Safe blood transfusion or blood safety is an essential lifesaving intervention for various medical conditions requiring the transfusion of blood or blood products. It is also one of the most effective strategies for the prevention of transfusion transmissible infections (TTIs), including HIV, hepatitis viruses, and syphilis. The burden of TTIs in Zambia is high. HIV prevalence in adults aged between 15 and 49 years is currently estimated at 14.3%, a decline from 16.1% in 2002 (ZDHS 2007), while the prevalence of Hepatitis B (HBV), Hepatitis C (HCV), and Syphilis in the general population are estimated at 8%, 2%, and 4.2%, respectively.

The main beneficiaries of blood transfusions in Zambia are pregnant women, largely due to maternal hemorrhage and anemia secondary to malaria in pregnancy (accounting for approximately 20% of the total blood units), and children under the age of 5 years (approximately 40% of blood units), largely due to anemia secondary to malaria or worm infestations. Other conditions requiring blood transfusions include different types of anemia complications, trauma, various types of cancers, and HIV/AIDS related complications.

The main objective for FY 2010 will be to increase annual blood collections from the 90,049 units collected in 2008/09 to 100,000 units in 2009/10, and to reduce the total discards attributable to TTIs from the 10.6% in 2008/09 to 6%, and HIV discards from 3.8% to 2.5%, respectively.

To support this objective, the ZNBTS will prioritize the following strategies:

Significant strengthening of blood donor management and retention by rolling-out the newly developed SmartDonor electronic blood donor database management system. The system was developed with technical and financial support from CDC Zambia. It is still currently being piloted and full-scale implementation will commence during 2009;

Strengthen blood donor retention by implementing the pledge 25 blood donor club strategy in all the ZNBTS centres, and by carrying out the planned knowledge, attitudes and practice study on blood donor attitudes during 2009/10, and implementing the recommendations from this study in 2010/11;

Improve the accuracy, timeliness, and relevance of blood donor data capturing and management, through implementation of the new blood donor tracing system, including acquisition of computer laptops for use by mobile blood collection teams;

Strengthen standards of mandatory laboratory screening of blood for TTIs, through improvements in technologies, testing capacities and methods;

Scaling-up of the production and use of blood components, through increased production capacities and staff training;

Strengthen infrastructure, including expansion of capacities, procurement of appropriate equipment, improvement in primary processes, and development and implementation of appropriate policy and legal frameworks;

Finalize the national blood transfusion legal framework, after the revision of the draft policy has been completed;

Complete the construction of the new Kabwe blood centre as scheduled, and source funding for renovating the Kitwe blood centre; and

Upgrade the technologies and scale-up capacities for blood collections, laboratory screening and processing, and cold chain for distribution and storage of blood and blood products. In this respect, it is proposed to procure automated Architect laboratory screening systems for Lusaka, Kitwe, and Livingstone blood centres, and automated Elisa systems for the other six centres. It is also proposed to procure additional cold chain to meet the gaps identified at blood centres and hospitals.

ZNBTS has its own internal systems for monitoring performance and is also subject to monitoring and evaluation by key stakeholders. During FY 2010, the focus will be directed at:

Supporting and facilitating technical/supervisory visits;

Complete the pilot and fully implement the new SmartDonor management system;

Participate in the on-going piloting of the new Web-based PEPFAR Blood Safety Indicators system;

Conduct national performance review meetings/workshops on a quarterly or semiannual basis. Continue to incorporate essential training programs into these meetings;

Facilitate the inclusion of blood safety in the MOH performance assessment system; and

Provide for internal and external audits, both financial/management and technical audits.

ZNBTS will ensure long-term sustainability of the blood safety program by focusing on completing the on-going development of appropriate policy and legal frameworks. Furthermore, by continuing the promotion of behavior change among the population in favor of blood safety/donations, which will help to develop a culture of donating blood.

Apart from the core blood safety activities, ZNBTS will develop linkages with the National Malaria Program. There is a link between blood safety and malaria, as a large proportion of blood collected goes towards the treatment of anemia secondary to malaria. ZNBTS will collaborate with the National Malaria Control Center to identify opportunities for mutual interests.

ZNBTS will continue to support the implementation and roll-out of the SmartDonor database system, developed in collaboration with CDC Zambia.

The existing SmartDonor system for capturing and managing strategic blood safety information will be fully implemented and strengthened. This includes facilitating a linkage between the clinical elements of SmartCare that are located in a hospital to capture transfusion information for the patient EHR (a new module for SmartCare that ZNBTS will soon complete specifications for), and the SmartDonor system that tracks the origin of the donated unit, to provide a vein-to-vein monitoring capacity.

Implementation of the new CDC/PEPFAR web-based blood safety indicators monitoring tool will be supported.

ZNBTS activities in 2010 will include:

Continuously strengthening of mandatory testing of blood for HIV, HBV and HCV using ELISA method, and syphilis using RPR kits, to continue being the standard minimum requirement for all the 9 blood transfusion centres. Kits and consumables have been standardized and are procured on centrally managed contracts;

Maximize the use of automated immuno-analysers, for HIV, HBV, and HCV testing, at the Lusaka and Kitwe centres;

Procure additional laboratory equipment, particularly the automated Elisa and Architect systems, so as to enhance capacities and standards of blood screening;

Maintain the existing algorithm for blood testing and confirmation, which requires that specific steps are followed;

Continue with improvement of the primary processes and systems;

Complete the description and documentation of all primary processes and standard operating procedures;

Standardize protocols and operating procedures for donor services, blood screening and processing, storage and transportation, at ZNBTS facilities;

Complete the process of developing and documenting the new quality assurance system;

Ensure 100% score on External Quality Assessment (EQA) for all the centres;

Ensure that all the samples for EQA are dispatched in accordance with the agreed timeframes and standards; and

Establish a complete QA laboratory at Lusaka.

Linkages with clinicians will be further strengthened. The focus will be directed at facilitating the establishment of provincial transfusion committees, regular scheduled meetings between ZNBTS and the Provincial and Hospital Directors, and appropriate training and sensitization for clinicians, on blood use and reporting. The specific areas of focus will include:

Continue providing safe blood supplies to all service outlets, currently at 130, and any new outlets throughout the country, regardless of whether they are public, private, faith-based or military hospitals;

Promote and increase capacities for production of blood components at Lusaka and Kitwe blood centers. This will be achieved by ensuring that component preparation equipment included in the budget is procured in good time;

Strengthen clinical interface and support the establishment of hemovigilance system, through the establishment of provincial and hospital transfusion committees, regular scheduled meetings between ZNBTS and the Provincial and Hospital Directors; and

Promote appropriate methods of blood use, through the revision of the current guidelines and, appropriate training and sensitization of clinicians.

Approximately two-thirds of blood donors are students. ZNBTS recruits these students through health education talks that include AB prevention messages. ZNBTS will target to reach out to over 200,000 students in 2010 with such talks. Prospective blood donors are deferred from donation if they had sex with any new partner in the previous six months, multiple partners, an STI in the prior 12 months, a commercial sex partner, or have a partner with an HIV-risk behavior. Therefore the messages provided are strong, explicit and implicit AB messages,, and ZNBTS seeks regular blood donors who exemplify healthy lifestyles with low HIV-risk. Blood donor clubs will be supported that encourage these behaviors. Records will be maintained on numbers of students reached with these messages and support provided to the donor clubs.