1
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van den Berg K, Murphy EL, Louw VJ, Maartens G, Hughes SD. Motivations for blood donation by HIV-positive individuals on antiretrovirals in South Africa: A qualitative study. Transfus Med 2023. [PMID: 36799902 PMCID: PMC10403373 DOI: 10.1111/tme.12957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2022] [Revised: 01/13/2023] [Accepted: 02/02/2023] [Indexed: 02/18/2023]
Abstract
OBJECTIVES We performed a mixed-methods study to explore the motivations associated with blood donation by donors with known, but undisclosed HIV-positive status and ARV use (HIV+/ARV+), seeking potential strategies to reduce such donations and mitigate risk for blood recipients. Here, we report predominantly the qualitative component. BACKGROUND A safe and sustainable blood supply is dependent in part, on effective pre-donation donor assessment. We previously described failure by HIV+/ARV+ blood donors to disclose their status. Such donations may lead to transfusion-transmitted HIV. METHODS The social ecological model provided the conceptual framework for this study. Previously identified HIV+/ARV+ donors were invited to complete a survey (including a validated stigma scale) and qualitative interview, which underwent inductive and deductive thematic analysis. RESULTS We uncovered two primary motivational paths to HIV+/ARV+ blood donations: privacy and altruism. The latter included a motivation not previously reported in the literature: donating specifically for other people living with HIV (PLWH). The other primary factor was a lack of privacy. These accounts often included donors encountering donation opportunities when accompanied by people to whom they had not and did not plan to disclose their HIV status. Most were highly confident their donations would be identified as HIV-positive and discarded. CONCLUSION We demonstrated a complex interaction between individual, social, cultural, and structural/policy factors in blood donations by PLWH who take ARV. Recommendations to limit HIV + ARV+ donations include: (1) Targeted communication strategies to increase knowledge among PLWH of their deferral from blood donation-without increasing stigma, and (2) development of procedures to assist those who feel unable to opt-out of donation due to privacy concerns.
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Affiliation(s)
- Karin van den Berg
- Medical Division, South African National Blood Service, Roodepoort, South Africa.,Division of Clinical Haematology, Department of Medicine, University of Cape Town, Cape Town, South Africa.,Division of Clinical Haematology, University of the Free State, Bloemfontein, South Africa
| | - Edward L Murphy
- Department of Laboratory Medicine, University of California, San Franciscco, San Francisco, California, USA.,Department of Epidemiology/Biostatistics, University of California, San Franciscco, San Francisco, California, USA.,Epidemiology and Bioinformatics Core, Vitalant Research Institute, San Francisco, California, USA
| | - Vernon J Louw
- Division of Clinical Haematology, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Gary Maartens
- Division of Clinical Pharmacology, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Shana D Hughes
- Epidemiology and Bioinformatics Core, Vitalant Research Institute, San Francisco, California, USA
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2
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Delatorre MVV, Batalha KM, Santos LD, Bonet-Bub C, Avelino-Silva VI. Demographics and serological profile of blood donors who opt for the confidential unit exclusion in a blood bank in Sao Paulo, Brazil. Rev Inst Med Trop Sao Paulo 2021; 63:e69. [PMID: 34495266 PMCID: PMC8428872 DOI: 10.1590/s1678-9946202163069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Accepted: 06/24/2021] [Indexed: 11/21/2022] Open
Abstract
Blood transfusion is still an irreplaceable therapeutic modality, widely applied
to medical care. Clinical interviews and laboratory testing for
transfusion-transmitted infections (TTI) are routinely performed to prevent TTI
among the recipients. However, there is still a residual risk of TTI, and some
blood banks have adopted the confidential unit exclusion (CUE) as an additional
safety strategy. In this study, we investigated the demographic characteristics
and laboratory results of the screening of TTI among blood donors who opted for
the CUE, compared to blood donors who did not opt for the CUE. In this study, we
included 32,261 blood donations collected in a single blood bank in Sao Paulo,
Brazil. A very small proportion of donors (0.25%) opted for the CUE. They were
mainly single males and were more likely to have HBV, syphilis, and other
positive results in the combined screening for TTI, in comparison with those who
did not opt for the CUE. This difference was statistically significant in both
the univariable and the multivariable analysis adjusted for age, gender ,
marital status and years of schooling. Our findings highlight that CUE may be a
useful tool to improve the safety for blood recipients, but its efficiency is
context-dependent.
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Affiliation(s)
| | - Kalyne M Batalha
- Faculdade Israelita de Ciências da Saúde Albert Einstein, São Paulo, São Paulo, Brazil
| | - Leandro Dinalli Santos
- Hospital Israelita Albert Einstein, Departamento de Hemoterapia e Terapia Celular, São Paulo, São Paulo, Brazil
| | - Carolina Bonet-Bub
- Hospital Israelita Albert Einstein, Departamento de Hemoterapia e Terapia Celular, São Paulo, São Paulo, Brazil
| | - Vivian Iida Avelino-Silva
- Faculdade Israelita de Ciências da Saúde Albert Einstein, São Paulo, São Paulo, Brazil.,Universidade de São Paulo, Faculdade de Medicina, Departamento de Moléstias Infecciosas e Parasitárias, São Paulo, São Paulo, Brazil
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3
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Abstract
Post-donation information (PDI) can be defined as any information provided by the donor or other source following a donation, that, had it been known to the blood establishment during the selection process, would have resulted in the donor's deferral. PDI reflects the shortcomings, limitations and complexity of the donor selection process. Knowledge of the causes of PDI events, their types and frequency, is a prerequisite not only for their effective management, but also for the implementation of measures to improve the selection process and the safety of donated blood. Managing PDI requires a considerable investment of time and close collaboration between the various stakeholders involved in this process. Despite its regular occurrence and the fact that PDI points to a possible problem of blood safety, very few studies have been published so far, mostly by US and Canadian authors. This review article aims at collecting and discussing available information on all aspects of PDI management, with particular reference to European experiences.
