Francis Sarkodie

Predonation screening of blood donors with rapid tests: implementation and efficacy of a novel approach to blood safety in resource-poor settings.

BACKGROUND:  In sub‐Saharan Africa, the percentage of screened blood is limited to approximately 75 percent for human immunodeficiency virus antibodies (anti‐HIV), 50 percent for hepatitis B surface antigen, and 19 percent for hepatitis C virus antibodies (anti‐HCV), mainly because of costs.

Screening for viral markers in volunteer and replacement blood donors in West Africa

West Africa is a highly endemic area for viral infections. The prevalence of five viral markers was determined in Ghanaian blood donors.

Relative safety of first-time volunteer and replacement donors in West Africa.

BACKGROUND: A significantly higher level of safety between nonremunerated volunteer and replacement donor blood is assumed. This is supported by global data without stratifying between genuine replacement and paid donors, for first‐time or repeat volunteer, or according to age.

Molecular and serological characterization of hepatitis B virus in deferred Ghanaian blood donors with and without elevated alanine aminotransferase.

Summary.  Candidate blood donors in Ghana are frequent carriers of hepatitis B virus (HBV). A comparative study of 117 donor samples including 46 with alanine aminotransferase (ALT) ≥ 60 IU/L and 71 with ≤40 IU/L level was undertaken. S and the basic core promoter‐precore regions (BCP/PC) sequencing was used to identify genotypes and variants relevant to HBV natural history, respectively. Age, viral load, HBe status were correlated with molecular data. HBV genotype E (87%) was dominant with little genotypes A (10%) and D (3%). Comparing individuals with or without liver disease, an association between liver disease and older age (P = 0.004) and higher viral load (P = 0.002) whether as a whole population or only genotype E was found. Compared with a commercial assay, BCP/PC sequencing had lower sensitivity to detect mixtures of wild‐type and variant viruses but detected BCP deletions. BCP 1762/1764 variants were positively correlated with older age (P < 0.0001) and elevated ALT levels (P = 0.01). PC 1896 stop codon was marginally correlated with viral load (P = 0.09). HBV genotype E infection natural history appears different from genotypes B and C prevalent in Asia. Donors with liver disease being older, with higher viral load and higher BCP variant proportion may be at higher risk of cirrhosis and hepatocellular carcinoma

A pool of repeat blood donors can be generated with little expense to the blood center in sub‐Saharan Africa

BACKGROUND: In sub‐Saharan Africa, most collected blood originates from accessible and cheaper replacement donors while recruiting and retaining volunteers requires considerable costs not all countries can afford. The Kumasi Teaching Hospital Blood Center and a local FM radio station developed a partnership calling three times a year for donation at the radio station where music, entertainment, and token gifts were available.

Prevalence of persistent and latent viruses in untreated patients infected with HIV-1 from Ghana, West Africa.

Only limited epidemiological data, pertaining to the prevalence of common persistent viruses has been reported in Ghana. This study was conducted to determine the prevalence of persistent viruses in individuals with untreated HIV‐1 infection and uninfected blood donors. Paired plasma and cellular samples from HIV‐negative blood donors, asymptomatic HIV and symptomatic/AIDS cohorts were screened by multiplex PCR then qPCR for parvovirus B19 (B19V), hepatitis B virus (HBV), GB virus‐C (GBV‐C), cytomegalovirus (CMV), Epstein–Barr virus (EBV), human herpesvirus‐8 (HHV‐8) and varicella‐zoster virus (VZV). IgG antibodies specific to each target virus were tested to determine exposure rates. No evidence of viraemia was found for B19V and VZV in any group. Prevalence of GBV‐C plasma viraemia was significantly higher in asymptomatic and symptomatic HIV infection (16.7%) and (16.2%) than in blood donors (4%) P < 0.005. Occult HBV infection was significantly more frequent in symptomatic HIV infection (10.9%) compared to asymptomatic HIV (3.6%) and blood donors (1.6%) P < 0.005. Although there was a high background of EBV viraemia in cellular fractions of blood donors (8.3%), it was significantly higher in asymptomatic (44.6%) and symptomatic HIV (14.6%) P < 0.0001. For CMV, the significantly increased prevalence of viraemia was only observed in the plasma fraction of the symptomatic HIV‐1/AIDS patients (7.6%) compared to asymptomatic individuals (1.8%) and blood donors (0.8%) P ≤ 0.001. The background seroprevalence in blood donors was high for B19V (≥64%), HBV (≥70%), CMV and EBV (≥90%) and was significantly increased in HIV infections for HBV, CMV, VZV (symptomatic HIV), and HHV‐8 (asymptomatic and symptomatic HIV). J. Med. Virol. 81:1860–1868, 2009.

