SUMMARY: South African National Blood Service (SANBS) will use PEPFAR funds to carry out activities to ensure an adequate supply of safe blood to patients. This includes expanding the Safe Blood Donor Base by donor education and selection; training of SANBS staff in donor and technical disciplines; logistics management; and developing appropriate information systems. The major areas of activity are donor and blood user education, emphasizing clear communication and understanding of causes and risks of HIV transmission by blood, and strengthening the technical and information systems infrastructure. The primary target population is the potential blood donors of South Africa.

BACKGROUND: SANBS operates in eight of the nine provinces in South Africa and is responsible for the delivery of transfusion services to 87% of the patients in the country. The Western Province Blood Transfusion Service (WPBTS) provides blood to patients in the Western Cape. The National Health Act requires a single national blood transfusion service. In the foreseeable future, the WPBTS will merge with SANBS, creating a sole provider. SANBS, WCBTS and the National Department of Health are discussing the way forward to comply with the provision of the National Health Act. FY 2007 funding to SANBS will be used to support processes in support of this merger.

The blood safety program is in accordance with the National Health Act and supports South African government regulations and standards. The donor education program is in harmony with the national HIV and AIDS strategy and plan, and the school program agrees with the objectives of the Department of Education. Most programs are ongoing but some pilot programs are now being introduced into other branches. A few programs are dependent on the implementation of new program processes and these are classified as new activities implemented within the broad framework of the program.

ACTIVITES AND EXPECTED RESULTS: ACTIVITY 1: Expanding the donor base The focus of this activity is to expand the donor base by including younger and more demographically representative population groups. Blood safety will be achieved by donor education and self-exclusion of those who have a higher risk of HIV exposure. Previous PEPFAR funding combined perception survey outcomes (KAP) study and geo-demographic segmentation analysis to define and identify effective recruitment strategies in previously untargeted geographic areas. In FY 2007 the results of the KAP study will be used to expand the donor base.

Culture and language-specific marketing, communication and education strategies will continue to be developed and implemented in previously neglected communities. Fifty thousand new donors will be exposed to the education, and selection programs will be developed. A further 50,000 scholars will be subjected to blood donation awareness education and HIV prevention programs on a continual basis by the donor recruiters and educators appointed under PEPFAR funding.

A donor deferral guideline will be developed to assist approximately 100 specially trained telerecruiters to better educate and inform the donor. A pilot project aimed at developing SANBS partnerships with private companies has been successfully initiated and will be broadened in FY 2007. This will serve to expand SANBS donor activities.

SANBS will actively pursue partnerships with PEPFAR partners, and donors identified as HIV reactive will be referred to PEPFAR-supported ARV sites. SANBS will also link with PEPFAR AB partners particularly in the areas of educating the youth on safe lifestyles, and where the experience of PEPFAR partners may be valuable for the development of culture-specific donor education and marketing materials.

ACTIVITY 2: Training Training activities will focus on human capacity development and addressing the skills shortage in SANBS through training programs for technicians, technologists, and donor, education and recruitment staff. This training is important for sustainability of the program. Ongoing training of donor and technical staff is a challenge because of the wide dispersion of SANBS staff in branches in eight provinces. This necessitates the development of appropriate distance learning programs and training materials; equipment

will be purchased to facilitate this process and make materials accessible.

The development of a national and regional Training Center will commence in FY 2007. This facility will focus on training of donor and technical staff and to develop programs to educate healthcare professionals in the appropriate use of blood and risk management. The facility and expertise will be made available to healthcare professionals operating in institutions in South Africa, Southern African Development Community and other African countries.

SANBS staff will continue to host seminars, workshops, symposia and lectures on blood safety and transfusion related topics to internal staff, as well as external medical and health practitioners. Specifically, training of 40 medical technicians will continue enabling them to complete the four year part-time training course at a tertiary institute to qualify as medical technologists. Forty SANBS staff will also receive specialist training in a one-week blood transfusion workshop by a specialist lecturer. Accredited training for 60 trainee phlebotomists will enable them to register with the Health Professionals Council of South Africa as Phlebotomy Technicians. Two members, one each from the donor and technical areas, under the American Association of Blood Banks' PEPFAR program, will attend a training course at Emory University. SANBS is assisting the University of the Free State to develop and implement a clinical course in transfusion medicine.

ACTIVITY 3: Plasma repository SANBS tests over 700,000 blood donations for HIV, HCV and HBV annually and there is a need to establish an appropriate plasma repository for storage of viral positive plasma which can be used to assess the impact and outcome of blood safety programs. The repository will necessitate the purchase of freezers, equipment and software to manage the inventory of viral positive plasma. In addition, 170 emergency blood fridges will be purchased and supplied to rural hospitals to ensure that blood is made available and stored optimally. A quality system to remotely monitor ambient temperatures of fridges and freezers in blood banks and outlying hospitals is critical. This will be achieved by purchasing and installing 450 temperature monitoring units.

ACTIVITY 4: Data warehouse The Meditech operational (information) system will be rolled out to the east coast region, and hardware and equipment upgrades procured to enable this rollout. The data warehouse is an essential component of the information system and will allow the management of the blood donor base, analysis of the effectiveness of donor education and selection programs, risk management and the optimal management of the blood inventory. The current system is not satisfactory for the extraction of data, report writing, measurements of outcomes and analysis of the blood safety programs and processes, and so software will be purchased in FY 2007 to complete the analysis and reporting functions of the data warehouse project. The wireless communication project deployed in the inland region needs to be deployed to the east coast region. This project, as well as the continuous uptime infrastructure deployed, requires support costs to ensure system sustainability.

These activities contribute to objectives in the USG Five-Year Strategy, and will help to ensure that the blood supply is safe and meets the blood supply needs in South Africa. Together, the activities to strengthen policies and guidelines, build human capacity, implement a functional information system, and improve infrastructure, ensure the sustainability of the SANBS PEPFAR program.