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TOPIC FOR THE PROJECT

HIV/AIDS Transmission
through unsafe blood
transfusion in Pakistan
PASS
(Project for AIDS Screening
and surveillance)

A 3 years Project to Prevent HIV/AIDS


transmission through unsafe blood
transfusion
In District Quetta
Balochistan

Dr Abdul Majeed Jaffar


HIV/AIDS is the world’s
leading infectious killer
claiming—to date—more
than 25 million lives. An
estimated 2 million people
die every year from
HIV/AIDS
WHO
DEFINITION

HIV (human immunodeficiency virus)


infects cells of the immune system and
destroys or impairs their function.
Infection results in the progressive
deterioration of the immune system,
breaking down the body's ability to
fend off infections and diseases.

WHO
DEFINITION

AIDS (Acquired immune deficiency


syndrome) refers to the most
advanced stages of HIV infection,
defined by the occurrence of any of
more than 20 opportunistic
infections or related cancers.

WHO
Global estimates for adults and children, 2007

• People living with HIV 33 million [30 – 36 million]

• New HIV infections in 2007 2.7 million [2.2 – 3.2


million]

• Deaths due to AIDS in 2007 2.0 million [1.8 – 2.3


million]
Adults and children estimated to be living with HIV,
2007

Western & Eastern Europe


Central Europe & Central Asia
North America 730 000 1.5 million
[1.1 – 1.9 million]
[1.1 – 1.9 million]
1.2 million [580 000 – 1.0
million]
East Asia
[760 000 – 2.0 740 000
million] Middle East & North [480 000 – 1.1
Caribbean Africa million]
230 000 380 000 South & South-East
[210 000 – 270 000] [280 000 – 510 000] Asia
Sub-Saharan Africa 4.2 million
Latin America 22.0 million [3.5 –Oceania
5.3 million]
1.7 million [20.5 – 23.6 million]
74 000
[1.5 – 2.1 million]
[66 000 – 93 000]

Total: 33 million (30 – 36 million)


Estimated number of adults and children
newly infected with HIV, 2007

Western & Eastern Europe


Central Europe & Central Asia
North America 27 000 110 000
[67 000 – 180 East Asia
54 000 [14 000 – 49
000] 000]
[9600 – 130 000] 52 000
Middle East & North [29 000 – 84 000]
Caribbean Africa
20 000 40 000 South & South-East
[16 000 – 25 000] [20 000 – 66 000] Asia
Sub-Saharan Africa 330 000
Latin America 1.9 million [150 000 – 590 000]
Oceania
140 000 [1.6 – 2.1 million]
13 000
[88 000 – 190
000] [12 000 – 15 000]

Total: 2.7 million (2.2 – 3.2 million)


Estimated adult and child deaths from AIDS, 2007

Western & Eastern Europe


Central Europe & Central Asia
North America 8000 58 000
[41 000 – 88 000]
23 000 [4800 – 17 000] East Asia
[9100 – 55 000] 40 000
Middle East & North [24 000 – 63 000]
Caribbean Africa
14 000 27 000 South & South-East
[11 000 – 16 000] [20 000 – 35 000] Asia
Sub-Saharan Africa 340 000
Latin America 1.5 million [230 000 – 450 000]
Oceania
63 000 [1.3 – 1.7 million]
1000
[49 000 – 98 000]
[<1000 – 1400]

Total: 2.0 million (1.8 – 2.3 million)


Over 7400 new HIV infections a day in 2007

• More than 96% are in low and middle income


countries

• About 1000 are in children under 15 years of age

• About 6300 are in adults aged 15 years and older


of whom:
— almost 50% are among women
— about 45% are among young people (15-24)

WHO
Regional and National estimates for
adults and children, 2007

• South East Asia: 4.2 Millions (estimated) of People


living with HIV and 0.34 Millions (estimated) of people
died due to AIDS.

• Pakistan: 96 Thousands (estimated) of People living


with HIV and 5100 (estimated) of people died due to
AIDS.

2008 Report on the Global AIDS Epidemic


HIV in Pakistan: Timeline
HASP round 2
40 RT/STI Study 2
EACP started
HASP pilot HASP round 1
RT/STI Study 1 Other studies
30 (FHI)

Larkana IDUs
NACP
20 incident
Formed HIV
Care
First
ANC started
case MSW
10 Study (GFATM
detected s
)
General ?
IDUs
Population
91
91
91

02

02

02

02

02

02
HIV prevalence among injecting drug users in Pakistan,
2004–2007

60
51.3
50

40
30 29.8
% 30 27
23
19.6
20 16.5
1313.3
9 10 9.5
10 5.3 6.5
3.7
0.5 2.2
0.5 0 0
0

