Prevention of blood-borne HIV transmission using a decentralized approach in Shaba, Zaire.
OBJECTIVE
To prevent blood transfusion-acquired HIV infection with a decentralized approach to HIV screening of blood donors, using an instrument-free rapid test.


METHODS
Shaba province, Zaire (496,877 km2).


METHODS
The programme consisted of training health-care workers, distribution of a rapid HIV-antibody test (DuPont's HIVCHEK) for screening of all blood donations, and quality control of testing by a regional reference centre.


RESULTS
Over a 2-year period, 11,940 rapid tests were distributed to 37 hospitals, covering 75% of all hospital beds outside the copper mine's health system in Shaba. Eighty-five per cent of the tests were used to screen blood donors (5.4% positive test rate) and 13% to test patients (39.7% positive test rate). At least 265 cases of HIV-positive blood donation were prevented, at an estimated cost of 137-279 ECU per case. Only 26% of initially positive specimens reached the central laboratory for supplemental testing, and sterile transfusion equipment and blood-grouping reagents were frequently unavailable. The lack of transport and communications and a deteriorating health system were major constraints.


CONCLUSIONS
District hospitals in Africa are often long distances from major cities, difficult to reach for most of the year, and perform a small number of transfusions. In this context a classical centralized regional blood bank may not be a feasible option to ensure safe blood transfusions. However, safe blood transfusion can be achieved with a decentralized approach using a rapid test, provided that minimum standards of health-care services are available.
Laleman
G
G
Centre Régional de Lutte Contre le SIDA, Lubumbashi, Zaire.
Magazani
K
K
Perriëns
J H
JH
Badibanga
N
N
Kapila
N
N
Konde
M
M
Selemani
U
U
Piot
P
P
D001771:Blood Banks / Q000191:economics / Q000592:standards; D001782:Blood Donors; D015023:Democratic Republic of the Congo; D005069:Evaluation Studies as Topic; D015483:HIV Antibodies / Q000097:blood; D015658:HIV Infections / Q000175:diagnosis / Q000517:prevention & control* / Q000635:transmission*; D015497:HIV-1 / Q000276:immunology; D015498:HIV-2 / Q000276:immunology; D006801:Humans; D008403:Mass Screening / Q000458:organization & administration*; D011786:Quality Control; D012041:Regional Medical Programs / Q000191:economics / Q000592:standards; D065227:Transfusion Reaction
D015483:HIV Antibodies