National AIDS Control Programme Research Articles

Shifting trends of HIV epidemiology among most at risk groups (MARGs) in India

Background: HIV/AIDS is one of the major barriers for community development. HIV epidemic in India is mainly concentrated among Most at Risk Groups (MARGs)/ High Risk Groups (HRGs) i.e. Injecting Drug Users (IDUs), Female Sex Workers (FSWs), Men who have sex with men (MSM) & Transgender and their sexual partners. National AIDS Control Programme (NACP) phase- II (year 1999-2006) & phase-III (year 2007-2012) envisaged and implemented Targeted Interventions (TIs) across country which has helped in somewhat containing the HIV epidemic among HRGs in various pockets. The implementation of Targeted Intervention programme has remained invariably different based on the response of respective State AIDS Control Societies (SACS). Objective: To analyze the shifting trends of HIV epidemiology among MARGs, identify lessons learnt and examine future aspects of public health interventions among MARGs. Materials and Methods: Present research has systematically reviewed HIV epidemiology among Most at Risk Groups (MARGs) using 16 peer reviewed research papers, HIV Sentinel Surveillance Survey (HSS) reports (years 2007 and 2008-09), National Family Health Survey (NFHS)-3 report, epidemiological studies, public health intervention reports via online database ‗PubMed‘ and ‗Web of Science‘ are analysed. Results: Findings of various studies defining the HIV prevalence among MARGs highlights HIV prevalence ranging between 3.0 % to 70.0% in some pockets. These findings may not be generalized considering the limited sample size used in such studies. Annual rounds of HIV Sentinel Surveillance Survey (HSS) are considered more reliable and generalizeable. The trend of HIV prevalence among MARGs based on three years moving average show a consistent fall in HIV prevalence among FSWs in erstwhile high prevalence states. Whereas the trend of HIV prevalence among MSM & Transgender show initial decrease between period 2003 to 2006 and then rise from 2006 to 2007. HIV prevalence among IDUs show decrease from 2003 to 2008 in Manipur, Nagaland, and Chennai and notable increase reported in Meghalaya, Mizoram, West Bengal, Mumbai, Kerala and Punjab. There are regional variations in HIV prevalence among MSM & Transgender and Injecting Drug Users. Conclusion: Review has outlined that despite reduction of new HIV infections (by 50% from 2000 to 2009) and reported decline in HIV prevalence among Female Sex Workers, a sustained focus on prevention is required among MARGs and their partner to contain HIV. However selection bias, non response bias, under reporting bias, surveillance bias in these studies might have also affected the results. There is felt need for more qualitative and behavioural researches to corroborate with HIV epidemiology and trends among MARGs.

National AIDS Control Organisation's human resource capacity building initiatives for better response to HIV/AIDS in India.

Human resource capacity building is a key strategy in the design, delivery, sustainability and scale up HIV treatment and prevention programmes. The review aims to present human resource capacity building initiatives undertaken by the National AIDS Control Organisation (NACO) and to discuss the available opportunities in India.There was minimal emphasis on human resource capacity building in National AIDS control programme (NACP)-I. The focus of capacity building in NACP-II was on strengthening the capacity of partners implementing various HIV/AIDS interventions. NACP-III (2007-2012) focussed on capacity building as a priority agenda. Other than short-term training programmes, NACP-III is strengthening the capacity of partners through the State Training and Resource Centre, Technical Support Unit, District AIDS Prevention Control Unit, Fellowship Programme and Network of Indian Institutions for HIV/AIDS Research.Various opportunities to enhance and consolidate capacity building responses in HIV/AIDS in India may include mainstreaming of capacity building, appropriate management of knowledge and resources, effective delivery of training, measuring and documenting impact,accreditation of programmes and institutes,use of information technology, identifying and implementing innovations and working for sustainability.Growing demand for capacity-building in HIV/AIDS needs substantial efforts to ensure that these are implemented effectively and efficiently. NACO had made significant strides in these regards, but at the same time there are arduous challenges like measuring impact, quality, documentation, operational research, and sustainability. NACO is formulating Phase-IV of NACP. This review will provide feedback to the NACO for strengthening its strategic document for human resource capacity building.

