AABB23: The BLOODSAFE Program: Building the Future of Access to Safe Blood in Sub-Saharan Africa

In many low- and middle-income nations in Sub-Saharan Africa (SSA), access to sufficient safe blood does is often insufficient to meet patients’ needs. Lack and delay of needed blood transfusions can cause harm to patients and slow the rate of development of a country’s health care system. Recognizing the power of implementation science, the NHLBI initiated the BLOODSAFE program, which supports three SSA-based study teams and one data coordinating center to improve access to safe blood transfusion in SSA.  

Today’s education session titled, “The BLOODSAFE Program: Building the Future of Access to Safe Blood in Sub-Saharan Africa,” featured speakers from Ghana, Kenya and Malawi study teams. Each speaker discussed the status of the blood system in their nation and highlighted their projects, topics of which included iron deficiency in blood donors to recruitment strategies of blood donors. The session also emphasized the BLOODSAFE program’s ability to improve access to safe blood in SSA, provide implementable strategies for others to use and build research capacity in SSA. 

Meghan Delaney, DO, MPH, chief of pathology and laboratory medicine at Childrens National Hospital, noted transfusion needs differ based on local demographic and disease profiles in the region and highlighted a large unmet need for more government support, financially, structurally, and through establishment of regulatory oversight to ensure supply, quality, appropriateness and safety to sustainably increase access to safe blood transfusions. “Many countries face critical undersupply of transfusions, which will likely become more pronounced as access to care improves,” Delaney said.  

Delaney gave a brief overview of the BLOODSAFE program’s history and highlighted its objective to support projects that develop and test feasible, effective and sustainable strategies to increase the number of safe blood donors, to improve quality and safety of blood supplies, and to enhance blood delivery to patients in need, especially in remote settings. 

She also discussed the African BLOODSAFE Donor Study (ABDS), a repeated cross-sectional observational study conducted over the duration of the BLOODSAFE program with a minimum of two three-week enrollment periods per year to determine the number of blood donation attempts over time. All individuals seeking to donate blood at participating sites in Ghana, Kenya and Malawi will contribute to data collection one time on the day of donation. 

“This is a unique study design. Every year, we collect data for three weeks in September and in March. We are specifically doing this study in hospitals, donor centers and blood drives to have different settings, so it’s not just one model,” she said. “We're really trying to characterize in this study who donates blood, why they come to donate blood and then what happens? Do they have ever have reactions? What’s the rate of TTIs, and what is the efficacy of that donation attempt?” 

Kenya
The study team in Kenya is building a “vein-to-vein” workflow model to elucidate and devise strategies to overcome barriers to blood donation and improve infrastructural components of blood product production. Pratap Kumar, MD, MPhil, MSc, PhD, senior lecturer, Strathmore University Business School, Nairobi City, Nairobi Area, Kenya, discussed pathways for innovation in blood transfusion services in Kenya (PITS). For this project, Kumar and Juan Carlos Puyana, MD, assembled an international, multidisciplinary team to evaluate gaps in the availability of safe blood for patients with severe anemia and hemorrhagic conditions in Kenya. 

Kumar shared PITS-Kenya goals to identify deficits in blood availability in Turkana, Nakuru and Siaya for different types of patients; create a visual representation and simulation of the processes between blood collection and transfusion; and work with donors, patients, blood banks and health care workers to identify feasible solutions to increase the availability of blood for patients. 

Ghana 
The study team in Ghana is focusing on studying and decreasing iron deficiency in blood donors and evaluating social engagement of blood donors through different approaches. Lucy Asamoah-Akuoko, MD, PhD, MPH, director of research, planning, monitoring and evaluation at National Blood Service Ghana, discussed the development and evaluation of community-based approaches and donor care intervention models for improving availability and safety of blood for the management of severe anemia in Ghana. The BLOODSAFE Ghana site project has two studies using implementation science: community-based communication interventions for increasing the blood donor pool in Ghana and iron supplementation and nutritional counseling interventions to improve availability and safety of blood in Ghana.

“There are many activities implemented to encourage blood donations,” Asamoah-Akuoko told attendees. “The need for robust research to improve blood donation is critical.” 

She also identified barriers to accessing safe blood transfusion in Ghana at the donor level (fear, lack of knowledge, negative service) and at the institutional level (lack of a fully developed national blood system with well-organized and coordinated blood services). “Repeat blood donors have the best safety profile and reliability for ensuring timely availability of blood,” she said. 

Malawi 
The Malawi team is studying the infectious disease ramifications of blood donation as well as blood donor retention strategies aimed at blood donors who commence their donation career in secondary schools. Mina C. Hosseinipour, MD, MPH, professor of medicine at University of North Carolina at Chapel Hill School of Medicine, Lilongwe, Malawi, provided Malawi BLOODSAFE program updates, including a description of the donor profile.  

Of the 213,626 donors who donated over the seven-year-period, data for 204,920 (95.8%) were included in the final analysis. She noted that among the 204,920 donors, 77.4% were males, 34.8% donated twice or more and 70.9% were students. The baseline median age was 19.9. At the conclusion of her presentation, Hosseinipour shared that TTI prevalence and incidence rates among blood donors from the study are consistent with estimates from other countries in sub-Saharan Africa. “By identifying geographical variations of TTI prevalence and incidence helped identify districts with low burden of disease for targeted blood collection activities to optimize usage of resources,” she noted.