Predonation testing of potential blood donors in resource-restricted settings

Clark and coworkers caution against adopting predonation screening practices lest they be inexpertly applied or delay a move toward nationalized blood transfusion services. Indeed, under the guidance of WHO-led programs, many countries in Sub-Saharan Africa, such as Uganda, have made significant strides toward establishing sustainable volunteer blood donor programs. I cannot help but wonder, however, whether the two programs have to be mutually exclusive. In Fall 2003, I had the honor of serving the CDC in assessing the status of blood transfusion in Tanzania in anticipation of the current administration announcing the PEPFAR (President’s Emergency Package for AIDS Relief) package that includes

Effects of transfusion on human erythrovirus B19-susceptible or -infected pediatric recipients in a genotype 3-endemic area

42 million to help 14 emerging countries establish blood transfusion services. A visit to the public hospital that serves nearly 2 million people in Dar Es Salaam revealed a blood bank that had few units on its shelves, and they were all directed donor units. At present, plans are under way to establish four zonal transfusion centers, which should greatly relieve the dearth of available safe blood. I also had the opportunity to visit a mission hospital in a remote area of Tanzania that had neither electricity nor refrigeration (http://www.iambi.org/). The hospital had implemented rapid screening (Determine HIV-1 and -2, Abbott Laboratories, Abbott Park, IL) and observed that 11 percent of prospective blood donors were HIV-seropositive. It took 15 hours to travel approximately 250 miles from Dar Es Salaam because most of the roads were not paved and many crossed over dry stream beds. In the rainy season, the hospital is inaccessible by any convenient route. Even if the zonal centers were fully stocked in the near future, the needs of the majority of the country’s population would not be addressed, because most citizens live in rural regions. During my travels, I passed many signs for “Money Maker” irrigation pumps, a simple

Fostering repeat donations in Ghana

50 stair-stepper device that allows subsistence farmers to become cash crop farmers. The developers of this technology, ApproTEC, have been so successful that there is a Harvard Business School case study describing their contributions. Simply put, ApproTEC, with its advocacy for providing simple and appropriate technology into the hands of users in resource-limited setting, has had greater and more sustainable impact on the East African economy than many more expensive and well-intentioned international relief programs. By analogy, organizations like PATH (Program for Appropriate Technology in Healthcare), have helped develop extremely sensitive, yet simple, blood screening strips for HIV that approach the sensitivity of Western blot tests, yet do not require refrigeration, extensive training, or other equipment. Because there are parallel needs, I would encourage international aid programs to support both the establishment of national transfusion services and innovative programs, such as those of J.-P. Allain, MD, MBA, and colleagues, that fill a much-needed niche. We should not let the perfect be the enemy of the good. Jed B. Gorlin, MD Memorial Blood Centers Minneapolis, Minnesota 55404 e-mail: jed@mbc.org

Deferred donor care in a regional hospital blood center in Ghana.

BACKGROUND: Human erythrovirus (parvovirus) B19 is transmitted by transfusion of blood, blood components, and plasma derivatives and is resistant to most viral inactivation methods. B19 genotype 3 is prevalent in Ghana, and no related clinical information is available.