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4
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Cappy P, Chaillon A, Pillonel J, Essat A, Chaix ML, Meyer L, Barin F, Tiberghien P, Laperche S. HIV transmission network analysis allows identifying unreported risk factors in HIV-positive blood donors in France. Transfusion 2021; 61:1191-1201. [PMID: 33592129 DOI: 10.1111/trf.16290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 12/04/2020] [Accepted: 12/05/2020] [Indexed: 11/27/2022]
Abstract
OBJECTIVES As sex between men is a major route of human immunodeficiency virus (HIV) infection in most western countries, restrictive deferral rules for blood donation have largely been implemented regarding men having sex with men (MSM). Here, we sought here to assign unreported HIV risk factors in blood donors (BDs) and reevaluated the MSM-associated fraction of HIV transfusion residual risk (%RRMSM ). METHODS We applied a genetic distance-based approach to infer an HIV transmission network for 384 HIV sequences from French BDs and 1337 HIV sequences from individuals with known risk factors (ANRS PRIMO primary HIV infection cohort). We validated the possibility of assigning a risk factor according to clustering using assortative mixing. Finally, we recalculated the %RRMSM . RESULTS A total of 81 of 284 (28.5%) male and 5 of 100 (5%) female BDs belonged to a cluster; 72 (88.9%) of the 81 male BDs belonged to MSM clusters. After cluster correction, 8 of 67 (11.9%), 4 of 21 (19.0%), and 19 of 88 (21.6%) HIV-positive (HIV+) male BDs with heterosexual, other, or unknown risk factors could be reclassified as MSM, accounting for 10.9% of the total HIV+ male BDs. Overall, 139 of 284 HIV+ male donors (48.9%) could be considered MSM between 2000 and 2016 in France. Between 2005 and 2016, the %RRMSM increase varied from 0 to 19%, without differing significantly from the %RRMSM before reclassification. CONCLUSION Network inference can be used to complement declaration data on risk factors for HIV infection in BDs. This approach, complementary to behavioral studies, is a valuable tool to evaluate the effect of changes in deferral criteria on BD compliance.
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Affiliation(s)
- Pierre Cappy
- Département des Agents Transmissibles par le Sang, CNR Risques Infectieux Transfusionnels, Institut National de la Transfusion Sanguine (INTS), Paris, France
| | - Antoine Chaillon
- Division of Infectious Diseases, University of California San Diego, La Jolla, California, USA
| | - Josiane Pillonel
- Département des maladies infectieuses, Santé publique France, Saint-Maurice, France
| | - Asma Essat
- INSERM CESP U1018, Université Paris Sud, Université Paris Saclay, Le Kremlin-Bicêtre, France
| | - Marie-Laure Chaix
- Service de Virologie, CNR VIH, Hôpital Saint-Louis, APHP - INSERM U944, Université de Paris, Paris, France
| | - Laurence Meyer
- INSERM CESP U1018, Université Paris Sud, Université Paris Saclay, Le Kremlin-Bicêtre, France.,Service de Santé Publique, Hôpital Bicêtre, APHP, Le Kremlin Bicêtre, France
| | - Francis Barin
- Laboratoire de Virologie, Laboratoire associé au CNR VIH, CHRU de Tours - INSERM U1259, Université de Tours, Tours, France
| | - Pierre Tiberghien
- Etablissement Français du Sang, La Plaine St Denis, France.,UMR 1098 INSERM, Université de Franche-Comté, Etablissement Français du Sang, Besançon, France
| | - Syria Laperche
- Département des Agents Transmissibles par le Sang, CNR Risques Infectieux Transfusionnels, Institut National de la Transfusion Sanguine (INTS), Paris, France
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5
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Reynolds CA, Davison KL, Andrews N, Brailsford SR. What are blood donors telling us about injecting drug use? Vox Sang 2020; 115:637-646. [PMID: 32702174 DOI: 10.1111/vox.12976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Revised: 06/04/2020] [Accepted: 06/20/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND OBJECTIVES Injecting drug use (IDU), a permanent deferral for blood donors, was included in a review of donor selection criteria completed in 2017. Here, we describe what is known about IDU in blood donors in the United Kingdom (UK). MATERIALS AND METHODS Data were obtained from routine surveillance of donation testing and confirmed positive donors and a 2013/2014 UK survey of behaviour and compliance in screen-negative donors. RESULTS Between 2009 and 2018, of 22 UK million donations screened, IDU was self-reported at the post-test discussion in 5% (86/1777) of donors with confirmed positive donations. Recent injecting within 12 months was reported in 8 HCV-positive donors, but only in 1/14 donors where it was clear HCV infection had been acquired in the previous 12 months. Of 65 439 survey responders, 25 reported IDU, which when weighted to the donor population gave 99·95% compliance. Most of the 111 donors reporting IDU felt it was not important to their donation, mainly because their injecting was in the past, while three HCV-positive recent injectors reported not sharing needles so presumably felt safe to donate. CONCLUSION Compliance with the permanent deferral appeared extremely high with low levels of injecting reported by donors, mainly in the past. This agreed with the low-incident HCV infection observed in UK donors. These data contributed to a recommendation to reduce the deferral to 1 year. Ways of improving compliance in those few donors at current increased risk of infection need to be investigated.
