This mechanism supports CARs PEPFAR Strategy Objectives 2 and 3. The primary goals of this award are to increase the capacity of the Republican Blood Center (RBC) in Tajikistan (TJ) to improve their blood safety program, ensure an adequate blood supply, perform accurate and appropriate blood screening for the TJ population, and to sustain these program improvements over time. Challenges in blood safety in TJ include lack of voluntary donors, inappropriate clinical use of blood, inadequate maintenance of the cold chain, inadequately trained staff, an outdated, unsustainable electronic blood donor database, and lack of a quality assurance management system (QMS), potentially hindering laboratory performance. Under this award, TA will be provided to the Republican Blood Center of TJ to improve these deficiencies and to develop a QMS covering all stages of the transfusion process. These activities will allow the TJ blood centers to improve their services and efficiency over time. The project will implement a nationwide M&E system for blood services indicators. The indicators will include number of donors served, number of donors tested, number of donors positive for transfusion transmissible infections (TTI), and number of trained people over time. Indicators will be monitored by review with the standardized checklist during regularly scheduled site visits. Sustainability of the program and country ownership will be fostered through training and capacity building of RBC staff, and development of effective and useful electronic databases for both QMS and M&E. These activities will allow the RBC monitor and improve the quality and efficiency of their activities.

Global Fund / Programmatic Engagement Questions

1. Is the Prime Partner of this mechanism also a Global Fund principal or sub-recipient, and/or does this mechanism support Global Fund grant implementation? Yes2. Is this partner also a Global Fund principal or sub-recipient? Sub Recipient3. What activities does this partner undertake to support global fund implementation or governance?

Budget Code Recipient(s) of Support Approximate Budget Brief Description of ActivitiesHMBL Republican Blood Center 150000 Build capacity of health providers in clinical use of blood, assist with the development of software and M&E system to consolidate data

This ongoing Cooperative Agreement supports CARs PEPFAR Strategy Objectives 2 and 3. In 2007, CDC re-screened 7500 samples from blood donors in the Central Asia Region (CAR), confirming that contaminated blood is being administered in health facilities. Transfusion of HIV-infected blood is 100 times more efficient for transmitting HIV infection than intravenous injection with a contaminated syringe. An adequate supply of safe blood and the appropriate clinical use of blood are important components of the CAR PEPFAR prevention strategy, as well as a priority for the Government of Tajikistan (TJ). Almost 98% of the blood supply in TJ is based on the principle of donor replacement. The goals for this activity are to: (1) improve the TJ strategy for voluntary blood donorship using international expertise and results of a Knowledge Attitude Practices/Behavior (KAP) survey; (2) help to establish a quality management system (QMS) for blood banking, including screening for transfusion transmissible infections (TTI), blood compatibility and typing; (3) assure cold chain maintenance, including expansion to the rural areas; (4) reduce non-evidence-based clinical use of blood products; (5) establish national norms, standards and organizational structures for a national blood service; (6) improve information systems and standardize databases for tracking blood donors and donated blood units; and (7) strengthen professional development of blood services staff. Technical assistance (TA) will be provided to assist with implementation of a newly developed electronic database to track blood donations at the oblast-level blood centers; conduct on-site training workshops on the database, including entering and using donation data; implement a bar code system for blood services at the oblast level; conduct trainings on cold chain maintenance for all levels of blood services, including national, oblast and rayon. These activities address the 1st (Policy), 5th (Training), 6th (Monitoring and Evaluation) and 7th (Sustainability) key elements identified by the Medical Transmission technical working group (TWG).The KAP surveys will inform the national strategy on voluntary donorship, including Information (IEC) campaigns for recruitment of donors. Trainings and recruitment materials will be developed for donor recruiters on republican, oblast and rayon levels, who will also collect basic donor information. These activities are related to the 1st, 2nd and 5th and 7th elements identified by the TWG. Ongoing activities include laboratory strengthening (using prior year funding). All activities will be conducted in the context of a QMS, currently being developed by the TJ MOH, spanning the entire chain of blood services. They will be integrated with other HIV/AIDS related services, as potential donors who test positive for TTIs will be referred to the TJ AIDS Center for further counseling and testing and treatment. Sustainability of the program and country ownership will be fostered through capacity building (training the TJ government to improve their blood safety program) and technology transfer (the electronic database).