HIV‐related stigma and NGO‐isation in India: a historico‐empirical analysis

In response to World Bank critiques in 2007, the Indian Ministry of Health and Family Welfare declared that human immunodeficiency virus (HIV)-related stigma was a barrier to the participation of non-governmental organisations (NGOs) in the implementation of HIV prevention targeted interventions. Taking a deeper view of HIV-related stigma as a historically inflected process of devaluation, this article details the history and transformation of NGO involvement in the HIV epidemic from 1986 through economic liberalisation in the 1990s up to the Second National AIDS Control Programme (NACP II 1999-2006). It additionally examines findings from interviews and participant observation of NGO workers (N = 24) from four targeted intervention NGOs in Delhi funded under NACP II. Analysis reveals that a second wave of HIV-related NGO involvement has mushroomed in the past two decades, affording NGO workers multiple pathways to credibility in the Indian response to the epidemic. Contradictions embedded in the overlap of these pathways produce stigma, reflecting 'adverse incorporation' of the NGO workers. Drawing upon noteworthy exceptions to this trend from the first wave of Indian HIV-related NGOs, the article calls for NGO participation as an explicitly political project of addressing the social inequalities that shape stigma as well as vulnerability to illness writ large.

HIV/AIDS knowledge, sexual behaviour and condom use among commercial motorcyclists in Lagos State, Nigeria

The incidence of HIV/AIDS infection within our society has gotten to an alarming proportion especially as it affects our youths, the group to which majority of our commercial motorcyclists belong. This promptedthe need to assess the level of awareness, knowledge and preventive measures by these stakeholders towards HIV/AIDS in the face of cultural beliefs, habits and ignorance. A total number of 345 questionnairescontaining well-structured questions relating to the subject matter were administered to commercial motorcyclists selected through purposive sampling technique at different locations in Lagos State. Majority(72.7%) of the respondents were of the age range 20-39 years, of polygamous families (74.5%), Moslems (65.5%), with secondary education (58.3%). All the respondents were aware of HIV/AIDS. Respondentsidentified virus (84.3%), bacteria (3.5%) and excessive drinking of alcohol (8.7%) as some of the causes of HIV/AIDS. Some ways of contacting it included penetrative sex (96.2%), sharing shaver blade (57.1%) andmaternal transmission (48.7%). Cases of misconception abound.  Respondents who indicated they sometimes use condom were 64.6%. Those who had no sexual partners apart from their wives were 70.7%. The men in this study only had high HIV/AIDS awareness and adequate knowledge in some areas, but lack such in other key areas and therefore do not possess sufficient knowledge to curtail the spread of this killer disease.Education and condom promotion should be part of every national AIDS control program.

Link to Slower Access to Care: What is the Stigma? An Indian Perspective

Stigma and discrimination have been "bed fellows" of HIV and AIDS in India. Perpetuated by lack of awareness, deep-rooted traditional beliefs, adherence to harmful practices, and a moralistic tag associated with a condition connected with sex (in India the method of HIV transmission being largely heterosexual in nature) and high-risk individuals such as sex workers, it made it difficult for the country to fight an epidemic that was hard to track, estimate, diagnose, and treat. Various interventions under India's National AIDS Control Program (NACP) have targeted stigma and discrimination among different groups. The program has been fairly successful in its outreach programs, bringing about a reduction in adult HIV prevalence and new infections. As the country transitions from NACP Phase III (2007-2012) to IV (2012-2017), making treatment and longevity its top priority, stigma is no longer such a terrifying word. This review discusses the social and cultural context of HIV/AIDS-related stigma in general and highlights various policies and intervention programs that have led India's campaign against HIV/AIDS-driven stigma into the testing, care, support, and treatment ambit.

Using surveillance data for action: lessons learnt from the second generation HIV/AIDS surveillance project in Pakistan

Although many countries are now collecting useful, high-quality HIV surveillance data, more efforts are put into the collection of data than into ensuring it is deployed effectively. The Canada-Pakistan HIV/AIDS surveillance project has strengthened and expanded the existing national AIDS control programme surveillance system in Pakistan through a comprehensive estimate of the size and location of some of the most at-risk populations (sex workers and injection drug users) and annual assessments of their sociodemographic characteristics, behaviours and HIV prevalence. The country now uses second generation surveillance data at a broad level to lobby for policy change, mobilize resources, improve programming and measure the success of prevention through an integrated national effort. This article aims to share the experiences and lessons learnt in the development of a second generation surveillance system for HIV/AIDS in Pakistan.