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Affiliation(s)
- Claire A Reynolds
- NHS Blood and Transplant/Public Health England Epidemiology Unit, NHS Blood and Transplant, London, UK
| | - Katy L Davison
- NHS Blood and Transplant/Public Health England Epidemiology Unit, Public Health England, London, UK
| | - Nick Andrews
- Statistics, Modelling and Economics Department, Public Health England, London, UK
| | - Susan R Brailsford
- NHS Blood and Transplant/Public Health England Epidemiology Unit, NHS Blood and Transplant, London, UK
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6
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Cutts JC, Quinn B, Seed CR, Kotsiou G, Pearson R, Scott N, Wilson DP, Harrod ME, Maher L, Caris S, Thompson AJ, Farrell M, Pink J, Hellard ME. A Systematic Review of Interventions Used to Increase Blood Donor Compliance with Deferral Criteria. Transfus Med Hemother 2020; 48:118-129. [PMID: 33976612 DOI: 10.1159/000509027] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Accepted: 05/28/2020] [Indexed: 11/19/2022] Open
Abstract
Background and Objectives Pre-donation screening of potential blood donors is critical for ensuring the safety of the donor blood supply, and donor deferral as a result of risk factors is practised worldwide. This systematic review was conducted in the context of an expert review convened by the Australian Red Cross Lifeblood in 2013 to consider Lifeblood's injecting drug use (IDU)-related policies and aimed to identify studies assessing interventions to improve compliance with deferral criteria in blood donation settings. Materials and Methods MEDLINE/PubMed, OVID Medline, OVID Embase, LILACS, and the Cochrane Library (CENTRAL and DARE) databases were searched for studies conducted within blood donation settings that examined interventions to increase blood donor compliance with deferral criteria. Observational and experimental studies from all geographical areas were considered. Results Ten studies were identified that tested at least one intervention to improve blood donor compliance with deferral criteria, including computerized interviews or questionnaires, direct and indirect oral questioning, educational materials, and a combination of a tickbox questionnaire and a personal donor interview. High-quality evidence from a single study was provided for the effectiveness of a computerized interview in improving detection of HIV risk behaviour. Low-quality evidence for the effectiveness of computerized interviews was provided by 3 additional studies. Two studies reported a moderate effect of direct questioning in increasing donor deferral, but the quality of the evidence was low. Conclusion This review identified several interventions to improve donor compliance that have been tested in blood donation settings and provided evidence for the effectiveness of computerized interviews in improving detection of risk factors.
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Affiliation(s)
| | - Brendan Quinn
- Burnet Institute, Melbourne, Victoria, Australia.,Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Clive R Seed
- Australian Red Cross Lifeblood, Melbourne, Victoria, Australia
| | - George Kotsiou
- Australian Red Cross Lifeblood, Melbourne, Victoria, Australia
| | - Ruth Pearson
- Burnet Institute, Melbourne, Victoria, Australia
| | - Nick Scott
- Burnet Institute, Melbourne, Victoria, Australia.,Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | | | - Mary Ellen Harrod
- NSW Users and AIDS Association, Surry Hills, New South Wales, Australia
| | - Lisa Maher
- Burnet Institute, Melbourne, Victoria, Australia.,Kirby Institute, UNSW Sydney, Sydney, New South Wales, Australia
| | - Sharon Caris
- Haemophilia Foundation Australia, Malvern East, Victoria, Australia
| | - Alex J Thompson
- Department of Gastroenterology, St Vincent's Hospital and the University of Melbourne, Melbourne, Victoria, Australia
| | - Michael Farrell
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, New South Wales, Australia
| | - Joanne Pink
- Australian Red Cross Lifeblood, Melbourne, Victoria, Australia
| | - Margaret E Hellard
- Burnet Institute, Melbourne, Victoria, Australia.,Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.,Department of Infectious Diseases, The Alfred Hospital, Melbourne, Victoria, Australia.,Doherty Institute and School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
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7
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Quinn B, Pearson R, Cutts J, Seed C, Scott N, Hoad V, Dietze P, Wilson D, Maher L, Thompson A, Farrell M, Harrod M, Caris S, Pink J, Kotsiou G, Hellard M. Blood donation amongst people who inject drugs in Australia: research supporting policy change. Vox Sang 2020; 115:162-170. [PMID: 32023663 DOI: 10.1111/vox.12891] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Revised: 12/23/2019] [Accepted: 01/07/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND OBJECTIVES Until recently, people in Australia with a history of injection drug use (IDU) were deferred indefinitely from donating blood. Knowledge gaps regarding policy non-compliance and the prevalence of blood donation practices amongst people who inject drugs (PWID) precluded changes to this policy. We sought to address these gaps and to estimate the additional risk to Australia's blood supply associated with changing the indefinite deferral policy to 1 or 5 years since last injecting episode. MATERIALS AND METHODS Data on blood donation amongst PWID were collected from 1853 interviews across two Australian studies of PWID conducted during 2015/16. Mathematical modelling was used to estimate the additional risk of hepatitis C (HCV)-infected window period collections as a result of changing the deferral policy. RESULTS A very few (2-4%) study participants reported ever donating blood after ≥1 IDU episode. Changing the deferral policy from indefinite to 1 or 5 years was estimated to result in an additional 0·00000070 (95%CI: 0·00000033-0·00000165) or 0·00000020 (95%CI: 0·00000008-0·00000041) HCV-positive window period collections per year, respectively. CONCLUSION Changing Australia's indefinite deferral period to 1 or 5 years since last injecting episode poses a negligible increase in the risk of HCV-infected window period collections from blood donors with a history of IDU. Our results informed a successful submission to the Australian regulator to change the deferral period from indefinite to 5 years since last injecting episode, a policy which came into effect in September 2018.
