ACTIVITY DESCRIPTION:

In COP08, a total of 108,000 units of blood are anticipated to be collected and screened, including 27,840

units of blood that will be collected by the Nigerian National Blood Transfusion Service (NBTS) from USG-

supported hospitals. NBTS will source blood collections from voluntary non-remunerated donors (VNRD),

with extensive mobile community outreach activities at all centers. An aggressive donor recruitment

campaign is in progress to educate the populace about the importance of voluntary blood donations to

improve blood safety and availability. The campaigns are carried out mostly in tertiary educational

institutions, via mass media (TV, radio), by road shows and through one-on-one recruitment. Young

persons are targeted to become regular blood donors through education, counseling and reinforcing

messages about living healthy lifestyles that reduce the risk of contracting HIV and other TTIs. The youth

recruitment program relies on the establishment of youth donor associations and NGOs (e.g., local Club 25,

Lifesavers Club and Rotaract Club). NBTS, through the linkages its zonal centers will develop with other

IPs, will provide TA for blood donation drives held by USG-supported hospital facilities.

The NBTS coordinates all blood safety activities in Nigeria. It is based on a centralized system that began

with six zonal blood screening centers in the first phase of the project and is comprised of 14 centers now.

The Abuja Center serves as headquarters covering the Federal Capital Territory and adjourning states with

a population of 7.2 million. The Kaduna Center serves the North-West Zone (seven states) with a population

of 35.8 million. The Owerri Center serves the South-East Zone (five states) with a population of 16.4 million.

The Ibadan Center serves the South-West Zone (six states) and a population of 27.6 million. The Maiduguri

Center covers the North-East Zone (six states) and 18.2 million people. The Jos Center covers the North-

Central Zone (six states) and18.2 million people. The Port-Harcourt Center is designated as the Armed

Forces Center. The South-South Zone (six states) with a population of 21 million has Benin City as its Zonal

Center. Lokoja is a state center complementing the Jos Zonal Center while the Potiskum Center

complements the North-East Zonal Center in Maiduguri. The Abeokuta State Center will complement the

Zonal Center in Ibadan while the Sokoto Center complements the Kaduna Center (North-West). The

Calabar Center will complement the South-South Zonal Centre in Benin City. NBTS employs an average of

35 persons per center (donor recruiters, nurses, phlebotomists, counselors and laboratory scientists).

Formal referral linkages exist between the NBTS centers to appropriate treatment facilities for TTI positive

donors.

Currently, most blood donation and screening in Nigeria occurs at the facility level and in emergency

settings. In such cases, best practices are not usually implemented in pre-donation screening of donors,

bleeding practices, or laboratory screening of blood units. This results in higher morbidity and mortality for

both donors and recipients. In COP08 NBTS will implement migration of fragmented hospital-based blood

services to centralized NBTS-based blood services nationwide. To achieve this, NBTS will develop and

maintain linkages with other IPs, hospitals and other facilities to ensure appropriate blood collection at these

outside facilities. Through these linkages NBTS will provide all USG-supported facilities with a pre-donation

screening questionnaire (developed by NBTS in conjunction with Safe Blood for Africa Foundation, SBFA),

a ready supply of blood bags, and equipment for standardized blood collection (patient scale,

sphygmomanometer/stethoscope, and blood bag scale). In addition, through the TA to NBTS from SBFA,

720 staff from USG-supported facilities and staff of other PEPFAR IPs will be trained in appropriate blood

collection and clinical use.

NBTS will take the lead in the development of an NBTS/hospital blood exchange program, working with

