Transfusion research priorities for blood services in sub-Saharan Africa

Evidence to support many blood transfusion policies and practices in sub-Saharan Africa (SSA) is weak or lacking. SSA cannot extrapolate from wealthy countries’ research findings because its environment, users and structures are very different and SSA has critical blood shortages. SSA needs to generate its own evidence but research funds are very scarce and need to be carefully targeted to match need. This study aimed to define this need by determining research priorities for blood services in SSA. Thirty-five stakeholders representing diverse blood services’ interests and expertise participated in a workshop. An adapted ‘consensus development method’ was used to identify, agree and justify research priorities under five themes through small group and plenary discussion, and cumulative voting. Research priorities covered traditional research areas, such as clinical use of blood and infection screening, but also highlighted many new, under-researched topics, mostly concerning blood service ‘systems’, such as economics, blood components and regulation. Lack of electronic information management systems was an important hindrance to the blood services’ ability to generate robust research data. This study has identified and prioritised novel research that will help blood services in SSA to address their own needs including their most urgent problem: the lack of access to adequate blood supplies. To catalyse this research blood services in SSA need to enhance their capacity to conduct, commission and manage research and to strengthen their collaborations within and beyond Africa

Клинические, гемодинамические и биохимические эффекты рамиприла у больных сахарным диабетом 2-го типа и артериальной гипертензией

Изучены клинические, гемодинамические и биохимические эффекты рамиприла у больных сахарным диабетом 2−го типа и артериальной гипертензией.Вивчено клінічні, гемодинамічні та біохімічні ефекти раміприлу у хворих на цукровий діабет 2−го типу та артеріальну гіпертензію.Clinical, hemodynamic, and biochemical effects of Ramipril were investigated in patients with type 2 diabetes mellitus and arterial hypertension

Building capacities in research for blood services in Africa

Background: Capacity building of African based blood services researchers has been identified as key in developing a sustainable programme of generation local evidence to support sound decision making. There are a number of research training programmes that have been instituted targeted at blood services in Africa. The article shares programme experiences of building research capacities for blood services in Africa. Methodology: The Francophone Africa Transfusion Medicine Research Training network, the NIH REDS-III and NIH Fogarty South Africa programmes and T-REC (Building research capacities in Africa) have been the key research capacity programmes targeting blood services in Africa over the last decade. Data were drawn from research outputs, publications and end of programme reports. The focus was to understand their experiences on the implementation of the capacity building programmes highlighting the success, challenges and the main research outputs from their initiatives. Results: The Francophone research network achievements included more than 135 trainees and in excess of 30 publications. The NIH REDS study the achievements included more than 12 research publications with South Africa junior investigators as lead authors. The NIH Fogarty program currently includes 56 short course trainees, 5 Masters and 6 PhD candidates. The four year (2011-2015, funding period) T-REC research capacity has as of 2020 managed to produce 4 PhDs, 42 in-service Diploma in Project Design and Management (DPDM), and supported bursaries for 60 Masters/undergraduate research. The main common challenges in the running of the research programmes include shortages of in-country mentoring and identified needs in high quality research grants writing. Discussion and conclusion: It has been noted that the key achievements for the blood services research capacity building include a mix of short courses, medium-term (epidemiology & biostats) and MS/PhD degree training. Also, having a train the trainers to develop in-country mentors has been instrumental. Overall, the key recommendations for blood services research capacity building include the need for research collaborations with high-income countries which can jump-start research. For a sustainable research programme, eventually there is need for in-country grant-writing capacity building

Within-Gender Changes in HIV Prevalence among Adults between 2005/6 and 2010/11 in Zimbabwe

INTRODUCTION: Zimbabwe has reported significant declines in HIV prevalence between 2005/06 and 2010/11 Demography and Health Surveys; a within-gender analysis to identify the magnitude and factors associated with this change, which can be masked, is critical for targeting interventions. METHODS: We analyzed change in HIV prevalence for 6,947 women and 5,848 men in the 2005/06 survey and 7,313 women and 6,250 men in 2010/11 surveys using 2005/06 as referent. The data was analyzed taking into consideration the survey design and therefore the svy, mean command in Stata was used in both linear and logistic regression. RESULTS: There were similar proportional declines in prevalence at national level for males (15% p=0.011) and females (16%,p=0.008). However, there were variations in decline by provincial setting, demographic variables of age, educational level and some sexual risk behaviours. In logistic regression analysis, statistically significant declines were observed among men in Manicaland, Mashonaland East and Harare (p<0.01) and for women in Manicaland, Mashonaland Central and Harare (p<0.01). Although not statistically significant, numerical increases were observed among men in Matebeleland North, Matebeleland South, Midlands and for both men and women in Bulawayo. Young women in the age range 15-34 experienced a decline in prevalence (p<0.01) while older men 30-44 had a statistically significant decline (p<0.01). Having a secondary and above education, regardless of employment status for both men and women recorded a significant decline. For sexual risk behaviours, currently in union for men and women and not in union for women there was a significant decline in prevalence. CONCLUSION: Zimbabwe has reported a significant decline among both men and women but there are important differentials across provinces, demographic characteristics and sexual risk behaviours that suggest that the epidemic in Zimbabwe is heterogeneous and therefore interventions must be targeted in order to achieve epidemic control

