Last data update: Jan 27, 2025. (Total: 48650 publications since 2009)
Records 1-11 (of 11 Records) |
Query Trace: Pitman JP[original query] |
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Geographic distribution of blood collections in Haiti before and after the 2010 earthquake
Bjork A , Jean Baptiste AE , Noel E , Jean Charles NPD , Polo E , Pitman JP . ISBT Sci Ser 2017 12 (2) 291-296 BACKGROUND: The January 2010 Haiti earthquake destroyed the National Blood Transfusion Center and reduced monthly national blood collections by > 46%. Efforts to rapidly scale-up blood collections outside of the earthquake-affected region were investigated. STUDY DESIGN AND METHODS: Blood collection data for 2004-2014 from Haiti's 10 administrative departments were grouped into four regions: Northern, Central, Port-au-Prince and Southern. Analyses compared regional collection totals during the study period. RESULTS: Collections in Port-au-Prince accounted for 52% of Haiti's blood supply in 2009, but fell 96% in February 2010. Haiti subsequently increased blood collections in the North, Central and Southern regions to compensate. By May 2010, national blood collections were only 10.9% lower than in May 2009, with 70% of collections coming from outside of Port-au-Prince. By 2013 national collections (27 478 units) had surpassed 2009 levels by 30%, and Port-au-Prince collections had recovered (from 11 074 units in 2009 to 11 670 units in 2013). CONCLUSION: Haiti's National Blood Safety Program managed a rapid expansion of collections outside of Port-au-Prince following the earthquake. Annual collections exceeded pre-earthquake levels by 2012 and continued rising annually. Increased regional collections provided a greater share of the national blood supply, reducing dependence on Port-au-Prince for collections. |
A tale of 2 HIV outbreaks caused by unsafe injections in Cambodia and the United States, 2014-2015
Gokhale RH , Galang RR , Pitman JP , Brooks JT . Am J Infect Control 2016 45 (2) 106-107 In 2014–2015, we saw 2 large outbreaks of HIV infection related to the unsafe use of injection equipment. In Cambodia, 242 persons in one rural commune (population: approximately 8,000) received a diagnosis of HIV infection over the course of 3 months. These infections were attributed to the reuse of injection equipment by an unlicensed health care provider in the informal health care sector.1 In the U.S. State of Indiana, 181 persons in a rural southeastern town (population: approximately 4,200) received a diagnosis of HIV infection over the course of 6 months. These infections were attributed to the unsafe injection of prescription opioids2 by people who inject drugs (PWID) for recreational uses. In Cambodia and Indiana, a large percentage of the infections were determined to have occurred recently (ie, within 6–9 months of diagnosis) (Table 1).3,4 |
Progress toward strengthening national blood transfusion services - 14 countries, 2011-2014
Chevalier MS , Kuehnert M , Basavaraju SV , Bjork A , Pitman JP . MMWR Morb Mortal Wkly Rep 2016 65 (5) 115-9 Blood transfusion is a life-saving medical intervention; however, challenges to the recruitment of voluntary, unpaid or otherwise nonremunerated whole blood donors and insufficient funding of national blood services and programs have created obstacles to collecting adequate supplies of safe blood in developing countries. Since 2004, the U.S. President's Emergency Plan for AIDS Relief (PEPFAR) has provided approximately $437 million in bilateral financial support to strengthen national blood transfusion services in 14 countries in sub-Saharan Africa and the Caribbean that have high prevalence rates of human immunodeficiency virus (HIV) infections. CDC analyzed routinely collected surveillance data on annual blood collections and HIV prevalence among donated blood units for 2011-2014. This report updates previous CDC reports on progress made by these 14 PEPFAR-supported countries in blood safety, summarizes challenges facing countries as they strive to meet World Health Organization (WHO) targets, and documents progress toward achieving the WHO target of 100% voluntary, nonremunerated blood donors by 2020. During 2011-2014, overall blood collections among the 14 countries increased by 19%; countries with 100% voluntary, nonremunerated blood donations remained stable at eight, and, despite high national HIV prevalence rates, 12 of 14 countries reported an overall decrease in donated blood units that tested positive for HIV. Achieving safe and adequate national blood supplies remains a public health priority for WHO and countries worldwide. Continued success in improving blood safety and achieving WHO targets for blood quality and adequacy will depend on national government commitments to national blood transfusion services or blood programs through increased public financing and diversified funding mechanisms for transfusion-related activities. |
