Although China passed a comprehensive Blood Donation Law in 1997 following the discovery of high rates of human immunodeficiency virus (HIV) in blood and plasma donors, infection of donors continues. Rates of HIV as high as 6% and of hepatitis C virus (HCV) as high as 23% still occur, especially in the rural area hospitals. Thus, it is clear that HIV and HCV are being transmitted to recipients of contaminated blood units. Most county hospitals have neither the funds nor the technical skills to test every unit of blood that is collected for the most likely blood pathogens. This, therefore, is a proposal to measure the prevalence of HIV, HBV and HCV among blood donors in two county hospitals in each of two provinces in which transmission of HIV to blood recipients has been reported and to evaluate alternative strategies to protect the blood supply. Eight hundred donors, as well as 80 donors who were traced from 800 infected recipients, will be tested concurrently and analyzed for both the prevalence of infected donors and for correlates of infection. In addition, a survey of usual blood practices will be conducted among physicians at the county hospitals to estimate the prevalence of unnecessary use of blood. Following the survey a workshop will be conducted with representatives of the hospitals, the director of the Southern California Region of the American Red Cross Services, and representatives of the local and provincial anti-epidemic stations and departments of health and the Ministry of Health to discuss strategies to reduce the unnecessary use of blood using the results of the prior survey. The outcome of the workshop will be development of guidelines for the use of blood in county hospitals. A second survey will be conducted among the county level hospitals to identify the current and potential sources of blood and potential constraints to alternative strategies for protecting the blood supply at the county hospital level. Following the survey a second workshop will be held for 30 health professionals concerned with the safety of the blood supply at the local, provincial, and national levels to identify the most acceptable and feasible alternative strategy to protect the blood. This strategy will then be evaluated in a pilot study in county hospitals adopting and not adopting the alternative strategy. Results of the surveys and workshops and the pilot study will be disseminated to the county hospitals, local and provincial health administrators, and the Ministry of Health.
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