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Affiliation(s)
- Brendan Quinn
- Burnet Institute, Melbourne, Vic., Australia.,Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Vic., Australia
| | - Ruth Pearson
- Burnet Institute, Melbourne, Vic., Australia.,Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Vic., Australia
| | - Julia Cutts
- Burnet Institute, Melbourne, Vic., Australia.,Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Vic., Australia
| | - Clive Seed
- Australian Red Cross Blood Service, Perth, WA, Australia
| | - Nick Scott
- Burnet Institute, Melbourne, Vic., Australia.,Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Vic., Australia
| | - Veronica Hoad
- Australian Red Cross Blood Service, Perth, WA, Australia
| | - Paul Dietze
- Burnet Institute, Melbourne, Vic., Australia.,Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Vic., Australia
| | | | - Lisa Maher
- Burnet Institute, Melbourne, Vic., Australia.,Kirby Institute, UNSW, Sydney, NSW, Australia
| | - Alexander Thompson
- Department of Gastroenterology, St Vincent's Hospital and the University of Melbourne (UoM), Fitzroy, Vic., Australia.,Doherty Institute and Melbourne School of Population and Global Health, UoM, Melbourne, Vic., Australia
| | - Michael Farrell
- National Drug and Alcohol Research Centre (NDARC), UNSW, Randwick, NSW, Australia
| | - Mary Harrod
- Australian Injecting and Illicit Drug Users League (AIVL), Canberra, ACT, Australia
| | - Sharon Caris
- Haemophilia Foundation Australia, Malvern East, Vic., Australia
| | - Joanne Pink
- Australian Red Cross Blood Service, Perth, WA, Australia
| | - George Kotsiou
- Australian Red Cross Blood Service, Perth, WA, Australia
| | - Margaret Hellard
- Burnet Institute, Melbourne, Vic., Australia.,Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Vic., Australia.,Infectious Diseases Department, Alfred Hospital, Melbourne, Vic., Australia
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8
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Tan PP, Fauzi HM, Bahar R, Chang CT, Rahim NAA. Knowledge and Perceptions of Blood Safety among Blood Donors in Kelantan, Malaysia. Malays J Med Sci 2020; 26:127-136. [PMID: 31908594 PMCID: PMC6939727 DOI: 10.21315/mjms2019.26.6.13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Accepted: 11/11/2019] [Indexed: 11/12/2022] Open
Abstract
Background Unsafe blood products may cause transfusion-transmissible infections. This study aimed to evaluate the knowledge and perceptions of blood donors regarding blood safety. Methods This was a cross-sectional study conducted in the Kelantan state of Malaysia. The questionnaire comprised 39 questions that covered areas such as donors’ social demographic information, knowledge of transfusion-transmitted diseases, blood screening and donor eligibility and perceptions towards blood safety. The knowledge score was categorised as good or poor. Results Of the 450 distributed questionnaires, 389 were suitable for analysis. Only 18.5% of the donors had good knowledge, with 81.5% having poor knowledge. Less than 30% were aware that people with multiple sexual partners, bisexual people and male homosexual people are permanently deferred from blood donation. Only 29.4% agreed that donors are responsible if their blood causes infection. Furthermore, 39.3% assumed that they could check their HIV status through blood donation, and 10.3% and 5.4% of the respondents believed that donors are free from infection if they wear a condom during sex or only have oral sex when involved in prostitution, respectively. Conclusion Poor knowledge and notable misperceptions concerning safe blood donation were found among blood donors. The Ministry of Health should incorporate safe blood education in future public awareness programmes.
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Affiliation(s)
- Pei Pei Tan
- Regenerative Medicine Cluster, Advanced Medical and Dental Institute, Universiti Sains Malaysia, Kepala Batas, Pulau Pinang, Malaysia
| | - Hafizuddin Mohamed Fauzi
- Regenerative Medicine Cluster, Advanced Medical and Dental Institute, Universiti Sains Malaysia, Kepala Batas, Pulau Pinang, Malaysia
| | - Rosnah Bahar
- Department of Haematology, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia
| | - Chee Tao Chang
- Clinical Research Centre, Hospital Raja Permaisuri Bainun, Ministry of Health Malaysia
| | - Nur Arzuar Abdul Rahim
- Regenerative Medicine Cluster, Advanced Medical and Dental Institute, Universiti Sains Malaysia, Kepala Batas, Pulau Pinang, Malaysia
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9
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Van Remoortel H, Matthysen W, Avau B, Compernolle V, Vandekerckhove P, De Buck E. Is sexual risk behaviour associated with an increased risk of transfusion-transmissible infections in blood donors from Western and Pacific countries? A systematic review and meta-analysis. Vox Sang 2019; 115:107-123. [PMID: 31823386 DOI: 10.1111/vox.12874] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Revised: 09/13/2019] [Accepted: 11/14/2019] [Indexed: 12/15/2022]
Abstract
BACKGROUND AND OBJECTIVES The donor medical questionnaire is designed to aid blood establishments in supporting a safe blood supply. According to blood donor deferral policies, sexual risk behaviour (SRB) leads to a (temporary) deferral from blood donation. This systematic review aimed to scientifically underpin these policies by identifying the best available evidence on the association between SRB and the risk of transfusion transmissible infections (TTIs). MATERIALS & METHODS Studies from three databases investigating the link between SRB (excluding men who have sex with men (MSM)) and TTIs (HBV, HCV, HIV, Treponema pallidum) in donors from Western and Pacific countries were obtained and assessed on eligibility by two reviewers independently. The association between SRB and TTIs was expressed by calculating pooled effect measures via meta-analyses. The GRADE methodology (Grades of Recommendation, Assessment, Development and Evaluation) was used to assess the quality of evidence. RESULTS We identified 3750 references and finally included 15 observational studies. Meta-analyses showed that there is a significant (P < 0·05) positive association between the following SRB and HBV and/or HCV infection: having sex with an intravenous drug user (high-certainty evidence), receiving money or goods for sex (moderate-high certainty evidence), having a sex partner with hepatitis/HIV (moderate-certainty evidence) and paid for sex or anal sex (low-certainty evidence). CONCLUSION Sexual risk behaviour (including having sex with an intravenous drug user, receiving money or goods for sex or having a sex partner with hepatitis/HIV) is probably associated with an increased risk of HBV/HCV infection in blood donors from Western and Pacific countries.
