Sub-Saharan African countries have improved access to safe and adequate blood supplies, but continued commitment and funding are required to maintain gains and achieve WHO targets. Although the number of blood units collected has increased since 2004, whole blood collections remain insufficient to meet national demand: 12 of 14 evaluated countries do not meet the WHO-recommended target (1). This shortfall especially affects women with pregnancy-related complications, trauma victims, and children with severe life-threatening malaria-related anemia (7).

Although most of the 14 PEPFAR-supported countries reported decreases in the percentage of collected blood units that screened positive for HIV since 2004, percentages remain significantly higher than the 0.003% reported by high-income countries (1). Seven countries have HIV screen-positive rates that exceed the WHO recommended target of <1.0%. Although HIV prevalence rates among blood donors have decreased, prevalences of other TTIs such as HBV, HCV, and syphilis increased in seven countries. To reduce the risk for TTIs in sub-Saharan Africa when PEPFAR support ends, MOHs can participate in cross-sector collaborations to implement blood bank quality and safety accreditation standards through the African Society for Blood Transfusion (AfSBT)^†† or other international accrediting bodies and implement PEPFAR-supported blood safety information systems. Recent data indicate that 50% of PEPFAR-supported countries still do not have a computerized information system for blood donor tracking and TTI testing. Since 2016, blood safety information systems have been implemented in three countries, with another two planned by 2019. To date, only four NBTSs in sub-Saharan Africa (Namibia [accredited in 2012], South Africa, Rwanda, and Tanzania) have achieved accreditation by an external body. Seven countries are currently in various stages of the accreditation process through AfSBT. Global CDC blood safety targets are that 50% of NBTS sites reach at least the first of three accreditation steps under AfSBT during the next 2–3 years.

As countries move toward the United Nations 95–95–95 targets (95% of HIV infection diagnosed, 95% of infected persons receiving antiretroviral therapy [ART], and 95% of those on ART achieving viral suppression) for achieving epidemic control, increasing outreach to priority populations for testing and preventive services become increasingly important (8). Currently, no systems exist within these NBTSs to link persons determined to be ineligible for donation through behavioral risk screening to HIV testing and preventive services.

During 2014–2016, four NBTSs transitioned from PEPFAR to full MOH funding. An additional five countries received ≥50% of their funding from MOHs; two countries reported a decrease in MOH funding. As PEPFAR transitions occur, countries should consider prioritization of funding to their NBTS to sustain the gains achieved (9).

The findings of this report are subject to at least four limitations. First, blood unit collections described in this report only represent units collected by the NBTS, and do not account for units collected in the private sector or by nonnational blood transfusion services. Second, variations in testing capacity and assays used for laboratory screening (most NBTSs lack HBV and HCV confirmatory testing) might result in over- or underestimation of TTI prevalence rates among blood donors. Third, lack of information systems to link donors who screen HIV-positive to treatment services might result in inaccurate estimations of the number of donors who are notified about their status. Finally, self-reported data from countries might result in inaccurate estimations.

A decade of PEPFAR support to NBTSs in 14 countries has led to increases in blood collections, fewer donors screening HIV-positive, and transition of support from PEPFAR to MOHs. However, gaps in linking deferred donors at high risk to HIV testing and prevention services, and in notifying HIV-positive donors of their status and linking them to confirmatory testing, care, and treatment underscore the need for enhanced focus on epidemic control, as well as innovative strategies to address donors who test positive for other TTIs. Ending reliance on unsafe blood donors requires continued investment in laboratory quality improvement, including increased engagement in external proficiency testing and increased use of highly sensitive assays at the NBTS and non-NBTS testing sites. Continued improvement of blood safety programs in sub-Saharan Africa will require sustained investments in continuous quality improvement, NBTS accreditation under AfSBT, linkage of deferred donors who report high risk behaviors and those who screen HIV-positive to HIV testing services and treatment, and stronger blood safety information systems. Strengthening health systems and developing local policy and sustainable financial resources are all important components to consider to ensure the future viability of blood safety programs.