High Incidence of Transfusion-Related HIV Infection in Nigeria

Abstract

There is a high incidence of transfusion related HIV infection in Nigeria. This was evident in our pilot study that indicated that the incidence was 1.2% in a teaching hospital in Enugu. In this article, we discuss several possible reasons for the high incidence of transfusion related HIV infections in the Enugu hospital. Firstly, most donors were paid. There was no structured questionnaire to identify populations at risk and to increase self-awareness of the risk of HIV infection. Even if a donor were concerned about having a HIV infection, there was no mechanism for self-deferral. Donated blood was screened only by an ELISA, a test that usually does not detect HIV if contracted within 90 days prior to testing. To control transfusion related HIV infection, the National Blood Transfusion Service (NBTS) was established in 2005, and a National Blood Policy was developed in 2006. Seventeen blood transfusion centers have been set up with support from the private sector, the United States Presidential Emergency Plan for AIDS Relief (PEPFAR), the Safe Blood for Africa (SFA) and the Center for Disease Control (CDC). The goals were: 1) to actively change attitudes to encourage voluntary non-paid donations; 2) to develop and use questionnaires to identify individuals and populations at risk for HIV and to increase self-awareness of the risk for HIV; 3) to introduce mechanisms for self-deferral; 4) to screen blood with antigen testing in addition to the ELISA to detect new HIV infections contracted within16 days prior to testing. An ELISA alone only detects HIV contracted 90 days prior to donation. Despite the regulations introduced by the NTBS, the incidence of HIV infected blood in blood banks is still high There are multiple reasons for the continued high incidence of transfusion related HIV infections in Nigeria, which includes high endemic incidence of HIV. Another reason is that most donors are still being paid. In teaching hospitals in Nigeria in 2009, about 75% of donors are still paid for donations. The guidelines outlined by NTBS have not been widely implemented. There are an insufficient number of established safe transfusion centers to meet the country’s need for safe blood. Although the government administers public health, the private sector accounts for about 70% of all the health facilities in the country. According to the Nigeria National Blood Transfusion Service, more than 80% of blood collected and transfused in Nigerian hospitals is not properly screened The donor deferral option has not been widely implemented. The ELISA is still the only test used to screen donated blood for HIV. Unfortunately, there is a lack of political will to regulate adequately the screening of donors for infections. An examples of successful reduction of transfusion-related HIV infection in South Africa is discussed that could serve as a role model for addressing this problem in Nigeria.