Investments in blood safety improve the availability of blood to underserved areas in a sub-Saharan African country
Pitman JP , Wilkinson R , Basavaraju SV , von Finckenstein B , Sibinga CS , Marfin AA , Postma MJ , Mataranyika M , Tobias J , Lowrance DW . ISBT Sci Ser 2014 9 (2) 325-333 BACKGROUND AND OBJECTIVES: Since 2004, several African countries, including Namibia, have received assistance from the U.S. President's Emergency Plan for AIDS Relief (PEPFAR). Gains have been documented in the safety and number of collected units in these countries, but the distribution of blood has not been described. MATERIALS AND METHODS: Nine years of data on blood requests and issues from Namibia were stratified by region to describe temporal and spatial changes in the number and type of blood components issued to Namibian healthcare facilities nationally. RESULTS: Between 2004 and 2007 (early years of PEPFAR support) and 2008-2011 (peak years of PEPFAR support), the average number of red cell units issued annually increased by 23.5% in seven densely populated but less-developed regions in northern Namibia; by 30% in two regions with urban centres; and by 35.1% in four sparsely populated rural regions. CONCLUSION: Investments in blood safety and a policy decision to emphasize distribution of blood to underserved regions improved blood availability in remote rural areas and increased the proportion of units distributed as components. However, disparities persist in the distribution of blood between Namibia's urban and rural regions. |
Namibia's transition from whole blood-derived pooled platelets to single-donor apheresis platelet collections
Pitman JP , Basavaraju SV , Shiraishi RW , Wilkinson R , von Finckenstein B , Lowrance DW , Marfin AA , Postma M , Mataranyika M , Smit Sibinga CT . Transfusion 2015 55 (7) 1685-92 BACKGROUND: Few African countries separate blood donations into components; however, demand for platelets (PLTs) is increasing as regional capacity to treat causes of thrombocytopenia, including chemotherapy, increases. Namibia introduced single-donor apheresis PLT collections in 2007 to increase PLT availability while reducing exposure to multiple donors via pooling. This study describes the impact this transition had on PLT availability and safety in Namibia. STUDY DESIGN AND METHODS: Annual national blood collections and PLT units issued data were extracted from a database maintained by the Blood Transfusion Service of Namibia (NAMBTS). Production costs and unit prices were analyzed. RESULTS: In 2006, NAMBTS issued 771 single and pooled PLT doses from 3054 whole blood (WB) donations (drawn from 18,422 WB donations). In 2007, NAMBTS issued 486 single and pooled PLT doses from 1477 WB donations (drawn from 18,309 WB donations) and 131 single-donor PLT doses. By 2011, NAMBTS issued 837 single-donor PLT doses per year, 99.1% of all PLT units. Of 5761 WB donations from which PLTs were made in 2006 to 2011, a total of 20 (0.35%) were from donors with confirmed test results for human immunodeficiency virus or other transfusion-transmissible infections (TTIs). Of 2315 single-donor apheresis donations between 2007 and 2011, none of the 663 donors had a confirmed positive result for any pathogen. As apheresis replaced WB-derived PLTs, apheresis production costs dropped by a mean of 8.2% per year, while pooled PLT costs increased by an annual mean of 21.5%. Unit prices paid for apheresis- and WB-derived PLTs increased by 9 and 7.4% per year on average, respectively. CONCLUSION: Namibia's PLT transition shows that collections from repeat apheresis donors can reduce TTI risk and production costs. |
Blood component use in a sub-Saharan African country: results of a 4-year evaluation of diagnoses associated with transfusion orders in Namibia
