Not applicable

New/Continuing Activity: Continuing Activity

Continuing Activity: 18553

Continued Associated Activity Information

Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds

System ID System ID

18553 11782.08 Department of Population 8127 5936.08 BCC and HIV $190,000

Defense Services Prevention

International

11782 11782.07 Department of Population 5936 5936.07 BCC and HIV $190,000

Defense Services Prevention

International

Emphasis Areas

Human Capacity Development

Estimated amount of funding that is planned for Human Capacity Development $5,000

Public Health Evaluation

Food and Nutrition: Policy, Tools, and Service Delivery

Food and Nutrition: Commodities

Economic Strengthening

Education

Water

Program Budget Code: 04 - HMBL Biomedical Prevention: Blood Safety

Total Planned Funding for Program Budget Code: $325,000

Total Planned Funding for Program Budget Code: $0

Program Area Narrative:

Biomedical Prevention

Overview

It is estimated that at least 5% of HIV infections in the DRC occur through transfusion of contaminated blood or blood products.

This has a disproportionate affect on pregnant women, children with life-threatening anemia, military, and trauma victims as blood

transfusions are most common in these populations. In 2008, the MOH National Program for Blood Safety (PNTS) estimated that

in 477 of 515 Health Zones, 235,945 blood transfusions were administered. Of the donated blood, 59% was received from a

patient's donating family member. Donating family members do not receive payment for their donations, unlike voluntary donors

which represent only 35% of all donors. The military health system also depends completely on the PNTS blood safety network

and thus is at risk for unsecured transfusions. In August 2007, one of the biggest military hospitals located at Kamina Base found

that HIV prevalence among blood donors was very high (66.7%). The PNTS reports frequent stock-outs of HIV tests and other

commodities, and a lack of available resources for the implementation of voluntary donor mobilization campaigns.

Insufficient attention is paid to the risk of HIV/AIDS infection during invasive medical procedures in the DRC. Lack of training and

an unreliable supply chain for universal precaution materials able to meet current demands are major constraints to minimizing

medical transmission of HIV/AIDS. The USG recognizes the following priorities for TA: (1) strengthening the supply chain, (2)

establishing a standardized training curricula, and (3) improving waste management practices. Also of concern is the limited

documentation relating to clinical practices that increase the risk of exposure.

Challenges

There is insufficient attention to blood safety in DRC's response to HIV/AIDS. The DRC has poorly developed, fragmented blood

safety practices. The blood transfusion system is predominantly hospital based and suffers from chronic staff shortages, a lack of

training, and a serious deficiency in pre-transfusion HIV testing capacity. There is no reliable supply chain to meet current

demands for universal precaution materials, lab reagents, and other basic supplies. These constraints, along with an acute

shortage of blood, are the major challenges to minimize medical transmission of HIV/AIDS. The provision of TA to strengthen the

supply chain, establish standardized training curricula, and safe blood supply management are all key priorities. In addition, donor

coordination and cost recovery/affordability of service remains a challenge. For example, all health services in the military are free

of charge yet the military must pay for safe blood from the PNTS network or from other civilian health structures.

Leveraging and Coordination

Current USG funding levels do not permit financial support of all of these priorities. Therefore, partnering with larger donors such

as the World Bank/MAP and Global Fund is critical. Both Global Fund and MAP incorporate blood safety into their planned

national HIV/AIDS programs. The focus of the PNTS and donor groups is to revitalize and improve the national blood safety

program through a combined approach of voluntary and remunerated donations.

The USG's role in improving blood safety programs is limited to: (1) program evaluations, (2) advocacy and policy development,

(3) and leveraging funding from other donors. DFID has expressed interest in working on blood safety policy and programming.

The USG will work with other partners, such as professional associations for physicians, nurses and laboratory technicians, to

ensure coverage of injection safety through the provision of TA.

Current USG Support

With USG support, Kinshasa School of Public Health (KSPH) conducted an evaluation of the National Blood Safety Program in

2006. The evaluation conducted an organizational audit, assessed stock management, and evaluated service coverage. The

evaluation also assessed strengths, weaknesses, opportunities and barriers to safe blood services nationwide. The evaluation

found that program activities are appropriate but that coverage is only effective in Kinshasa and the provincial capitals. Coverage

outside of the provincial capitals is scarce, partial and incomplete. Furthermore, untrained hospital staff are completing blood

transfusions with limited capacity in proper safe blood procedures. The USG assisted the PNTS to establish ongoing volunteer

blood donor groups; however, results were limited as most volunteers donate blood irregularly or infrequently. The average cost

per transfusion is $5.00, while most Congolese live on less than $1.00 a day.

