Technical Guidance for Global Fund HIV Proposals
Broad Area PREVENTION
Service Delivery Area Blood Safety
Working document - 22 October 2008
Rationale for including the SDA in the proposal
Blood transfusion saves lives and improves health, but millions of patients requiring transfusion
do not have timely access to safe blood. Unsafe blood transfusion is a well documented mode
of transmission of HIV and other infections, and was estimated to be responsible for 5−10% of
HIV infections in the 1980s and early 1990s. This is substantially higher than other modes of HIV
transmission Recognition of the high risk of transmission of HIV through unsafe blood
transfusions (>90%), due to the transfusion of a large volume of infected blood with a high viral
load, led to the introduction of blood safety interventions.
Access to safe blood transfusion is an essential part of modern health care but the risk of HIV
transmission through unsafe blood transfusion is of continuing concern, especially in countries
with high HIV prevalence. WHO has estimated that about 5% of new HIV infections in developing
and transitional countries may be attributable to unsafe health care injections, including unsafe
blood and occupational exposures. Information reported by governments to the WHO Global
Database on Blood Safety for the period 2004–2005 indicates that of the 158 countries that
reported performing 100% screening for HIV, only 50 countries screen all blood donations in a
quality-assured manner: i.e. all laboratories screening blood have standard operating procedures
(SOPs) and participate in an external quality assessment (EQA) scheme.
Blood shortages also lead to an increased risk of transfusion of unsafe blood, particularly in
emergency situation. In many countries, even where blood is available, many recipients of blood
and blood products remain at risk of transfusion-transmissible infections, including HIV, as a
result of poor blood donor recruitment and selection practices, unsafe donors and the use of
unscreened blood, and unnecessary blood transfusions.
Safety of the blood supply is dependent on the collection of blood from voluntary unpaid blood
donors from low-risk populations; screening of all donated blood for transfusion transmissible
infections and reduction in unnecessary transfusions. These activities need to be carried out by a
well coordinated blood transfusion service with a quality system in all areas.
1
, Elements to be considered in the situation analysis
A systematic approach to strengthen the blood transfusion services is required for ensuring the
quality, safety, availability and equitable access of blood and blood products for all patient in need
of transfusion. Comprehensive situation analysis will allow identify gaps in policy and operational
aspects of blood transfusion and will also assist in understanding unsafe blood transfusion
practices and the required strategies to address these gaps.
WHO recommends the following strategic area to prevent HIV transmission through unsafe blood
transfusion and to provide safe and adequate supplies of blood and these should be considered
in the situation analysis and while developing interventions
o Development of voluntary unpaid blood donor programme and reduction in
family/replacement and paid donation
o Provision of HIV counselling to blood donors and, where appropriate, referral
o Quality-assured testing of all donated blood for HIV
o Reduction in unnecessary transfusions
o Maintenance of safe blood transfusion systems in emergency situations.
o Safe disposal of blood collection bags and needles, and safe waste management in blood
transfusion services.
Examples of programme objectives
To prevent HIV transmission through unsafe blood transfusion and to provide safe and adequate
supplies of blood and to reduce the risks associated with transfusion.
Target populations
All people that need blood transfusion are the major target population. Education for donor and
community and promoting health life style are key strategies in develop voluntary non-
remunerated blood donor programme which is the foundation for safe blood supply. General
public and blood donors, including those who received counselling for HIV and other transfusion
transmissible infections also compose of the target populations.
Suggested activities
In supporting countries, efforts should focus on advocacy and policy implementation, capacity
building, monitoring and quality assurance. The key activities to consider in implementing
2
Broad Area PREVENTION
Service Delivery Area Blood Safety
Working document - 22 October 2008
Rationale for including the SDA in the proposal
Blood transfusion saves lives and improves health, but millions of patients requiring transfusion
do not have timely access to safe blood. Unsafe blood transfusion is a well documented mode
of transmission of HIV and other infections, and was estimated to be responsible for 5−10% of
HIV infections in the 1980s and early 1990s. This is substantially higher than other modes of HIV
transmission Recognition of the high risk of transmission of HIV through unsafe blood
transfusions (>90%), due to the transfusion of a large volume of infected blood with a high viral
load, led to the introduction of blood safety interventions.
Access to safe blood transfusion is an essential part of modern health care but the risk of HIV
transmission through unsafe blood transfusion is of continuing concern, especially in countries
with high HIV prevalence. WHO has estimated that about 5% of new HIV infections in developing
and transitional countries may be attributable to unsafe health care injections, including unsafe
blood and occupational exposures. Information reported by governments to the WHO Global
Database on Blood Safety for the period 2004–2005 indicates that of the 158 countries that
reported performing 100% screening for HIV, only 50 countries screen all blood donations in a
quality-assured manner: i.e. all laboratories screening blood have standard operating procedures
(SOPs) and participate in an external quality assessment (EQA) scheme.
Blood shortages also lead to an increased risk of transfusion of unsafe blood, particularly in
emergency situation. In many countries, even where blood is available, many recipients of blood
and blood products remain at risk of transfusion-transmissible infections, including HIV, as a
result of poor blood donor recruitment and selection practices, unsafe donors and the use of
unscreened blood, and unnecessary blood transfusions.
Safety of the blood supply is dependent on the collection of blood from voluntary unpaid blood
donors from low-risk populations; screening of all donated blood for transfusion transmissible
infections and reduction in unnecessary transfusions. These activities need to be carried out by a
well coordinated blood transfusion service with a quality system in all areas.
1
, Elements to be considered in the situation analysis
A systematic approach to strengthen the blood transfusion services is required for ensuring the
quality, safety, availability and equitable access of blood and blood products for all patient in need
of transfusion. Comprehensive situation analysis will allow identify gaps in policy and operational
aspects of blood transfusion and will also assist in understanding unsafe blood transfusion
practices and the required strategies to address these gaps.
WHO recommends the following strategic area to prevent HIV transmission through unsafe blood
transfusion and to provide safe and adequate supplies of blood and these should be considered
in the situation analysis and while developing interventions
o Development of voluntary unpaid blood donor programme and reduction in
family/replacement and paid donation
o Provision of HIV counselling to blood donors and, where appropriate, referral
o Quality-assured testing of all donated blood for HIV
o Reduction in unnecessary transfusions
o Maintenance of safe blood transfusion systems in emergency situations.
o Safe disposal of blood collection bags and needles, and safe waste management in blood
transfusion services.
Examples of programme objectives
To prevent HIV transmission through unsafe blood transfusion and to provide safe and adequate
supplies of blood and to reduce the risks associated with transfusion.
Target populations
All people that need blood transfusion are the major target population. Education for donor and
community and promoting health life style are key strategies in develop voluntary non-
remunerated blood donor programme which is the foundation for safe blood supply. General
public and blood donors, including those who received counselling for HIV and other transfusion
transmissible infections also compose of the target populations.
Suggested activities
In supporting countries, efforts should focus on advocacy and policy implementation, capacity
building, monitoring and quality assurance. The key activities to consider in implementing
2
