1. LIST OF RELATED ACTIVITIES This activity relates to the prevention of medical transmission of HIV through mobilization of low-risk volunteer blood donors by (BloodLink Foundation), under the umbrella organization CHF. (Internews) will help promote voluntary blood donation by training radio journalists.

2. ACTIVITY DESCRIPTION This activity relates to reduction of medical transmission of HIV through blood by the provision of adequate supplies of safe blood to all health care facilities in Kenya. Fear of HIV/AIDS and weakened health infrastructure led to a 50% drop in blood donation in Kenya over the last 20 years. A national survey in 1994 demonstrated a 2% risk of HIV transmission in all transfusions due to inadequate testing and poor quality control. A study in 2001 found that 83% of blood was obtained from family replacement donors. Kenya is estimated to require 250,000 units of blood for transfusion. Currently only about 120,000 units are collected annually. The foregoing observations indicated that Kenya's blood supply was neither sufficient nor safe. Following the bombing of the US Embassy in Nairobi in 1998, USG supported the Kenya Government in developing a nationally coordinated blood program through establishment of the National Blood Transfusion Service (NBTS). USG assistance has contributed to development of Policy Guidelines on Blood Transfusion, National Strategy on Blood Donor Mobilization, and Clinical Guidelines for Appropriate Use of Blood and Blood Products. While the government of Kenya policy on blood transfusion has outlined the structure of the NBTS, there is a lack of legislative authority for it to become a semi-autonomous agency of the Ministry of Health. Blood safety receives limited financial support from government resources. Frequent staff transfers and overall staff shortages hampered quality improvements. In Y05 the NBTS received a PEPFAR grant to support the recruitment of volunteer blood donors, procurement of supplies and equipment for blood testing and processing and to support the training and supervision of staff. This facilitated invigoration of blood donor recruitment drives with a corollary increase in blood collections of over 100% between 2005 and 2006. The NBTs has procured equipment and hired additional staff including nurses, donor recruiters and data personnel, to support blood collection and processing. Contracts with sub partners (Hope Worlwide and Kenya Red Cross Society) for donor mobilization have continued to operate smoothly. It is estimated that less than 0.5% of Kenyans are blood donors and that 90% of Kenya's blood supply is currently obtained from students. The World Health Organization (WHO) suggests that a country cannot be self- sufficient in blood unless about 2% of the population are blood donors. This funding will expand the partnership between the NBTS and the sub-partners who will recruit for low-risk non-remunerated volunteer blood donors in work places, training institutions, out-of-school youth and among faith and community based organizations. FY07 funding will be used to scale up blood donor recruitment to increase blood collections by 40,000 units while reducing the prevalence of HIV to below 1%. Repeat donations will be increased by 20 %. This funding will be utilised to increase from 42 to 60, the number of health care facilities that obtain at least 80% of their blood supply from the NBTS. Training in donor recruitment, data management, National Standards for Transfusion services and quality processing will be organized nationally. Regional blood transfusion centres will organize training for user hospitals in appropriate blood use. A national Blood transfusion Strategic plan will be developed. The in- country WHO supported distance-learning course in blood banking at the Kenya Medical Training College which has previously focused on blood bank staff will be expanded to encompass hospital blood bank personnel at the hospital level so as to ensure strict observation of the blood cold chain and rationalise demand for blood. Y07 funding will enable two clinicians to participate in the CDC/Emory University-developed transfusion medicine course in Atlanta GA. As blood collections increase manual and semi-automated testing has been identified as a bottleneck within the blood bank. This will be addressed in Y07 by increased automation and centralization of testing. This funding will also support contractual staff hired for the NBTS head office to facilitate administrative, financial and IT support as the final moves towards semi-autonomy are taken. It has been estimated that $15 is required to collect and screen a single unit of blood. This excludes salaries and overheads. A business plan will be developed to ensure continuity and growth of the blood safety program in later years. Other donors contributing to a safe blood supply include the Japanese International Cooperation Agency (JICA), which has trained laboratory staff, conducted a national assessment of blood safety and improved laboratory infrastructure. There is excellent donor coordination through a national committee chaired by the NBTS.

3. CONTRIBUTIONS TO OVERALL PROGRAM AREA This activity aims to result 100,000 units of blood from low-risk volunteer blood donors. This would meet the current blood consumption in the country and contribute to the prevention of 4,000 cases of HIV. At least 100 health care workers will be trained in blood safety.

4. LINKS TO OTHER ACTIVITIES: American Association of Blood Banks (#6840) gives technical support to NBTS through provision of training in BDR, blood processing and banking preparation of policy guidelines, protocols for quality assurance schemes, standard operating procedures and blood bank management. Bloodlink- BDR is among corporate organizations to broaden donor base and develop sustainability plan.

5. POPULATIONS BEING TARGETED NBTS activities target health care workers within the NBTS who mobilize and recruit, blood donors, test and process blood, counsel donors and manage blood banks as well as health care workers in hospitals and nursing homes who prescribe blood and blood products, group and cross match blood and monitor transfusions. These activities will benefit the general population including people living with HIV/AIDS.

6. EMPHASIS AREAS COVERED This activity includes major emphasis on local organization capacity development (NBTS), for community mobilisation and participation through the recruitment of low-risk-voluntary blood donors from among all adults above 16 years of age so as to identify a safe source of blood for transfusion. Minor emphasis will be placed in infrastructure development for the renovation of blood banks, procurement of specialized equipment, reagents, lab consumables, furniture and vehicles to ensure safe blood under the PEPFAR program.