ACTIVITY HAS BEEN MODIFIED IN THE FOLLOWING WAYS FROM COP 2008:

1) A prevention component has been integrated into NBTS activities. This will involve implementation of

blood donor notification of test results for HIV, hepatitis B and C and Syphilis and referral for appropriate

care.

2) NBTS will support national training in transfusion sciences of five medical lab technologists for higher

national diploma at the Kenya Medical Training College (KMTC) and two physicians at Emory University

and/ or at Sanquin/ Groningen University- Netherlands.

3) In collaboration with CDC - National Center for Health Marketing and Bloodlink Foundation, mobile phone

messaging will be developed to recall donors for regular blood donation.

COP 2008

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 the National blood Transfusion Service (NBTS) supported by Kenya Red Cross

society (KRCS), Hope Worldwide Kenya, (HWWK), Africa Society for Blood Transfusion- Kenya Chapter

(AfSBT-K) and Bloodlink Foundation (BLF), under an umbrella funding and capacity building organization.

Internews will help promote voluntary blood donation by training radio and TV journalists in generating blood

safety related stories. USAID APHIA II Health and Communication will develop IEC material for blood donor

mobilization and appropriate blood use. Supply Chain Management Systems (SCMS) will procure

equipment and reagents to facilitate centralized blood testing, preparation of blood components and

maintenance of the blood storage cold chain. American association of Blood banks (AABB) will continue to

give technical assistance to NBTS through training in donor recruitment, donor care, testing, inventory

management and appropriate blood use.

2. ACTIVITY DESCRIPTION

This activity relates to reduction of medical transmission of HIV through blood transfusion 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, Clinical Guidelines for Appropriate Use

of Blood and Blood Products and National Standards for Blood Transfusion Services. While the government

of Kenya policy on blood transfusion has outlined the structure of the NBTS, there is still 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. In 2004 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 (HWWK, BLF, AfSBT-K

and KRCS ) for donor mobilization have continued to operate smoothly. It is estimated that less than 0.5%

of Kenyans are blood donors and that 70% 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 is donates blood regularly. 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. FY09 funding

will be used to scale up blood donor recruitment to increase blood collections by 20,000 units while

maintaining the prevalence of HIV to below 2%. Repeat donations will be increased by 20 %. This funding

will be utilized to increase the number of health care facilities that obtain at least 80% of their blood supply

from the NBTS from 162 in FY07 to 190 in FY09. AABB facilitated training in donor recruitment, data

management, quality standards and blood processing will be organized nationally. Regional blood

transfusion centers in collaboration with Africa society for Blood Transfusion- Kenya Chapter (AfSBT-K) will

train 20 hospitals in appropriate blood use. The national Blood transfusion Strategic plan and annual

operational plan will be implemented. Higher diploma training in blood Transfusion Science at the Kenya

Medical Training College will be supported. Two physicians will also be trained in blood banking either at

Emory University and/ or at Sanquin/ Groningen University- Netherlands. FY09 funding will enable two

NBTS staff to acquire advanced exposure in Quality Management Systems at institutions in South Africa.

As blood collections increased manual and semi-automated testing were identified as a bottlenecks within

the blood bank. This was addressed in Y07 by increased automation and centralization of testing. Testing

reagents will continue to be procured through SCMS. 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 190,000 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 4,200 cases of HIV. At least

100 health care workers will be trained in blood safety.

4. LINKS TO OTHER ACTIVITIES

This activity is linked to biomedical prevention of HIV and to counseling and testing through notification of

Activity Narrative: test results. It is also linked to sexual prevention of HIV activities through the delivery of ABC messages to

all potential blood donors. Increasingly, blood transfusion is required for management of AIDS related

anaemia thus creating a link to the Care /ART program. Training and policies developed in this activity

contribute to building of sustainable safe blood systems for the Ministry of Health and government of Kenya.

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. Safe blood benefits the general population including children and pregnant women who

consume 30% and 25% respectively of the blood supply. These activities will also benefit the people living

with HIV/AIDS.

6. EMPHASIS AREAS COVERED

This activity includes major emphasis on HIV prevention through the provision of safe blood. There is minor

emphasis on local organization capacity development (NBTS), procurement of specialized equipment,

reagents and lab consumables to ensure safe blood under the PEPFAR program.

New/Continuing Activity: Continuing Activity

Continuing Activity: 14943

Continued Associated Activity Information

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

System ID System ID

14943 4273.08 HHS/Centers for National Blood 6982 1457.08 $3,000,000

Disease Control & Transfusion

Prevention Service, Kenya

7011 4273.07 HHS/Centers for National Blood 4267 1457.07 $3,000,000

Disease Control & Transfusion

Prevention Service, Kenya

4273 4273.06 HHS/Centers for National Blood 3273 1457.06 $2,000,000

Disease Control & Transfusion

Prevention Service, Kenya

Emphasis Areas

Health-related Wraparound Programs

* Malaria (PMI)

* Safe Motherhood

Human Capacity Development

Estimated amount of funding that is planned for Human Capacity Development $573,000

Public Health Evaluation

Food and Nutrition: Policy, Tools, and Service Delivery

Food and Nutrition: Commodities

Economic Strengthening

Education

Water

Table 3.3.04: