Blood safety is an essential component of Uganda's Health Sector Strategic Plan (2006-2011) and one of

the main strategies of the country's HIV/AIDS prevention and care. PEPFAR support to the Uganda Blood

Transfusion Service (UBTS) and sub-partner, the Uganda Red Cross Society (URCS) has increased the

supply of safe blood to 166 hospitals in the country by 45.6% and reduction of HIV in the blood donor

population from 1.7% in 2004 to 1.36% in 2006 (a reduction of 20%). An estimated 21,000 new HIV

infections have been prevented; 75% of these infections would have occurred in children and pregnant

women who receive most of the blood transfusion.

In FY08, UBTS (in collaboration with RPSO) will construct 2 regional blood banks, purchase vehicles for

blood collection (5) and for blood donor recruitment (5), buy more laboratory equipment and supplies for

blood testing and processing, ensure that blood collected is from low-risk, voluntary non-remunerated blood

donors with an HIV <1.2% and increase total blood collection by 10%. All blood will be tested for HIV,

Hepatitis B and C, and syphilis. An extensive training programme will be implemented as well as an

effective M&E programme and Quality Assurance. 80% (100,000) of blood donors will be counseled while

58% will be retained as safe repeat donors. Collaboration with key partners will continue to complement

and supplement UBTS' efforts to be able to supply sufficient quantities of safe blood to all hospitals. 50% of

hospitals will form transfusion committee to support the planned haemovigilance programme.

The current infrastructure for all regional blood banks is very inadequate because none of the regional blood

banks has a purpose-built facility compliant with Good Manufacturing Principles (GMP). The headquarters

at Nakasero is too small to handle the current workload of increased blood testing and processing. To

address this problem, UBTS has proposed a five-year plan to build 7 regional blood banks. The new

regional blood banks, at Mbale and Mbarara, will be occupied before the end of 2007. The facilities will be

model blood banks, with improved services and higher targets for blood collection and processing. The first

phase of the rehabilitation of the UBTS headquarters referral laboratory and the construction of Gulu

Regional Blood Bank will be accomplished during FY07 with collaboration from RPSO. Two more regional

blood bank buildings will be constructed at Arua and Fort Portal in FY08. Laboratory equipment for blood

processing into components and TTI testing, and back-up power generators will be provided for these units

as well as more vehicles.

UBTS blood donor clubs are the equivalent of "Club 25" elsewhere. Members of these clubs are regular

repeat donors with lowest infection risk who are always ready to donate blood especially when the blood

shortage is anticipated, e.g., school holidays. In FY08 existing clubs will increase their membership and

also more clubs will be registered.

UBTS collaborates closely with the Uganda Red Cross Society (URCS) in the area of community

mobilization and blood donor recruitment and counseling. All blood donors in Uganda are voluntary non-

remunerated donors, with repeat donors being about 50% of all donors. Blood collection is largely (>80%)

carried out by a network of 20 mobile teams. New initiatives in FY08 will include more efficient mobilization

of blood donors using media, text messages on mobile phones by recall centers (being set up in at each

regional blood bank in FY07) and better planning tool to increase numbers of blood units at sessions and

frequency of visits to blood donor clubs.

This is expected to increase blood donation from 170,000 units projected for FY07 to 187,000 in FY08 and

increase the proportion of repeat donors from <50% to58%. Currently, 70% of all our donors receive post-

donation counseling; this proportion will increase to 80% (100,000 donors) because of expected better

planning, communication with donors and availability of better transport. More effective methods of donor

education and selection and an increase in the proportion of repeat donors are expected to lower the HIV

prevalence among blood donors from the current 1.36% to <1.2% in FY08.

All blood units will be tested for HIV, hepatitis B and C, and syphilis. Regional blood banks use the ELISA

technique to test HIV hepatitis B ad C, while the reference laboratory has automatic equipment for high

throughput and uses the chemilumenescent-based technology. All test results are confirmed before they

are used by counselors for donor notification. This arrangement is expected to continue in FY08.

Blood components are prepared on a limited scale because of lack of adequate facilities. Nakasero Blood

Bank is able to prepare paediatric packed cells, platelets, cryoprecipitate and fresh plasma on a limited

scale. Regional blood banks can only prepare paediatric packs. Availability of better facilities will enable all

regional blood banks to prepare blood components regularly for better management of patients.

In the last 2 years, the UBTS in collaboration with the Sanquin Consulting Services (SCS) have developed a

quality assurance programme, and recently finalized a quality manual. Implementation of the quality system

has begun in FY07 with training of various cadres; these activities will be intensified in FY08. Marked

improvement in standards for blood collection, testing and processing are expected. Better documentation

of blood supplied to hospitals will improve traceability of the blood units. Seminars for transfusing clinicians

will be conducted to promote appropriate clinical use of blood in hospitals as well as distribution of national

clinical transfusion guidelines. Hospital transfusion committees, <10% of which are functional, will be

revised to ensure that by the end of FY08, 50% are active. These activities will form the basis of a

haemovigilance to be initiated in FY08.

CDC-Uganda has helped UBTS develop a Management Information System (MIS) programme, which will

be rolled out in FY08. The monitoring and Evaluation programme being designed in FY07 is expected to

utilize the MIS both of which will improve the quality of data, reporting and the supervision of the whole

programme.

The Ministry of Health provides funds for blood bags, utilities and UBTS staff salaries and has supported the

restructuring of UBTS. The latter has resulted in UBTS being self accounting (financial autonomy) having a

full contingent of a dedicated staff structure and expects to be fully autonomous when the legal mechanisms

have been put in place, thus ensuring future sustainability of the institution. Other valuable partners include

corporate and church groups, the ROTARY Club of Uganda, who all offer help in blood donor mobilization.

UBTS has developed and implements training courses for all professional cadres of staff. Short courses

and seminars will be conducted for blood donor recruiters(20), counselors(40), hospital technicians(170) as

well as clinicians (160) who prescribe blood. Two more regional blood bank directors will start the Masters

Degree in Management of Transfusion Medicine (MMTM) course in FY08. The course is being taught at

the University of Groningen Faculty of Medical Sciences as a collaborative initiative of the Dutch Sanquin

Blood Foundation, the World Health Organization (WHO) and the University of Groningen. Staff will also

continue to benefit from counselors courses conducted by the AIDS Support Organization (TASO) and the

AIDS Information Centre (AIC). Plans by UBTS and Sanquin (SCS) to develop a blood safety course for

integration in the National Medical School Curriculum will be finalized in FY08.

Currently, the Ministry of Health Injection Safety Programme collaborates with UBTS to put in place a

programme for safe waste disposal; this will greatly help UBTS in safe disposal of the laboratory biological

Activity Narrative: waste.

Provision of safe blood is an essential component of Uganda's Health Sector Strategic Plan (2006-2011) as

indicated in the minimum health care package of the plan. It is also one of the main strategies of the

country's HIV/AIDS prevention and care. PEPFAR support to the Uganda Blood Transfusion Service

(UBTS) and sub-partner, the Uganda Red Cross Society (URCS) has enabled them to maintain and

increase the supply of safe blood to 166 hospitals in the country by 45.6% and reduce the HIV prevalence

among the blood donor population from 1.7% in 2004 to 1.36% in 2006 (a reduction of 20%). It is estimated

that over 21,000 new HIV infections have been prevented through provision of safe blood since the

beginning of the PEPFAR support to UBTS; 75% of these infections would have occurred in children and

pregnant women who receive most of the blood transfusion.

In FY08 existing blood donor clubs will be encouraged to recruit more members, and new donor clubs will

be formed. The URCS plays a key role in the blood donor recruitment, counseling activities as well as

overseeing and maintaining the blood donor clubs. The main objective of pre-donation counseling is

selection of low-risk healthy blood donors, whereas post-donation counseling (donor notification) gives

opportunity to blood donors to learn their health status and make informed decisions about their lives, be

encouraged to continue donating blood, as well as preventing infected blood donors from donating once

again. UBTS and URCS collaborate with several AIDS Support Organizations in the country and refer

identified HIV positive blood donors for care and support. During FY08 the percentage of blood donors who

receive post-donation counseling will increase from the current 70% to at least 80%. Currently, 100% of

donors in Uganda are voluntary, non-remunerated individuals; this trend will be maintained in FY08. For

every 100 persons that receive HIV health education aimed at recruiting blood donors, only 10 donate

blood.

Although HIV counseling and testing is not the main activity for the Blood Safety program, but key to the

provision of adequate amounts of safe blood, UBTS and URCS indirectly contribute to this program area.

UBTS and URCS have to provide health education to 1,300,000 individuals in order to obtain 100,000 blood

donors. These donors will receive HCT; most of them are young people above 17 years in education

institutions, and others in rural communities and urban work places. Through the blood donor mobilization

and recruiting activities, UBTS/URCS reach large numbers of individuals as far as HIV prevention campaign

is concerned.