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Affiliation(s)
- Hans Van Remoortel
- Centre for Evidence-Based Practice, Belgian Red Cross, Mechelen, Belgium
| | - Wout Matthysen
- Centre for Evidence-Based Practice, Belgian Red Cross, Mechelen, Belgium
| | - Bert Avau
- Centre for Evidence-Based Practice, Belgian Red Cross, Mechelen, Belgium.,Cochrane Belgium, Belgian Centre for Evidence-Based Medicine (Cebam), Leuven, Belgium
| | - Veerle Compernolle
- Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium.,Blood Services, Belgian Red Cross, Mechelen, Belgium
| | - Philippe Vandekerckhove
- Department of Public Health and Primary Care, Faculty of Medicine, KU Leuven, Leuven, Belgium.,Belgian Red Cross, Mechelen, Belgium
| | - Emmy De Buck
- Centre for Evidence-Based Practice, Belgian Red Cross, Mechelen, Belgium.,Department of Public Health and Primary Care, Faculty of Medicine, KU Leuven, Leuven, Belgium
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10
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Mitchel J, Custer B, Kaidarova Z, Murphy EL, van den Berg K. Implementation of a script for predonation interviews: impact on human immunodeficiency virus risk in South African blood donors. Transfusion 2019; 59:2344-2351. [PMID: 30946490 PMCID: PMC6610781 DOI: 10.1111/trf.15288] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Revised: 03/06/2019] [Accepted: 03/06/2019] [Indexed: 12/25/2022]
Abstract
BACKGROUND The way in which the donor history questionnaire is conducted plays a crucial role in the self-disclosure of behavioral risk factors for human immunodeficiency virus (HIV) infection by prospective donors. The South African National Blood Service changed its policy on the process of donor assessment in May 2015 by implementing a compulsory interviewer script used to assess donor eligibility. STUDY DESIGN AND METHODS A pre- and postevaluation study to determine the impact of scripted interviews on high-risk deferrals and recently acquired HIV infections. We used historical data to compare 18 months before and after the implementation of the script. RESULTS We recorded a total of 3,169,656 donor presentations during the two 18-months periods, of which 52.2% (1,655,352) were made during the scripted period. A multivariable logistic regression analysis adjusting for donor and demographic characteristics found the odds of high-risk deferral to be slightly greater (odds ratio [OR], 1.06; 95% confidence interval [CI], 1.05-1.07) during the scripted period. A separate multivariate logistic regression model, also adjusting for donor and demographic characteristics, showed that the odds of recently acquired HIV infection were significantly lower (OR, 0.88; 95% CI, 0.79-0.97) during the scripted period. CONCLUSION This study showed that implementation of a scripted interview was associated with increased HIV risk deferral and decreased recent HIV infection. This study indicates potential improvement in blood safety with the implementation of a scripted donor interview and has relevance to blood safety in other sub-Saharan African countries.
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Affiliation(s)
| | - Brian Custer
- Vitalant Research Institute, San Francisco, California, United States.,University of California San Francisco, San Francisco, California, United States
| | - Zhanna Kaidarova
- Vitalant Research Institute, San Francisco, California, United States
| | - Edward L. Murphy
- Vitalant Research Institute, San Francisco, California, United States.,University of California San Francisco, San Francisco, California, United States
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11
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Prinsze FJ, van de Laar T, Slot E, de Jong M, Bokhorst A, de Kort W, Zaaijer H, van den Hurk K. No increased risk of transfusion-transmissible infections after tattooing, body piercing, or acupuncture among blood donors in the Netherlands. Transfusion 2019; 59:2575-2583. [PMID: 31228271 DOI: 10.1111/trf.15421] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Revised: 05/23/2019] [Accepted: 05/23/2019] [Indexed: 12/13/2022]
Abstract
BACKGROUND In the Netherlands, needle-related events (NREs) including tattoos, piercings, and acupuncture are a reason for temporary blood donor deferral. This study aims to evaluate whether donors with recent NREs had a higher risk of transfusion-transmissible infections (TTIs) compared to donors without recent NREs. STUDY DESIGN AND METHODS Data from 2006 through 2015 on all blood donation attempts in the Netherlands were collected. Multivariate regression models (for repeated measurements) were used to assess the associations between recent NREs and the acquisition of TTIs. Posttest counseling data were used to determine the most likely risk factor in TTI-positive new and repeat donors. RESULTS Recent NREs were documented in 97,518 out of 9,266,036 (1.1%) donation attempts; 14,097 (14.5%) NREs resulted in NRE-based donor deferral. Recent NREs reported pre-donation were not associated with an increased risk for TTIs. A total of 29 out of 287 TTI-positive donors (11 repeat donors, 18 new donors) reported a recent NRE pre- and/or post-donation. Recent NREs, all needle-stick injuries, were the likely route of transmission in 12 out of 287 (4.2%) of TTI-positive donors. The donor health questionnaire (DHQ) identified only 1 out of 12 TTI-linked NREs. Non-return after NRE deferral, any deferral, or no deferral was 24, 15, and 5%, respectively. DISCUSSION Recent tattoos, body piercings, or acupuncture were not associated with an increased risk for TTIs in Dutch donors. Given the lower return rates of donors following a temporary NRE-based deferral, we advocate ending blood donor deferral policies for acupuncture, tattooing, and body piercings, but not needle-stick injuries, in countries where these practices can be considered safe.