Management of HIV and AIDS at lower primary health care facility in Chalinze, eastern Tanzania

Implementation of Antiretroviral Therapy (ART) services at health centres in Tanzania were delayed due to several reasons including shortage of qualified staff, inadequate infrastructure and logistics problems. However, patients from peripheral areas experienced difficulties in accessing ART services due to long distances from clinics. National AIDS Control Programme (NACP) and Non-Governmental Organizations (NGOs) embarked on ART services scale-up programme aimed at improved ART availability and accessibility. Through this programme ART services were established at health centres and selected dispensaries. However, no previous documented experiences existed at country level to guide provision of services. Therefore, this study was designed to gather experiences and share lessons learnt with other health care providers and programme implementing partners. This was a descriptive cross-sectional study involved patients enrolled to ART services between May 2007 and April 2009. Data collection involved observation of health providers’ performance and retrospective ART and care patients’ registers review. During the study period, 611 care and 284 ART patients were attended. Majority of patients (85.1%; 762/895) were adults aged 25-45 years. In total 61.5% (550/895) of the patients had CD4+T lymphocytes ≤350/µl the cut-off point for initiating ART. The frequency of symptoms was noted to significantly decrease with increasing CD4 counts (P

Cost effectiveness of targeted HIV prevention interventions for female sex workers in India

ObjectiveTo ascertain the cost effectiveness of targeted interventions for female sex workers (FSW) under the National AIDS Control Programme in India.MethodsA compartmental mathematical Markov state model was used over a...

Scientific Approaches to AIDS Prevention and Control in China

The HIV epidemic in China started among intravenous drug users in the late 1980s. The second wave of the epidemic was caused by an outbreak in the paid plasma donors in central China in the mid-1990s. Sexually transmitted HIV cases have steadily increased and comprised more than half the reported HIV/AIDS infections since 2007. In the last 5 years, there has been a sharp increase of HIV infection in men who have sex with men. The HIV epidemic in China has expanded from high-risk groups to the general population and from rural regions to urban areas. This brief article discusses the history of HIV epidemics in China and the challenges facing the current AIDS control efforts in the country. It explains that only scientific approaches can sustain the national AIDS control programs and introduce the type of research needed to address those challenges. The selected research areas include molecular epidemiology, drug resistance surveillance, and the Chinese HIV vaccine research.

What can transaction costs tell us about governance in the delivery of large scale HIV prevention programmes in southern India?

This paper aims to understand the transaction costs implications of two different governance modes for large scale contracting of HIV prevention services to non-governmental organisations (NGOs) in 2 states in India as part of the National AIDS Control Programme between 2001 and 2003.Interviews at purposively selected case study NGOs, contracting agencies and key informants as well as document review were used to compile qualitative data and make comparisons between the states on five themes theoretically proposed to shape transaction costs: institutional environment, informational problems, opportunism, scale of activity and asset specificity (the degree to which investments made specifically for the contract have value elsewhere).The State AIDS Control Society (SACS) in state Y used a management agency to manage the NGO contracts whereas the SACS in state X contracted directly with the NGOs. A high level of uncertainty, endemic corruption and weak information systems served to weaken the contractual relationships in both states. The management agency in state Y enabled the development of a strong NGO network, greater transparency and control over corrupt practises than the contract model in state X. State X’s contractual process was further weakened by inadequate human resources.The application of the transaction cost framework to contracting out public services to NGOs identified the key costs associated with the governance of HIV prevention services through NGO contracts in India. A more successful form of relational contract evolved within the network of the contract management agency and the NGOs. This led to improved flows of information and perceived quality, and limited corrupt practises. It is unlikely that the SACS on its own, with broader responsibilities and limited autonomy can achieve the same ends. The management agency approach therefore appears to be both transaction cost reducing and better able to cope with the large scale of these contracting programmes.

Prevalence and Risk Factors of HIV Infection among Clients Attending ICTCs in Six Districts of Tamilnadu, South India

Objective. To assess the HIV serostatus of clients attending integrated counseling and testing centres (ICTCs) in Tamilnadu, south India (excluding antenatal women and children), and to study its association with demographic, socioeconomic, and behavioral risk factors. Design. In a prospective observational study, we interviewed clients attending 170 ICTCs from six districts of Tamilnadu during 2007 utilizing a standard pretest assessment questionnaire. All the clients were tested for HIV with rapid test kits. Multiple logistic regression analysis was used to identify determinants of HIV infection. Results. Of 18329 clients counseled, 17958 (98%) were tested for HIV and 732 (4.1%; range 2.6 to 6.2%) were tested positive for HIV. Median age of clients was 30 years; 89% had never used condoms in their lives and 2% gave history of having received blood transfusion. In multivariate analysis HIV seropositivity was associated with HIV in the family (adjusted odds ratio) (AOR 11.6), history of having sex with sex workers (AOR 2.9), age ≥31 years (AOR 2.8); being married (AOR 2.5), previously tested for HIV (AOR 1.9), illiteracy (AOR 1.7), unemployment (AOR 1.5), and alcoholism (AOR 1.5). Conclusion. HIV seroprevalence being high in ICTC clients (varied from 2.6 to 6.2%), this group should also be included in routine programme monitoring of sero-positivity and risk factors for better understanding of the impact of the National AIDS Control Programme. This would help in evolving appropriate policies and strategies to reduce the spread of HIV infection.

Trend analysis and short-term forecast of incident HIV infection in Ghana

The study uses time-series modelling to determine and predict trends in incident HIV infection in Ghana among specific age groups. The HIV data for Ghana were grouped according to northern and southern spatial sectors as they exhibited slightly different data collection formats. The trend of the epidemic is modelled using moving-average smoothing techniques, and the Box-Jenkins ARIMA model is used to forecast cases of newly acquired (incident) HIV infection. Trend analysis of past growth patterns reveals an increase in new cases of HIV infection in the northern sector, with the greatest increase occurring among persons aged 30 years and over. The epidemic in the southern sector appears to have levelled off. However, incident HIV infection in the 20–39-year-old age group of females in the sector is estimated to increase in the next three years. Moreover, the estimates suggest a higher increase in incident cases than that predicted by the National AIDS Control Programme. Nevertheless, incident HIV infection among persons aged 19 and below is found to be relatively stable. Thus, if efforts are made to reduce or prevent an increase in the number of new infections in the northern sector, and for the 20–39 years age group in the southern sector, Ghana will have a brighter future with regard to its response to the HIV epidemic. These findings can assist with developing strategic-intervention policy planning for Ghana and other countries in sub-Saharan Africa.

Experience implementing electronic health records in three East African countries.

Efficient use of health care resources in low-income countries by providers and local and national managers requires timely access to patient data. To implement electronic health records (EHRs) in HIV clinics in Kenya, Tanzania, and Uganda. We initially developed and implemented an EHR in Kenya through a mature academic partnership. The EHR was then implemented in six HIV clinics in Tanzania and Uganda in collaboration with their National AIDS Control Programmes. All implementations were successful, but the system's use and sustainability varied depending on who controlled clinic funding. Successful EHR use and sustainability were enhanced by local control of funds, academic partnerships (mainly by leveraging research funds), and in-country technology support.

How to Pay 'Cash-on-Delivery' for HIV Infections Averted: Two Measurement Approaches and Ten Payout Functions

In contrast to current donor policy, which funds a recipient country’s national AIDS control program, this paper proposes a measurement strategy to enable a donor to reward a recipient country’s success at HIV prevention, irrespective of the inputs, activities, or who gets the credit. In accordance with the “cash-on-delivery” model of foreign assistance, the objective is not to replace traditional input- or activity-oriented aid, but to complement it by enhancing the motivation for local actors and their partners (including the traditional bilateral and multilateral funding agencies and their agents) to achieve measurable reductions in the rate of new HIV infections. This paper proposes two approaches to measuring the number of HIV infections averted between a baseline survey and a follow-up survey and explores the properties of ten alternative “payout functions” which would link measured epidemic changes to the size of the reward to be paid. All measurement approaches include the possibility of statistical error and thus a risk of rewarding the country too little or too much. This risk depends on the initial rate of infection and on HIV prevention success and can be reduced by either increasing the survey sample size or increasing the interval between surveys. By negotiating in advance the choice of one of these measurement approaches and one of a menu of payout functions, the donor and recipient agree on the recipient’s incentive structure with respect to the magnitude and precision of the estimated reduction in the rate of new infection.

HIV Testing for Children in Resource-Limited Settings: What Are We Waiting For?