SBFA and other IPs. NBTS will develop Standard Operating Procedures with each facility that participates

in this blood exchange program. The goals of such linkages are to ensure that blood units are properly

screened and also to promote the migration of family replacement donors to VNRD. The NBTS/hospital

blood exchange program will put a system in place whereby NBTS will develop and implement a delivery

system with hospitals, including select USG-supported hospitals, which have appropriate blood banking

facilities in place. NBTS will pick up unscreened blood units that the hospitals have appropriately collected

and stored and will transport these units back to NBTS centers where they will be screened for the 4

transfusion transmissible infections (TTIs) of HIV I and II, hepatitis B, hepatitis C and syphilis using ELISA

techniques. All NBTS centers maintain cold chain by a 24-hour power supply augmented by standby

generators. The NBTS in addition will deliver to the hospitals their requested order of screened units for

blood banking and use at the facilities. NBTS will also provide monthly feedback on rates of the four TTIs

found by ELISA screening of blood units collected by the facility. This will facilitate improvement of donor

prescreening and deferment. NBTS Zonal Centers will maintain a Hot Line during working hours for

receiving inquiries from donors, facilities, IPs and interested parties. This program will be piloted at select

facilities with each USG partner and then expanded as NBTS absorptive capacity improves. The goal will be

that 80% of blood transfusions that occur at these hospitals will be with NBTS-screened blood units, while

only 20% will be emergency transfusions screened by the hospital using rapid test kits.

While the NBTS/hospital blood exchange is the standard that USG Nigeria is moving towards, only a

fraction of facilities will be capable of piloting such an exchange program with NBTS in this initial year.

Therefore, all facilities will be supported to improve their collection practices and on site lab screening

practices, including utilizing the blood donor setting as another point of service for HCT during pre-donation.

SBFA and NBTS will participate in a University of Maryland led assessment of blood safety activities in

Nigeria. This operational research will provide insight into rates of TTIs, including HIV, that go undetected in

the current emergency-based transfusion system.

A national blood policy has been adopted and launched, and a bill is currently being considered by the

National Assembly while a ten-year strategic plan drawn together with SBFA is in place to direct

implementation of the program. In order to increase coverage of the service, NBTS is proposing GON

funding for three additional centers in calendar year 2008, bringing the total number nationwide from 14 in

2007 to 17 at the end of 2008.

Training on appropriate clinical use of blood, dangers of TTIs, and the risks associated with family

replacement and remunerated donors will be conducted by SBFA on behalf of NBTS. Standard training

modules approved by NBTS will be used and updated as needed. NBTS, together with SBFA, will develop

IEC materials and job aids. A total number of 280 staff will be trained by NBTS as a step down training from

SBFA. In addition, 100 staff will be trained directly by SBFA on behalf of NBTS by the end of COP08. In

order to avoid double counting, these targets are counted under the SBFA blood safety narrative. In addition

to assistance through training, NBTS will also assist other IPs to establish and maintain blood transfusion

Activity Narrative: committees in the USG-supported facilities where they work so that practices learned during training will be

reviewed on a regular basis and maintained. NBTS is developing a quality management protocol for the

assessment of its program at regular intervals. Standard operating guidelines for all processes and

procedures carried out within the service have been developed including recruitment, phlebotomy, donor

care, blood grouping and infectious agent screening. Appropriate trainings and regularly scheduled and

unscheduled monitoring activities at zonal centers using a standard checklist will complement quality

management efforts.

CONTRIBUTIONS TO OVERALL PROGRAM AREA:

Safe blood supplies in our communities will result in a significant reduction in the transmission of HIV and

other TTIs from unsafe blood transfusions. This contributes to the EP Five-Year Strategic Plan for Nigeria to

reduce HIV transmission through the provision of safe blood and the implementation of safe blood

interventions in the country.

LINKS TO OTHER ACTIVITIES:

This activity links with HCT and Injection safety. Donors will receive predonation HCT at the hospital level

and at the NBTS level will receive referrals to USG-supported hospitals based on TTI screening results.

Proper health care waste management will also be supported through use of incinerators for disposal of

infectious medical waste including sharps.

POPULATIONS BEING TARGETED:

Low-risk populations will be targeted to become regular VNRBD and will include select youth groups and

select cohorts of adult men and women. There is also a very active population of donors from faith-based

organizations.

EMPHASIS AREAS:

An emphasis will be human capacity development community mobilization and participation for voluntary

non-remunerated blood donation.

Other issues to be addressed include gender, stigma and discrimination, and volunteers. NBTS activities

will help to increase gender equity in voluntary blood donations through counseling messages targeted to

the populace.