conclusions: District hospitals in Africa are often long distances from major cities, difficult to reach for most of the year, and perform a small number of transfusions. In this context a classical centralized regional blood bank may not be a feasible option to ensure safe blood transfusions. However, safe blood transfusion can be achieved with a decentralized approach using a rapid test, provided that minimum standards of health-care services are available.