In many African countries, HIV has reversed previously recorded declines in child mortality. Worldwide, children account for 18% of HIV-related deaths and 15% of HIV infections each year [1]–[3], an estimated 2.3 million children are infected, and 730,000 urgently need antiretroviral therapy (ART), which only about 275,000 currently receive. The mortality of untreated pediatric patients is very high in the first 2 years of life, and reaches 80% by age 5 [4]. While the number of children under age 15 in low- and middle-income countries receiving ART rose dramatically between 2005 and 2007 (Figure 1), it is nonetheless evident that those children currently on treatment still represent only a small proportion of those who need it. Coverage will need to be greatly expanded if the global community's goal of providing ART to 80% of children in need by 2010 is to be met [1]. Figure 1 Number of children under 15 receiving antiretroviral therapy in low- and middle-income countries, 2005–2007. As more low-cost fixed-dose combination antiretrovirals (ARVs) for children become available, the issue of access to medication is less of an impediment to treatment (Table 1). Why then are so few children in developing countries on ART? We propose that the primary reason is insufficient identification of infected children. There are many causes for this—including poor coverage of services for prevention of mother-to-child transmission (PMTCT), poor linkages to infant testing programs, provider uncertainty on how best to diagnose and treat infants, and insufficient numbers of pediatric HIV treatment sites—but the end result is that many infected children are either never identified or lost from the system before they can be enrolled into care. We believe it is essential for national HIV programs to recognize that HIV testing and counseling systems designed for adults do not meet the needs of children. The time has come to develop and implement specific strategies to increase opportunities for children to access HIV testing, especially in sub-Saharan Africa. Table 1 Costs of Pediatric ARV for Resource-Limited Settings, 2009. As criteria for treatment initiation evolve and ART programs are scaled up in resource-limited settings, the need to expand HIV testing will become more urgent. Surveys in sub-Saharan Africa document 39% of adult men and women as having at some time been tested and received their results, up from 15% just 2 years before [3]. However, even when strong adult testing programs exist, access to pediatric testing remains low. The 2004 World Health Organization (WHO) HIV testing guidelines did not identify children as a specific target group for testing [5]. More recent WHO guidance on provider-initiated HIV testing provides direction on how to overcome barriers to testing children but offers little on how to operationalize pediatric testing [6]. Data from the South African CHER study highlight the survival benefit of early treatment for infants, showing an overall 75% decline in mortality in those infants who were started on ART immediately after diagnosis [7]. In response, the WHO has changed its treatment recommendations, calling for treatment of all infected infants under 12 months of age, irrespective of clinical stage [8]. This is a critical advance in treatment policy, which national AIDS control programs should adopt as soon as possible. But without better ways to identify infected infants, the policy alone will not change the treatment landscape in the short term. Although infant diagnosis is now available in many PMTCT programs, at current rates of PMTCT coverage, the majority of HIV-infected infants are born to mothers who were never tested and never received PMTCT prophylaxis. These infants are very unlikely to be identified and get on to treatment without targeted testing strategies. Scale up of testing programs for children will no doubt require investment in key areas such as training and support for providers, improvement of laboratory facilities and referral networks, and community mobilization, but such investments are necessary to reduce the substantial mortality of HIV in children. Because of the marked survival advantage among those identified and treated in a timely manner, the US Centers for Disease Control and Prevention has recommended routine HIV testing for US adults during contact with medical facilities [9]. This represents a clear shift away from voluntary testing (which emphasizes personal choice) toward an emphasis on the public and individual health benefits of improved identification and control of HIV disease and prevention of HIV transmission. Of course, success in operationalizing these recommendations depends on a well-functioning health care system—which does not exist in many of the countries most affected by the AIDS epidemic. As such, these recommendations have not been widely implemented in the most affected parts of the world, where making a diagnosis is most critical, particularly in children.

Assessing risk criteria and HIV prevalence in antenatal clinic clients from 2 urban tertiary hospitals in Pakistan

Background Pakistan is in the concentrated phase of HIV epidemic for the last five years. The HIV prevalence among injecting drug users and hijra sex workers has been reported by second generation surveillance to be more than 5%. Considering the risk of HIV transmission to the spouses and children of the high risk groups including migrant workers, the National AIDS Control Programme established six comprehensive prevention of parent to child transmission (PPTCT) sites linked with HIV treatment centres in tertiary hospitals. The objective of this study was to determine the HIV prevalence among antenatal clinic (ANC) attendees at two tertiary care hospitals and correlate risk assessment questionnaire with HIV diagnosis.

