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Lancet. 1995 Jul 22;346(8969):225-7.

Benefits of HIV screening of blood transfusions in Zambia.

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Department of Public Health and Policy, London School of Hygiene and Tropical Medicine, UK.


Blood transfusion continues to be an important route of transmission of HIV in developing countries, especially for young children following the perinatal period. Testing for HIV is costly and reliable donor support for the purchase of test kits is often essential, yet difficult to secure. The costs of screening transfusions for HIV and the financial benefits in terms of savings on treatment costs averted were calculated for a district hospital in Zambia where seroprevalence among donors was 15.9%. Financial benefits exceed costs by a factor of 2.7-3.5. In 1991, 1073 transfusions were given and an estimated 150 cases of transfusion-related AIDS were prevented by screening, of which 59% were in children aged 5 years or under and 31% were in women. The total cost of HIV screening was 3061 pounds ($4745), and the cost per case of HIV infection prevented was 20.40 pounds ($31.62); the cost of this protection for the population served by the hospital was 0.02 pounds ($0.03) per person. An estimated 3625 undiscounted healthy years of life were saved, of which nearly 69% were in children under 6, at a cost of 0.85 pounds ($1.32) per year of life saved. It is essential that financial and political support for HIV screening of blood for transfusion is maintained.


Monze Hospital is a 250-bed hospital located in the southern province of Zambia. In 1991 overall seroprevalence of HIV was about 15.9% among the hospital's blood donors. The usual procedure was to interview and weigh the donor, measure his or her hemoglobin concentration, and then to collect the blood. Blood was tested for HIV with HIVChek or another rapid test or by ELISA. The cost of testing was dependent on which HIV test was available at the time. A rapid test such as HIVChek was preferred but the price was high. The alternative was an ELISA such as the Wellcozyme ELISA. The total cost of collection of 1 unit of blood was about $11.76 when HIVChek was used, when ELISA was used, the cost of 1 unit was $9.69. For the 1073 units transfused in 1991, 1276 units had to be tested and 203 were rejected. About 2/3 of units were screened by HIVChek and 1/3 by ELISA. The approximate cost of blood collection was $14,128, of which HIV tests accounted for $4745, 33.6% of the total. About 16% of units were discarded because of HIV positivity, and the costs of this wastage brought the total cost per usable unit to an average of $12.82. A minimum of 11.4 of the 1073 units transfused were probably infected but were not detected by screening. Of these about 8 units would have caused new infections. Therefore, 150 infections were prevented by screening and the cost of HIV screening per infection prevented was $31.62. About 59% of infections prevented would have been in children no more than 5 years old and 31% in women. The cost of HIV screening was $4745, an annual expenditure of $0.03 per person. The cost of HIV screening per year of healthy life saved was $1.32. The cost to the health services of treating HIV disease in the 2 years before death was about $110.60 per person. The cost of screening blood in 1991 was estimated at $4745. Thus, the benefit/cost ratio was 3.5/1.

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