A new strategy to improve the cost-effectiveness of human immunodeficiency virus, hepatitis B virus, hepatitis C virus, and syphilis testing of blood donations in sub-Saharan Africa: a pilot study in Burkina Faso.

BACKGROUND

In Africa where blood-borne agents are highly prevalent, cheaper and feasible alternative strategies for blood donations testing are specifically required.

STUDY DESIGN AND METHODS

From May to August 2002, 500 blood donations from Burkina Faso were tested for hepatitis B surface antigen (HBsAg), human immunodeficiency virus (HIV), syphilis, and hepatitis C virus (HCV) according to two distinct strategies. The first strategy was a conventional simultaneous screening of these four blood-borne infectious agents on each blood donation by using single-marker assays. The second strategy was a sequential screening starting by HBsAg. HBsAg-nonreactive blood donations were then further tested for HIV. If nonreactive, they were further tested for syphilis. If nonreactive, they were finally assessed for HCV antibodies. The accuracy and cost-effectiveness of the two strategies were compared.

RESULTS

By using the simultaneous strategy, the seroprevalences of HBsAg, HIV, syphilis, and HCV among blood donors in Ouagadougou were estimated to be 19.2, 9.8, 1.6, and 5.2%. No significant difference of HIV, syphilis, and HCV prevalence rates was observed by using the sequential strategy (9.2, 1.9, and 4.7%, respectively). Whatever the strategy used, 157 blood donations (31.4%) were found to be reactive for at least one transfusion-transmissible agent and were thus discarded. The sequential strategy allowed a cost decrease of euro 908.6, compared to the simultaneous strategy. Given that approximately there are 50,000 blood donations annually in Burkina Faso, the money savings reached potentially euro 90,860.

CONCLUSIONS

In resource-limited settings, the implementation of a sequential strategy appears as a pragmatic solution to promote safe blood supply and ensure sustainability of the system.