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Affiliation(s)
- Femmeke J Prinsze
- Department of Donor Medicine Research, Sanquin Research, Amsterdam, The Netherlands
| | - Thijs van de Laar
- Department of Donor Medicine Research, Sanquin Research, Amsterdam, The Netherlands.,Laboratory of Medical Microbiology, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands
| | - Ed Slot
- Department of Donor Medicine Research, Sanquin Research, Amsterdam, The Netherlands
| | - Maarten de Jong
- Department of Donor Medicine Research, Sanquin Research, Amsterdam, The Netherlands
| | - Arlinke Bokhorst
- Department of Medical Donor Affairs, Sanquin Blood Bank, Amsterdam, The Netherlands.,TRIP National Hemovigilance and Biovigilance Office, Leiden, The Netherlands
| | - Wim de Kort
- Department of Donor Medicine Research, Sanquin Research, Amsterdam, The Netherlands.,Department of Public Health, Amsterdam UMC, Location AMC, Amsterdam, The Netherlands
| | - Hans Zaaijer
- Department of Donor Medicine Research, Sanquin Research, Amsterdam, The Netherlands.,Department of Clinical Virology (CINIMA), Amsterdam UMC, Location AMC, Amsterdam, The Netherlands
| | - Katja van den Hurk
- Department of Donor Medicine Research, Sanquin Research, Amsterdam, The Netherlands
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12
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Van Remoortel H, Moorkens D, Avau B, Compernolle V, Vandekerckhove P, De Buck E. Is there a risk of transfusion-transmissible infections after percutaneous needle treatments in blood donors? A systematic review and meta-analysis. Vox Sang 2019; 114:297-309. [PMID: 30972765 DOI: 10.1111/vox.12780] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Revised: 03/07/2019] [Accepted: 03/17/2019] [Indexed: 12/29/2022]
Abstract
BACKGROUND AND OBJECTIVES The donor medical questionnaire identifies a blood donor's history of known blood safety risks. Current Australian, Canadian, European and USA legislation temporarily defers blood donors who received different percutaneous needle treatments (i.e. tattooing, acupuncture and piercing) from blood donation. This systematic review aimed to scientifically underpin these deferrals by identifying the best available evidence on the association between percutaneous needle treatments and the risk of transfusion-transmissible infections (TTIs). MATERIALS AND METHODS Studies from three databases investigating the link between percutaneous needle treatments and TTIs (HBV, HCV and HIV infection) in blood donors were retained and assessed on eligibility by two reviewers independently. The association between percutaneous needle treatments and TTIs was expressed by conducting meta-analyses and calculating pooled effect measures (odds ratios (ORs) and 95% CIs). The GRADE methodology (Grades of Recommendation, Assessment, Development and Evaluation) was used to assess the quality of evidence. RESULTS We identified 1242 references and finally included 21 observational studies. Twenty studies assessed the link between percutaneous needle treatments and HCV infection and found that blood donors receiving these treatments had an increased risk of HCV infection (tattooing: pooled OR 5·28, 95% CI [4·33, 6·44], P < 0·00001 (low-quality evidence); acupuncture: pooled OR 1·56, 95% CI [1·17, 2·08], P = 0·03 (very low-quality evidence); and piercing: pooled OR 3·25, 95% CI [1·68, 6·30], P = 0·0005 (low-quality evidence)). CONCLUSION Percutaneous needle treatments may be associated with an increased HCV infection risk. Further high-quality studies are required to formulate stronger evidence-based recommendations on percutaneous needle treatments as a blood donor deferral criterion.
