ABSTRACT
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 facilities in Afghanistan. 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. 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 [HB[s]Ag] [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 HB[s]Ag, and none for HCV Ab. Of sites with available test kits, 7.5% of HIV, 0.9% of HB[s]Ag, 2.3% of HCV, and 6.5% of syphilis tests were expired at time of assessment. For expired tests, private facilities were more likely to have expired HIV and syphilis tests [p=0.07 and p=0.02, respectively] than other facility types. Blood collection/transfusion is a multisectoral service in Afghanistan, with substantial differences in test availability and type between sectors. 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