Pitman JP , Wilkinson R , Liu Y , von Finckenstein B , Smit Sibinga CT , Lowrance DW , Marfin AA , Postma MJ , Mataranyika M , Basavaraju SV . Transfus Med Rev 2014 29 (1) 45-51 National blood use patterns in sub-Saharan Africa are poorly described. Although malaria and maternal hemorrhage remain important drivers of blood demand across Africa, economic growth and changes in malaria, HIV/AIDS, and noncommunicable disease epidemiology may contribute to changes in blood demand. We evaluated indications for blood use in Namibia, a country in southern Africa, using a nationally representative sample and discuss implications for the region. Clinical and demographic data related to the issuance of blood component units in Namibia were reviewed for a 4-year period (August 1, 2007-July 31, 2011). Variables included blood component type, recipient age and sex, and diagnosis. Diagnoses reported by clinicians were reclassified into International Statistical Classification of Diseases, 10th Revision categories. Multiple imputation methods were used to complete a data set missing age, sex or diagnosis data. Descriptive analyses were conducted to describe indications for transfusions and use of red blood cells (RBCs), platelets, and plasma. A total of 39 313 records accounting for 91 207 blood component units were analyzed. The median age of Namibian transfusion recipients was 45 years (SD, +/-19). A total of 78 660 RBC units were issued in Namibia during the study period. Red blood cells transfused for "unspecified anemia" accounted for the single largest category of blood issued (24 798 units). Of the overall total, 38.9% were for diseases of the blood and blood-forming organs (D50-D89). Infectious disease (A00-B99), pregnancy (O00-O99), and gastrointestinal (K20-K93) accounted for 14.8%, 11.1%, and 6.1% of RBC units issued, respectively. Although a specific diagnosis of malaria accounted for only 2.7% of pediatric transfusions, an unknown number of additional transfusions for malaria may have been categorized by requesting physicians as unspecified anemia and counted under diseases of blood forming organs. During the study period, 9751 units of fresh-frozen plasma were issued. Nearly one-quarter of these units (23.1%) were issued for gastrointestinal (K20-K93) diagnoses. Malignant neoplasms (C00-C97) accounted for 38.1% of 2978 platelet units issued. Blood use in Namibia reflects changes in the health care system due to economic development, improvement in HIV/AIDS and malaria epidemiology, high rates of health care facility-based childbirth, and access to noncommunicable disease treatment. However, better documentation of the indications for transfusion is needed to confirm these observations. Changing patterns of health care will result in changing demands for blood components. Improved methods to evaluate blood use patterns in sub-Saharan Africa may help set realistic national blood collection goals. |
The impact of external donor support through the U.S. President's Emergency Plan for AIDS Relief on the cost of red cell concentrate in Namibia, 2004-2011
Pitman JP , Bocking A , Wilkinson R , Postma MJ , Basavaraju SV , Von Finckenstein B , Mataranyika M , Marfin AA , Lowrance DW , Sibinga CT . Blood Transfus 2014 13 (2) 1-8 BACKGROUND: External assistance can rapidly strengthen health programmes in developing countries, but such funding can also create sustainability challenges. From 2004-2011, the U.S. President's Emergency Plan for AIDS Relief (PEPFAR) provided more than $8 million to the Blood Transfusion Service of Namibia (NAMBTS) for supplies, equipment, and staff salaries. This analysis describes the impact that support had on actual production costs and the unit prices charged for red cell concentrate (RCC) units issued to public sector hospitals. MATERIALS AND METHODS: A costing system developed by NAMBTS to set public sector RCC unit prices was used to describe production costs and unit prices during the period of PEPFAR scale-up (2004-2009) and the 2 years in which PEPFAR support began to decline (2010-2011). Hypothetical production costs were estimated to illustrate differences had PEPFAR support not been available. RESULTS: Between 2004-2006, NAMBTS sold 22,575 RCC units to public sector facilities. During this time, RCC unit prices exceeded per unit cost-recovery targets by between 40.3% (US$16.75 or N$109.86) and 168.3% (US$48.72 or N$333.28) per year. However, revenue surpluses dwindled between 2007 and 2011, the final year of the study period, when NAMBTS sold 20,382 RCC units to public facilities but lost US$23.31 (N$170.43) on each unit. DISCUSSION: PEPFAR support allowed NAMBTS to leverage domestic cost-recovery revenue to rapidly increase blood collections and the distribution of RCC. However, external support kept production costs lower than they would have been without PEPFAR. If PEPFAR funds had not been available, RCC prices would have needed to increase by 20% per year to have met annual cost-recovery targets and funded the same level of investments as were made with PEPFAR support. Tracking the subsidising influence of external support can help blood services make strategic investments and plan for unit price increases as external funds are withdrawn. |
Knowledge and barriers related to reporting of acute transfusion reactions among healthcare workers in Namibia
Basavaraju SV , Lohrke B , Pitman JP , Pathak SR , Meza BP , Shiraishi RW , Wilkinson R , Bock N , Mataranyika M , Lowrance DW . Transfus Med 2013 23 (5) 367-9 In sub-Saharan Africa, only South Africa has had a long-standing national haemovigilance system to monitor acute transfusion reactions (ATR) (Nel and Heyns, 2000). To improve monitoring, recognition and reporting of ATR more countries in the region have implemented or are considering national haemovigilance systems (Dahourou et al., 2012). In Namibia, The Blood Transfusion Service of Namibia (NAMBTS) is the only organisation authorised to collect, process and distribute blood and blood components for transfusion. Since 2006, NAMBTS has invested heavily in the development of guidelines and training for doctors and nurses in the appropriate clinical use of blood. Coupled with this focus on appropriate use, in 2008 NAMBTS launched a national haemovigilance system with a standardised reporting tool backed by clinical and laboratory investigations of all reported ATR. Under this system, healthcare workers (HCW) in Namibia who order or perform transfusions (primarily physicians and nurses) are responsible for voluntary reporting of ATR to NAMBTS by phone or via a paper-based system. Reportable ATR include allergic, acute haemolytic, febrile non-haemolytic reactions, sepsis due to bacterial contamination of the donor unit, transfusion-associated acute lung injury, transfusion-associated circulatory overload and transfusion-associated dyspnoea. |
Comparison of HIV-1 detection in plasma specimens and dried blood spots using the Roche COBAS Ampliscreen HIV-1 test in Kisumu, Kenya
Okonji JA , Basavaraju SV , Mwangi J , Shiraishi RW , Odera M , Ouma K , Pitman JP , Marum LH , Ou CY , Zeh C . J Virol Methods 2012 179 (1) 21-5 The World Health Organization recommends screening donor blood for HIV in centralized laboratories. This recommendation contributes to quality, but presents specimen transport challenges for resource-limited settings which may be relieved by using dried blood spots (DBS). In sub-Saharan Africa, most countries screen donor blood with serologic assays only. Interest in window period reduction has led blood services to consider adding HIV nucleic acid testing (NAT). The U.S. Food and Drug Administration (FDA) mandates that HIV-1 NAT blood screening assays have a 95% detection limit at or below 100copies/ml and 5000copies/ml for pooled and individual donations, respectively. The Roche COBAS Ampliscreen HIV-1 test, version 1.5, used for screening whole blood or components for transfusion, has not been tested with DBS. We compared COBAS Ampliscreen HIV-1 RNA detection limits in DBS and plasma. An AIDS Clinical Trials Group, Viral Quality Assurance laboratory HIV-1 standard with a known viral load was used to create paired plasma and DBS standard nine member dilution series. Each was tested in 24 replicates with the COBAS Ampliscreen. A probit analysis was conducted to calculate 95% detection limits for plasma and DBS, which were 23.8copies/ml (95% CI 15.1-51.0) for plasma and 106.7copies/ml (95% CI 73.8-207.9) for DBS. The COBAS Ampliscreen detection threshold with DBS suggests acceptability for individual donations, but optimization may be required for pooled specimens. |
Reduced risk of transfusion-transmitted HIV in Kenya through centrally co-ordinated blood centres, stringent donor selection and effective p24 antigen-HIV antibody screening
Basavaraju SV , Mwangi J , Nyamongo J , Zeh C , Kimani D , Shiraishi RW , Madoda R , Okonji JA , Sugut W , Ongwae S , Pitman JP , Marum LH . Vox Sang 2010 99 (3) 212-9 BACKGROUND: Following a 1994 study showing a high rate of transfusion-associated HIV, Kenya implemented WHO blood safety recommendations including: organizing the Kenya National Blood Transfusion Service (NBTS), stringent blood donor selection, and universal screening with fourth-generation p24 antigen and HIV antibody assays. Here, we estimate the risk of transfusion-associated HIV transmission in Kenya resulting from NBTS laboratory error and consider the potential safety benefit of instituting pooled nucleic acid testing (NAT) to reduce window period transmission. METHODS: From November to December 2008 in one NBTS regional centre, and from March to June 2009 in all six NBTS regional centres, every third unit of blood screened negative for HIV by the national algorithm was selected. Dried blood spots were prepared and sent to a reference laboratory for further testing, including NAT. Test results from the reference laboratory and NBTS were compared. Risk of transfusion-associated HIV transmission owing to laboratory error and the estimated yield of implementing NAT were calculated. FINDINGS: No cases of laboratory error were detected in 12 435 units tested. We estimate that during the study period, the percentage of units reactive for HIV by NAT but non-reactive by the national algorithm was 0.0% (95% exact binomial confidence interval, 0.00-0.024%). INTERPRETATION: By adopting WHO blood safety strategies for resource-limited settings, Kenya has substantially reduced the risk of transfusion-associated HIV infection. As the national testing and donor selection algorithm is effective, implementing NAT is unlikely to add a significant safety benefit. These findings should encourage other countries in the region to fully adopt the WHO strategies. |
The need for computerized tracking systems for resource-limited settings: the example of Georgetown, Guyana
Basavaraju SV , Pitman JP , Henry N , McEwan C , Harry C , Hasbrouck L , Marum L . Transfus Med 2009 19 (3) 149-51 Blood services in industrialized countries routinely use computerized tracking systems, the merits of which are described extensively in the literature. Such systems ease blood utilization review, enhance safety and improve tracking (Dohnalek et al., 2004; Davies et al., 2006; Dzik, 2007). Computerized blood-use modelling and prediction systems are typically used in developed nations to forecast demand (Katz et al., 1983; Sirelson & Brodheim, 1991; Nightingale et al., 2003). Because of financial and logistical challenges, such systems are uncommon in resource-limited settings, where blood services rely on manual, paper-based methods, or simple electronic tools (e.g., Microsoft Excel). Here we highlight the specific challenges faced by a blood service in a resource-limited setting and describe future options for low-cost, scalable computerized systems for developing countries. | In Guyana, blood is collected, screened and distributed by the National Blood Transfusion Service (NBTS), a branch of the Guyana Ministry of Health. Approximately 80% of all blood collected by NBTS is distributed to the Georgetown Public Hospital Corporation (GPHC), Guyana's only tertiary-care referral centre. For record keeping, NBTS collects daily information on blood (whole blood and blood products) units requested, cross-matched units issued and units returned unused in three paper-based registers. In October 2007, NBTS instituted an expanded paper-based Blood Request Form (BRF), which, for the first time, allowed NBTS to match patient data from the wards with blood centre data from the three registers. Properly completed BRFs, which are submitted by physicians, are now required for NBTS to dispense blood. NBTS files BRFs in three folders labelled as follows: (1) cancelled before preparation by NBTS; (2) prepared and retrieved by ward and (3) prepared but not retrieved by ward. In December 2007, NBTS conducted a preliminary internal review of November 2007 (the first complete month in which BRFs were used) records. This review suggested that nearly 60% of all blood units requested by GPHC were not delivered by NBTS. In January 2008, NBTS requested technical assistance from the U.S. Centers for Disease Control and Prevention (CDC) to conduct a rapid and focused assessment to investigate the extent of this apparent blood shortage. The investigation focused on the blood-ordering process at GPHC, the NBTS system to track GPHC requests and the distribution and flow of blood units. In conjunction with NBTS, CDC conducted a retrospective review and descriptive analysis of NBTS records for November 2007. The review tracked blood request information through the paper-based system of registers and folders. Data were extracted from the sources described above: BRFs filed in the three folders and entries in the three data registers. |
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