How to Pay ‘Cash-on-Delivery’ for HIV Infections Averted: Two Measurement Approaches and Ten Payout Functions

In contrast to current donor policy, which funds a recipient country’s national AIDS control program, this paper proposes a measurement strategy to enable a donor to reward a recipient country’s success at HIV prevention, irrespective of the inputs, activities, or who gets the credit. In accordance with the “cash-on-delivery” model of foreign assistance, the objective is not to replace traditional input- or activity-oriented aid, but to complement it by enhancing the motivation for local actors and their partners (including the traditional bilateral and multilateral funding agencies and their agents) to achieve measurable reductions in the rate of new HIV infections. This paper proposes two approaches to measuring the number of HIV infections averted between a baseline survey and a follow-up survey and explores the properties of ten alternative “payout functions” which would link measured epidemic changes to the size of the reward to be paid. All measurement approaches include the possibility of statistical error and thus a risk of rewarding the country too little or too much. This risk depends on the initial rate of infection and on HIV prevention success and can be reduced by either increasing the survey sample size or increasing the interval between surveys. By negotiating in advance the choice of one of these measurement approaches and one of a menu of payout functions, the donor and recipient agree on the recipient’s incentive structure with respect to the magnitude and precision of the estimated reduction in the rate of new infection.

An Intervention Study To Enhance Aids Awareness Among Underprivileged Population In Chandigarh

It is estimated that 4 million persons are suffering from HIV infection/AIDS in India. A family health awareness campaign (FHAC) has been implemented under the National AIDS Control Programme (NACP) to scale up HIV/AIDS awareness in vulnerable groups.A community based study was conducted in April 2001 to find the impact of FHAC and IEC activities in 12 villages and slums with a population of 1-1.5 lakhs in Chandigarh. Information was collected from 643 persons in the age group of 15-49 years, 323 in the pre-intervention phase and 320 in the post-intervention phase.Awareness about AIDS increased from 58.2% to 70% (p The major sources of information were the mass media and friends. Knowledge regarding the mode of spread also increased after the campaign. Knowledge regarding prevention of AIDS by using condoms increased from 42% to 61.2%; having a single partner, from 59% to 72.3%; using safe blood, from 14.9% to 29%; and sterile needles/syringes, from 18.1% to 33.9%. Over 90% of respondents consider AIDS a dangerous disease.Community based intervention such as FHAC and IEC activities were successful in enhancing the awareness among underprivileged groups. Since a large section of the population still remained unaware, regular efforts must be made to achieve universal awareness about AIDS.

An Intervention Study To Enhance Aids Awareness Among Underprivileged Population In Chandigarh

It is estimated that world wide, 33.2 million people were suffering, 2.1 million died and 2.5 million got newly infected from HIV/AIDS in the year 2007. Nearly 2.5 million people are suffering in India at present. Family health awareness campaign (FHAC) has been implemented under National AIDS Control Programme (NACP) to scale up HIV/AIDS awareness in the vulnerable groups. Community based study was conducted in April 2001 to find out the impact of FHAC and IEC activities in 12 villages and slums in Chandigarh. Nearly 1-1.5 lac people are living in these areas. Information was collected from 323 subjects in pre-intervention phase and from 320 subjects in post-intervention phase in the age group of 15-49 years. The awareness about AIDS increased from 58.2% to 70%. The major sources of information were mass media and friends. Knowledge regarding mode of spread also increased and the majority were aware about multiple sex partners and use of unhygienic/ used syringes and needles, after the campaign. Knowledge regarding prevention of AIDS by using condom increased from 42% to 61.2%, having single partner from 59% to 72.3%, using safe blood from 14.9% to 29% and sterile needles/syringes from 18.1% to 33.9%. Over 90% of respondents consider AIDS as a dangerous disease. Community based intervention such as FHAC and IEC activities were successful in enhancing the awareness among underprivileged groups. Still a large section of the population remains unaware, thus regular efforts must be made to achieve universal awareness.

Whole blood and component use in resource poor settings

Data on blood collection, testing and component preparation has improved worldwide; however, there is limited information on blood utilization from the developing countries. Blood requirement in the Southeast Asia region is 15 million units against a collection of 9.3 million. There is huge diversity in the management of blood transfusion services, the voluntary blood collection (range 40–100%) and proportion of blood separated into components (10–95%). The major indications for transfusion are for emergency obstetric care, surgery, pediatric and trauma patients. The prevalence of thalassemia in this region is high and in India alone 2 million units of packed red cells are required for transfusion to these patients. The Blood Safety Program in India has developed as a component of the National Aids Control Program and has lead to infrastructure development, blood component separation facilities and formulation of a National Blood Policy. In order to facilitate emergency obstetric care nearer home, blood storage centers are being established at primary health care centers. Emerging infectious threats like dengue hemorrhagic fever necessitate platelet transfusion therapy. A few centers in India issue NAT screened blood. It is envisaged to establish a nationally co-ordinated transfusion service for cost-effective quality blood/components for appropriate clinical use.