Previously, the USG supported efforts to prevent transfusion of unscreened blood through its rural health zone program. This

effort increased safe blood transfusions from 69% to 97% in the USG-supported health zones.

Presently, the USG is contributing directly to basic training and provision of universal precaution equipment in the 57 rural health

zones supported by Project AXxes. The USG complemented the rural health program with a blood safety public-private

partnership that leveraged $1.30 (in total $1,909,426) for every $1.00 invested by the USG (in total $1.2M). The Global

Development Alliance (GDA) with Safe Blood for Africa (SBFA), in collaboration with the KSPH, is working to strengthen blood

safety efforts for the 7.5 million Congolese in the Project AXxes health zones. This program provides support and facilitates the

implementation of an effective National Transfusion Service to build a safe and sustainable blood supply in DRC. The support

includes expert guidance and TA in the areas of policy and infrastructure development, blood collection, testing, quality

management, transfusion and blood utilization, test kit use training, and monitoring and evaluation. The program includes the

distribution of HIV rapid test kits, blood bank and laboratory administration. This project also strengthens the MOH capacity in

quality assurance, development of a volunteer non-remunerated blood donation program including training in volunteer donor

recruitment and waste-management considerations.

The USG also collaborated with the Belgian Red Cross to set up a pediatric blood bank at Kalembe Lembe Pediatric Hospital in

Kinshasa, where UNC is implementing HIV care for kids.

The USG is working with the MOH on policy-level changes in injection safety with the goal of creating policies that decrease

demand for injections. The KSPH with USG support is assessing the incidence of accidental blood exposure. Using USG funding,

a survey in medical transmission safety has been conducted in Kinshasa to determine the extent of the problem, its causes and

possible remedial actions. The results of this study that are expected next year will provide specific information for health care

provider professional associations to assist in their efforts to reduce accidental medical transmission of HIV. Also, TA will be

provided on risk reduction to associations of physicians, nurses, lab technicians and dentists to develop information packages for

their members.

FY09 Support

With FY09 funds, the USG will continue the GDA with SBFA to implement the blood safety program based on voluntary blood

donations in the 57 rural health zones. The SBFA and the new integrated bilateral health project (mechanism TBD) will join efforts

to continue to provide blood safety services including HIV test kit distribution, training of providers on the use of the test kits,

quality assurance, and support the non-remunerated and volunteer blood donation program. With FY09 funds, there will be

expanded efforts to provide testing for major transfusion-transmissible diseases in accordance with national policies and PEPFAR

blood safety guidance as well as sensitization campaign related to blood donors. Health zone teams will be trained to recruit and

retain low-risk blood donors, especially volunteer, non-remunerated blood donors from low-risk populations. With PNTS support,

SBFA and the new integrated bilateral health project will reduce unnecessary transfusions by training health care providers in the

appropriate use of blood transfusions and alternatives to transfusion.

The USG will provide support for improving the blood safety at military hospitals to mitigate their increased risk pending the

availability of additional funding from the Partnership Compact.

TA in policy and programming will continue in 2009 in collaboration with the National Blood Safety Program (PNTS). Support for

the PNTS will be leveraged by conducting an assessment and by expanding on KSPH's work to include a strategic plan, a policy

matrix, a review of blood safety norms and standards, laboratory protocols, equipment standardization, maintenance, training

materials, and planned human resource capacity development. Experts will also assess and make recommendations regarding

recurrent stock management, equipment and human investments, commodity procurement/supply chain, and quality control of

laboratory services. This assessment will also address issues such as appropriate use of blood transfusions and recommend a

policy statement to reduce blood transfusions, especially among women and young children under the age of five. National

program staff will be assisted in determining medium and long term planning objectives. In FY09, there will be increased training

and dissemination of these assessment results and national guidelines.

Using FY09 funding, the KSPH will provide technical assistance to the MOH National AIDS Control Program (NACP) to develop

guidelines and training manuals and to establish national standards for universal precautions. A training session for trainers will be

conducted.

INJECTING AND NON-INJECTING DRUG USERS

Currently, there are no PEPFAR programs addressing this population.

MALE CIRCUMCISION

Currently, there are no PEPFAR programs addressing male circumcision. The DHS 2007 estimates that the almost all men (97%)

between 15-59 years of age are already circumcised. *

Program Area Downstream Targets:

3.1 Number of service outlets carrying out blood safety activities: 114

3.2 Number of individuals trained in blood safety: 570

4.1 Number of individuals trained in medical injection safety: 55

Table 3.3.04: