Aids Dr Majeed Jaffar

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

730 000 1.5 million [1.1 – 1.9 million]

North America

[1.1 – 1.9 million] [580 000 – 1.0 East Asia million]

1.2 million [760 000 – 2.0 million]

Caribbean

230 000

Middle East & North Africa

380 000

[210 000 – 270 000] [280 000 – 510 000]

Latin America

1.7 million

[1.5 – 2.1 million]

Sub-Saharan Africa

22.0 million

[20.5 – 23.6 million]

740 000

[480 000 – 1.1 million]

South & South-East Asia

4.2 million

[3.5 –Oceania 5.3 million]

74 000

[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

27 000

North America

54 000

[9600 – 130 000]

Caribbean

20 000

[14 000 – 49 000]

110 000

[67 000 – 180 East Asia 000]

Middle East & North Africa

[16 000 – 25 000]

Latin America

140 000

[88 000 – 190 000]

40 000

[20 000 – 66 000]

Sub-Saharan Africa

1.9 million

[1.6 – 2.1 million]

52 000

[29 000 – 84 000]

South & South-East Asia

330 000

[150 000 – 590 000] Oceania

13 000

[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

8000

North America

23 000

[9100 – 55 000]

Caribbean

14 000

Middle East & North Africa

[11 000 – 16 000]

27 000

[20 000 – 35 000]

Latin America

63 000

58 000

[41 000 – 88 000] [4800 – 17 000] East Asia

[49 000 – 98 000]

Sub-Saharan Africa

1.5 million

[1.3 – 1.7 million]

40 000

[24 000 – 63 000]

South & South-East Asia

340 000

[230 000 – 450 000] Oceania

1000

[<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 RT/STI Study 2

40

EACP started HASP pilot HASP round 1 RT/STI Study 1 Other studies (FHI)

ANC Study

02

02

02

02

91

91

IDUs

91

10

First case detected

HIV Care started (GFATM )

MSW s General ? Population

02

20

IDUs

Larkana incident

NACP Formed

02

30

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

60 51.3

50 40 30

1313.3 9

5.3

Karachi

0

20 04 20 0 20 5 06

20 0 20 5 06

20 0 20 5 06

6 20 0

6

0.5 0

20 0

0

16.5

0.5

3.7

6.5

Larkana Faisalabad Rawalpindi Sukker Hyderabad Sargodha Lahore

10 9.5 2.2

7

10

19.6

20 0

20

20 0 20 5 06

23

29.8

20 0 20 4 0 20 5 06

27

20 0 20 5 06

30

20 04 20 0 20 5 06

%

Quetta 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 B lo o d & B lo o d P ro d u cts

26.90%

ID U s

2.20% 4.55% 2.02% 4.55%

52.55%

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

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 National AIDS Control Program National AIDS Control Program& Provincial AIDS Control Program Strategic Frame work Enhanced HIV/AIDS Control Program

1987 1990 1994 1999-2000 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 Area Population Density Tehsils Zones Teaching Hospitals HIV prevalence among IDUs

114000 2.65 km2 281/km2 3 27 2 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 Blood Bank

Incharge Blood 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 MS BMCH Member Incharges of Blood BanksMember

Member

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 a) b) c) d) e)

RS 10.0 millions

Seminars Health education sessions Documentary movies /Puppet shows IEC /Posters /Wall chalking 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