20 5
6

20 5
06

20 4
20 5
04

20 5

20 5

20 5
06

04

06

06

20 5
06
06

06

7
0
0

0
0
0

0
0

0
20
20

20

20

20

20
20

20

20

20
20

20
Karachi Larkana Faisalabad Rawalpindi Quetta
Sukker Hyderabad Sargodha Lahore Peshawar

Source: Ministry of Health Pakistan. HIV Second Generation Surveillance in Pakistan, National Report Rounds I and II.
Modes of Transmission
• Unprotected sexual intercourse (vaginal or anal)
or oral sex with an infected person
• Transfusions of contaminated blood
• Sharing of contaminated needles
• Sharing of syringes or other sharp instruments
• Mother to child during pregnancy, childbirth and
breastfeeding

WHO
High Risk Groups
• Injecting drug users
• People who engage in sexual behavior that puts
them at risk
• Migrant workers
• Long distance Truck drivers and associated
population
• Jail inmates
• Sexual partners, spouses and children of the
people in these groups
• Most at Risk Adolescents

National HIV and AIDS Policy 2007


HIV/AIDS in PAKISTAN
• Estimated Number of HIV/AIDS cases in
Pakistan: 85,000
• Prevalence of HIV among General public: less
than 1%
• Prevalence of HIV among High risk groups in
Pakistan:
– Injecting Drug users: 21%
– Male Sex Workers: 0.9%
– Hijra Sex Workers: 6.4%
– Female Sex Workers: <0.01%

NACP
Transmission in Pakistan
H e te ro s e xu a l

26.90% B lo o d & B lo o d P ro d u cts

ID U s

Ma le to m a le o r B is e xu a l
52.55%
2.20% re la tio n s
Mo th e r to ch ild (Ve rtica l
4.55%
tra n s m is s io n )
2.02% U n d e rm in e d
tra n s m is s io n
4.55%

Source: Bhurgri Y, HIV/AIDS in Pakistan; J Pak Med Ass. Vol. 56, No. 1, January 2006, pp-1
Facts about Blood Transfusion

• Saves life and improve health


• Millions of patients requiring Blood Transfusion don’t
have timely access to safe blood
• More than 85 million units of blood donations are
collected globally every year
• Family or replacement donors and paid donors still
remain a significant source of blood for transfusion
• If 1% to 3% of a country's population donated blood, it
would be sufficient to meet the country's needs

WHO
Facts about Blood Transfusion
• It is estimated that 40 percent of the 1.5 million annual
blood transfusions in Pakistan are not screened for HIV.
• About 20 percent of the blood transfused comes from
professional donors.
• Professional Blood donors include
– People who are typically poor
– Drug Users
– Who give blood for money
• 20% Hep. C +ve, 10% Hep. B +ve and 1% HIV +ve.
(Study conducted by World Bank on Professional blood
donors)

The World Bank, HIV/AIDS in Pakistan Aug.08


Facts about Blood Transfusion
• 15% of the blood is still donated by the
professional donors
• 10% are voluntary unpaid donations and 75%
are replacement (hidden payment) donations.

National Blood Policy & Strategic Framework 2008-2012 For


Blood Transfusion Services in Pakistan
Current Situation in Pakistan
• 170 Public Sector blood bank are operational
• 450 small and medium scale blood banks are
operational in the private sector
– 289 in Punjab
– 35 in Sindh
– 44 in Balochistan
– 4 in AJK
– 78 in NWFP

WHO country office Pakistan


National HIV/AIDS law
CHAPTER VII
PROMOTING SAFE BLOOD SUPPLIES
26. Screening for HIV Positive Blood and Blood Products. (1) All blood and blood
products, including organs and tissues for donation, shall be screened for HIV, and
shall be disposed unless used for research purposes, in accordance with the
provisions of the Islamabad Transfusion of Safe Blood Ordinance, 2002 (Ordinance
LXXIII of 2002) in the Islamabad Capital Territory and in areas administered by the
Federal Government, and in accordance with the provisions of the Balochistan
Safe Blood Transfusion Act 2004 (Act III of 2004); the NWFP Transfusion of Safe
Blood Act, 1999 (Act IX of 1999); the Punjab Transfusion of Safe Blood Ordinance
1999 (Ordinance XXXVI of 1999); and the Sindh Transfusion of Safe Blood Act
1997 (Act I of 1997) and the rules promulgated therein, in relation to the respective
Province.
National Response to HIV/AIDS
• Federal committee on AIDS 1987
• National AIDS Control Program 1990
• National AIDS Control Program& 1994
• Provincial AIDS Control Program
• Strategic Frame work 1999-2000
• Enhanced HIV/AIDS Control Program 2003-2008

• More than 54 NGOs are involved in HIV/AIDS Public


awareness
National Response to HIV/AIDS
• National AIDS prevention and Control
Program has objectives of
– Prevention of HIV transmission
– Safe Blood Transfusion
– Reduction of STIs transmission
– Establishment of Surveillance System
– Training of Health staff
– Research and Behavioral studies
– Development of Program management
PASS
(Project for AIDS SCREENING
AND SURVEILLANCE)