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Affiliation(s)
- Hans Van Remoortel
- Centre for Evidence-Based Practice, Belgian Red Cross, Mechelen, Belgium
| | - Dorien Moorkens
- Centre for Evidence-Based Practice, Belgian Red Cross, Mechelen, Belgium
| | - Bert Avau
- Centre for Evidence-Based Practice, Belgian Red Cross, Mechelen, Belgium.,Cochrane Belgium, Belgian Centre for Evidence-Based Medicine (Cebam), Leuven, Belgium
| | - Veerle Compernolle
- Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium.,Blood Services, Belgian Red Cross, Mechelen, Belgium
| | - Philippe Vandekerckhove
- Department of Public Health and Primary Care, Faculty of Medicine, KU Leuven, Leuven, Belgium.,Belgian Red Cross, Mechelen, Belgium
| | - Emmy De Buck
- Centre for Evidence-Based Practice, Belgian Red Cross, Mechelen, Belgium.,Department of Public Health and Primary Care, Faculty of Medicine, KU Leuven, Leuven, Belgium
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13
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Reynolds CA, Davison KL, Andrews N, Patel P, Kitchen A, Brailsford SR. Dissecting the decline of hepatitis C in first-time donors in England and Wales. Vox Sang 2018; 113:329-338. [PMID: 29441589 DOI: 10.1111/vox.12638] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Revised: 12/14/2017] [Accepted: 01/14/2018] [Indexed: 12/17/2022]
Abstract
BACKGROUND AND OBJECTIVES The rate of confirmed hepatitis C virus (HCV) cases, in first-time donors, is much lower in 2015 than 20 years ago. We investigate reasons for the decline. MATERIALS AND METHODS HCV rates were analysed by gender and birth cohort for 1996 to 2015 and ethnic group for 2006 to 2015. Variables for confirmed positive cases were compared for two ten-year periods (1996 to 2005 and 2006 to 2015) including genotyping data for 2006 to 2015. RESULTS There were 2007 confirmed HCV cases identified between 1996 and 2015. The rate per 100 000 donations fell from 78·6 in 1996 to 26·9 by 2015. By birth cohort, HCV rates were highest in donors born in the 1950s and 1960s who contributed a decreasing proportion of first-time donors. Between 2006 and 2015, there was no significant decline in HCV rate. The HCV-positive donor profile has changed in the last 10 years with increased proportions of younger donors, donors born abroad and decreased reported injecting drug use. Genotype 1a remains predominate, but genotype 1b has increased associated with this change in birth cohort and ethnicity. CONCLUSION The decline in number and rate of confirmed HCV-positive first-time donors is mainly due to a decrease in first-time donors born before 1970, with the highest rate of HCV. However, the decline has slowed and the profile of HCV-positive first-time donors is changing. A better understanding of behaviour and sources of HCV in younger and ethnic minority donors are needed.
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Affiliation(s)
- C A Reynolds
- NHS Blood and Transplant/Public Health England Epidemiology Unit, NHS Blood and Transplant, London, UK
| | - K L Davison
- NHS Blood and Transplant/Public Health England Epidemiology Unit, Public Health England, London, UK
| | | | - P Patel
- Public Health England, London, UK
| | - A Kitchen
- National Transfusion Microbiology Reference Laboratory, NHS Blood and Transplant, London, UK
| | - S R Brailsford
- NHS Blood and Transplant/Public Health England Epidemiology Unit, NHS Blood and Transplant, London, UK
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14
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Öhrner C, Kvist M. How do blood donors interpret the Swedish donor history questionnaire? ACTA ACUST UNITED AC 2017. [DOI: 10.1111/voxs.12372] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- C. Öhrner
- Department of Clinical Immunology and Transfusion Medicine; Stockholm Blood Bank; Karolinska University Hospital; Stockholm Sweden
| | - M. Kvist
- Department of Clinical Immunology and Transfusion Medicine; Stockholm Blood Bank; Karolinska University Hospital; Stockholm Sweden
- Department of Laboratory Medicine; Karolinska Institutet; Stockholm Sweden
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15
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Quinn B, Seed C, Keller A, Maher L, Wilson D, Farrell M, Caris S, Williams J, Madden A, Thompson A, Pink J, Hellard ME. Re-examining blood donor deferral criteria relating to injecting drug use. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2017; 48:9-17. [PMID: 28666205 DOI: 10.1016/j.drugpo.2017.05.058] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2016] [Revised: 04/21/2017] [Accepted: 05/30/2017] [Indexed: 11/15/2022]
Abstract
BACKGROUND AND AIMS Potential Australian blood donors are deferred indefinitely if they report a history of injecting drug use (IDU), or for 12 months if they report having engaged in sexual activity with someone who might have ever injected. Given incremental improvements in blood safety, this study sought to examine whether Australia's IDU-related eligibility criteria reflected current scientific evidence, were consistent with international best practice and, if current IDU-related policies were to be changed, how this should happen. METHODS An expert committee was formed to review relevant literature with a focus on issues including: the epidemiology of IDU in Australia and key transfusion-transmissible infections (TTIs) among Australian people who inject drugs (PWID); and, 'non-compliance' among PWID regarding IDU-related blood donation guidelines. International policies relating to blood donation and IDU were also reviewed. Modelling with available data estimated the risk of TTIs remaining undetected if the Blood Service's IDU-related guidelines were changed. RESULTS Very few (<1%) Australians engage in IDU, and IDU risk practices are reported by only a minority of PWID. However, the prevalence of HCV remains high among PWID, and IDU remains a key transmission route for various TTIs. Insufficient data were available to inform appropriate estimates of cessation and relapse among Australian PWID. Modelling findings indicated that the risk of not detecting HIV becomes greater than the reference group at a threshold of non-admission of being an active PWID of around 1.8% (0.5-5.1%). Excluding Japan, all Organisation for the Economic Co-operation and Development member countries permanently exclude individuals with a history of IDU from donating. CONCLUSION Numerous research gaps meant that the study's expert Review Committee was unable to recommend altering Australia's current IDU-related blood donation guidelines. However, having identified critical knowledge gaps and future areas of research, the review made important steps toward changing the criteria.
