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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.

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.

Infectious disease screening of Namibia blood donations for infectious diseases was contracted to the South African National Blood Service (SANBS) since 2004 and needed to be relocated back to Namibia. A cost analysis conducted showed that by introducing certain strategies, it was cost-effective to implement ID-NAT in Namibia. NAMBTS chose Ultrio Elite assay/Panther System (Gen-Probe and Novartis, USA) for ID-NAT for HIV 1/2 RNA, HBV DNA and HCV RNA and Chemiluminescent immunoassay done on the Architect i2000SR system (Abbott, Delkenheim, Germany) for HIV 1/2 Ag/Ab, anti-HCV, HBsAg and Syphilis. For performance evaluation, the Panther System was compared with the Procleix TIGRIS system-Ultrio Plus assay (Gen-Probe and Novartis, USA) while the Architect system was compared with the Abbott PRISM. The results of this evaluation demonstrated a 100% sensitivity and 100% specificity of the Ultrio Elite assay while the Architect also demonstrated 100% sensitivity and specificity of above 99% for detecting viral markers for HBV, HIV and HCV, and 97% sensitivity and 99Á7% specificity for detecting syphilis. We found both the Procleix Panther and Architect systems to be flexible, robust and effective in screening blood for transfusion in our setting. Donor screening for HIV 1/2, HBV, HCV and syphilis for ID-NAT and serology using the Procleix Panther and Architect systems was successfully relocated from South Africa and implemented in February 2014 in Namibia.