Risk modelling of transfusion transmissible infections

Het modelleren van het risico op bloedoverdraagbare infectieziekten in Afrika Bloedtransfusie kan een levensreddende medische behandeling zijn, zeker in Afrika ten zuiden van de Sahara. Er is echter een risico van transfusie overdraagbare infecties die kan worden geminimaliseerd door geschikte bloeddonoren te selecteren en bloed te testen. Ondanks deze veiligheidsmaatregelen is het risico van transfusie overdraagbare infecties niet tot nul te reduceren, vandaar de behoefte dit rest-risico te berekenen met modellen. We onderzochten de HIV-dynamiek in het algemene en de bloeddonorpopulaties in Zimbabwe. Dit maakte de identificatie mogelijk van een laag risico populatie voor de overdracht van HIV. We gebruikten drie methodes om de overdracht van HBV, HCV en HIV te berekenen. Vergelijkbare resultaten werden gevonden, dit geeft vertrouwen voor het gebruik van deze modellen. Globalisering is een uitdaging voor de bloedtransfusieveiligheid omdat bloeddonoren in toenemende mate naar gebieden reizen met bloed overdraagbare infectieziekten. Daarom ontwikkelden wij een nieuwe methode om het risico te bereken van de overdracht van een infectieziekte door een bloeddonor die door een gebied reist met een bloedoverdraagbare infectieziekte. Omdat in Zimbabwe overwogen wordt om gevoelige nucleïnezuur testen voor HBV, HCV en HIV in te voeren, is een kosteneffectiviteitsanalyse uitgevoerd. In verhouding tot de hoge kosten is de gezondheidswinst aan de lage kant. Echter, de verhouding tussen kosten en gezondheidswinst is wel veel gunstiger dan die wordt gevonden voor dezelfde testen in de westerse wereld. Het proefschrift laat zien dat er een noodzaak is om risico’s van bloedtransfusies te modelleren om de bloedtransfusieveiligheid te optimaliseren in landen met beperkte financiële mogelijkheden

Additional file 1: of Modelling the risk of transfusion transmission from travelling donors

Deriving the risk of transfusion transmission from travelling donors. (DOCX 91 kb

Impact of using different blood donor subpopulations and models on the estimation of transfusion transmission residual risk of human immunodeficiency virus, hepatitis B virus, and hepatitis C virus in Zimbabwe

BACKGROUND: Various models for estimating the residual risk (RR) of transmission of infections by blood transfusion have been published mainly based on data from high-income countries. However, to obtain the data required for such an assessment remains challenging for most developing settings. The National Blood Service Zimbabwe (NBSZ) adapted a published incidence-window period (IWP) model, which has less demanding data requirements. In this study we assess the impact of various definitions of blood donor subpopulations and models on RR estimates. We compared the outcomes of two published models and an adapted NBSZ model. STUDY DESIGN AND METHODS: The Schreiber IWP model (Model 1), an amended version (Model 2), and an adapted NBSZ model (Model 3) were applied. Variably the three models include prevalence, incidence, preseroconversion intervals, mean lifetime risk, and person-years at risk. Annual mean RR estimates and 95% confidence intervals for each of the three models for human immunodeficiency virus (HIV), hepatitis B virus (HBV), and hepatitis C virus (HCV) were determined using NBSZ blood donor data from 2002 through 2011. RESULTS: The annual mean RR estimates for Models 1 through 3 were 1 in 6542, 5805, and 6418, respectively for HIV; 1 in 1978, 2027, and 1628 for HBV; and 1 in 9588, 15,126, and 7750, for HCV. CONCLUSIONS: The adapted NBSZ model provided comparable results to the published methods and these highlight the high occurrence of HBV in Zimbabwe. The adapted NBSZ model could be used as an alternative to estimate RRs when in settings where two repeat donations are not available

Change in HIV prevalence in Zimbabwe by sex between the 2005/6 and 2010/11 surveys by different socio-demographic characteristics (weighted).

<p>Change in HIV prevalence in Zimbabwe by sex between the 2005/6 and 2010/11 surveys by different socio-demographic characteristics (weighted).</p

Logistic regression of the factors associated with change in HIV prevalence among adults aged 15–49 years who were tested for HIV, ZDHS 2005/6 and 2010/11.

<p>Logistic regression of the factors associated with change in HIV prevalence among adults aged 15–49 years who were tested for HIV, ZDHS 2005/6 and 2010/11.</p