Availability and Suitability of Rapid Diagnostic Kits for Screening Donated Blood in Afghanistan

Background. As health infrastructure is being rebuilt in Afghanistan, military, public, and private facilities offer donor blood collection/transfusion services. This study aims to measure availability and type of blood screening test kits in the military, public and private facilitiesin Afghanistan.Methods. This national cross-sectional assessment targeted all facilities providing donor blood collection/transfusion services across all sectors.Descriptive statistics were generated with screening test availability compared by setting (urban vs. rural), province/region, and facility type(private vs public) using Chi-square test.Results. A total of 243 facilities were assessed, with all 34 provinces represented with urban settings containing 63% of the facilities.Screening rapid tests were widely present for most pathogens, including HIV (87.7% of facilities), hepatitis B surface antigen (HBsAg)(93.8%), hepatitis (HCV) antibody (90.5%), and syphilis (70.0%). Private facilities were less likely to have syphilis tests available (51.4% vs.84.1% (public), p<0.01). Nineteen percent of facilities use the WHO evaluated test kit for HIV, 2.1% for HBsAg, and none for HCV Ab. Ofsites with available test kits, 7.5% of HIV, 0.9% of HBsAg, 2.3% of HCV, and 6.5% of syphilis tests were expired at time of assessment. Forexpired tests, private facilities were more likely to have expired HIV and syphilis tests (p=0.07 and p=0.02, respectively) than other facilitytypes.Conclusions. Blood collection/transfusion is a multisectoral service in Afghanistan, with substantial differences in test availability and type betweensectors. Mechanisms are needed that ensure availability of quality test kits at all levels where blood collection/transfusion is performed.Test kits that have been evaluated by the WHO should be used for blood screening in all facility types.