District Quetta
Rationale
• The majority of research studies focused on High Risk Groups and Sexual
transmission of HIV/AIDS but unfortunately little work is done particularly on
Transmission of HIV/AIDS through unsafe blood transfusion.
• RATIONALE:
– This Project will not only prevent the transmission of HIV/AIDS through
unsafe blood transfusion but also will serve as a tool to provide base line
data regarding HIV prevalence among general population. The data will
also serve to formulate new as well help in improving existing policies.
Additionally it will benefit to reduce the disease burden both at the national
& international level thus achieving MDG-6.
District Quetta
• Capital of Balochistan Province
• Population 114000
• Area 2.65 km2
• Population Density 281/km2
• Tehsils 3
• Zones 27
• Teaching Hospitals 2
• HIV prevalence among IDUs 10%
Aims and Objectives
• Aims
– To decrease the morbidity and mortality due to HIV/AIDS
and to prevent its transmission through unsafe blood
transfusion in Pakistan
• Objectives:
– Ensure mandatory screening of blood and blood products
for HIV in 100% public and private sectors Blood Banks of
District Quetta
– Raise awareness among general population of District
Quetta to promote voluntary blood donation
– Develop Quality Surveillance Systems for public and
private blood banks to ensure that all blood is properly
screened for HIV.
Organogram of PASS
EDO (H)
(Chairman)

District Surveillance
Coordinator
(Epidemiologist)

Incharge Incharge Blood


Blood Bank Banks
(Public Sector) (Private Sector)
Coordination of District Support
Team (Multisectoral Approach)
• Health Department
• People’s Primary Health Care Initiative
• LHWs Program
• Population Welfare Department
• Education Department
• NGOs and Line Departments
District HIV/AIDS Prevention and
Control Committee (DHAPCC)
• A committee will be formulated for regular
monitoring and on job supervision of PASS
• The committee meeting will be conducted every
fourth month
• Members will be
– Distt. Nazim/DCO Chairman
– EDO (H) Secretary
– Distt. Surveillance Coordinator PASS Member
– MS BMCH Member
– Incharges of Blood BanksMember
Activity Plan
• Introductory meeting with DHMT.
• Situational Analysis—Base line survey
• Meeting about budget allocation.
• Purchase committees about purchase of screening, vehicle,
equipment and furniture and printing material.
• Tender will be given in newspapers about purchase of screening
kits, vehicle, equipment and furniture and renovation of
infrastructure accordingly.
• Meeting with DHMT about training of staff of Blood Bank and
awareness campaigns.
• Training and then regular refresher courses for staff
• Awareness campaigns
• Ongoing surveillance
• Ongoing monitoring, Supervision and Evaluation
Ongoing Activity
• Monthly meeting about the progress and efficacy
of the project will be conducted at EDO(H) office
Quetta.
• All in charges of Blood Banks will make sure
their presence in the meetings along with
monthly progress reports.
• Monthly meeting will be conducted in first week
of every month.
• Process and Outcome indicators of the project
will be analyzed in the meeting
BUDGET
1. AWARENESS CAMPAIGNS RS 10.0 millions
a) Seminars
b) Health education sessions
c) Documentary movies /Puppet shows
d) IEC /Posters /Wall chalking
e) Radio / TV (local cable)

2. TRAINING RS 5.0 millions

3. PURCHASE OF VEHICLE RS 2.0 millions

4. POL RS 1.5 millions

5. IMPROVEMENT OF INFRASTRUCTURE RS 7.5 millions

6. EQUIPEMENTS AND FURNITURE RS 4.0 millions

Total RS 30
millions
Strategies
• First Step: Situational Analysis/Base
line Survey
– # of Blood Banks (Public and Private) operational in
the District
– # of Blood Banks Registered
– # of Blood Banks following National Guidelines for
blood donation
– # of Blood Banks following SOPs for Blood
transfusion
– # of staff properly trained for Blood Banks
– # of donors +ve screened by these blood banks
– # of Paid professional blood donors
Strategies
• 2nd Step: Implementation and Management
– Registration of 100% of blood Banks
– Repair and renovation of Blood Banks
– Capacity building of staff in Blood Bank
– Provision of National Guideline for blood donation
– Provision of HIV screening Kits
– Awareness in People regarding voluntary blood donation (Mass
media, local methods, IEC material)
– BCC
– Display of voluntary Blood donation Promotional materials in
Blood banks
– Regular Supportive supervision and monitoring
– Formulation of District HIV/AIDS Prevention and Control
Committee
Surveillance Activities
• DSC will visit all the High Priority sites (Blood Banks)
every week, MP site every fortnightly an LP sites
monthly (According to the tentative monthly plan)
• Weekly zero report for HIV cases will be collected from
all sites (blood banks)
• DSC will conduct a detailed Epidemiological case
investigation of any Positively screened donor.
• DSC will maintain District WZ chart and AS visit Charts
in EDO-H office.
• DSC will submit Progress report to EDO-H every month.
Evaluation
• % of Blood Banks having National
guidelines
• % of Blood Banks following National
guidelines
• % of Blood Banks following SOPs for blood
transfusion
• # of Blood bags delivered
• # of donations by Paid/professional donors
• % of Blood donors screened +ve for HIV
Slogan of PASS

Young Donors with Safe and


new blood for District Quetta

THANKS