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Affiliation(s)
- Brendan Quinn
- Burnet Institute, Melbourne, Australia; Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia.
| | - Clive Seed
- Australian Red Cross Blood Service, Australia
| | | | - Lisa Maher
- Kirby Institute, University of New South Wales, Australia
| | - David Wilson
- Burnet Institute, Melbourne, Australia; Kirby Institute, University of New South Wales, Australia
| | - Michael Farrell
- National Drug & Alcohol Research Centre, University of New South Wales, Australia
| | | | | | - Annie Madden
- Australian Injecting & Illicit Drug Users League, Australia
| | | | - Joanne Pink
- Australian Red Cross Blood Service, Australia
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16
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van de Laar TJ, Bezemer D, van Laethem K, Vandewalle G, de Smet A, van Wijngaerden E, Claas EC, van Sighem AI, Vandamme AM, Compernolle V, Zaaijer HL. Phylogenetic evidence for underreporting of male-to-male sex among human immunodeficiency virus-infected donors in the Netherlands and Flanders. Transfusion 2017; 57:1235-1247. [PMID: 28375576 DOI: 10.1111/trf.14097] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2016] [Revised: 12/14/2016] [Accepted: 01/08/2017] [Indexed: 12/13/2022]
Abstract
BACKGROUND Separate transmission networks for human immunodeficiency virus (HIV) coexist. Molecular typing of viral genomes can provide insight in HIV transmission routes in donors for whom risk behavior-based donor selection failed. STUDY DESIGN AND METHODS This study includes all HIV-infected Dutch and Flemish donors in the period 2005 to 2014 (n = 55). Part of the HIV polymerase (pol) gene was amplified, sequenced, and compared with more than 10,000 HIV strains obtained from HIV-infected Dutch and Flemish patients. The most likely transmission route was determined based on HIV phylogeny and the donor's self-reported risk behavior during the exit interview. RESULTS HIV-infected donors were predominantly male (69%), were repeat donors (73%), were born in the Netherlands or Belgium (95%), and harbored HIV Subtype B (68%). Seventy-five percent of HIV-infected male donors were part of robust phylogenetic clusters linked to male-to-male sex, while only 24% of HIV-infected male donors reported male-to-male sex during posttest counseling. Sex between men and women accounted for 13% of HIV infections in male donors and 93% of HIV infections in female donors based on phylogenetic analysis. Only 40% of HIV-infected female donors had HIV Subtype B; 65% of female donors reported a foreign partner and indeed HIV sequences interspersed with sequences from HIV-endemic areas abroad, in particular sub-Saharan Africa. CONCLUSION HIV typing helps to understand HIV transmission routes in donor populations. We found substantial underreporting of male-to-male sex among HIV-infected male donors. Donor education on HIV risk factors and the danger of window-period donations and a donor environment that encourages frank disclosure of sexual behavior will contribute to a decrease of HIV-infected donors.
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Affiliation(s)
- Thijs J van de Laar
- Department of Blood-borne Infections, Sanquin Research, Amsterdam, the Netherlands
| | | | - Kristel van Laethem
- Laboratory for Clinical and Epidemiological Virology, Department of Microbiology and Immunology, Rega Institute for Medical Research, KU Leuven-Leuven University, Leuven, Belgium.,AIDS Reference Laboratory, University Hospitals Leuven, Leuven, Belgium
| | | | - Annie de Smet
- Blood Service, Belgian Red Cross-Flanders, Mechelen, Belgium
| | - Eric van Wijngaerden
- AIDS Reference Center, University Hospitals Leuven, Leuven, Belgium.,Laboratory for Clinical Infectious and Inflammatory Disorders, Department of Microbiology and Immunology, KU Leuven-Leuven University, Leuven, Belgium
| | - Eric C Claas
- Department of Medical Microbiology, Leiden University Medical Centre, Leiden, the Netherlands.,Department of Molecular Biology, MC Slotervaart, Amsterdam, the Netherlands
| | | | - Anne-Mieke Vandamme
- Laboratory for Clinical and Epidemiological Virology, Department of Microbiology and Immunology, Rega Institute for Medical Research, KU Leuven-Leuven University, Leuven, Belgium.,Center for Global Health and Tropical Medicine, Microbiology Unit, Institute for Hygiene and Tropical Medicine, University Nova de Lisboa, Lisbon, Portugal
| | - Veerle Compernolle
- Blood Service, Belgian Red Cross-Flanders, Mechelen, Belgium.,Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Hans L Zaaijer
- Department of Blood-borne Infections, Sanquin Research, Amsterdam, the Netherlands.,Department of Medical Microbiology (CINIMA), Academic Medical Center/University of Amsterdam, Amsterdam, the Netherlands
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17
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Bogdanović S, Đurić P, Jovanović R, Bogdanović J. Blood donors' awareness and attitudes towards blood transfusion safety in the Autonomous Province of Vojvodina, Serbia. Transfus Med 2017; 27:303-306. [PMID: 28233935 DOI: 10.1111/tme.12398] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2016] [Revised: 02/03/2017] [Accepted: 02/03/2017] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To assess the awareness and attitudes related to blood transfusion safety among blood donors from the Autonomous Province (AP) Vojvodina, Republic of Serbia. BACKGROUND Blood donors are at the initial point of safe blood transfusion systems. The active participation of blood donors in the selection process contributes to increasing the safety of blood transfusions and reduces potential risks for the recipients. MATERIALS AND METHODS This cross-sectional survey included 1191 blood donors from AP Vojvodina. The awareness and attitudes regarding safe blood supply were measured as 5-point scales of agreement/disagreement with statements on a Likert scale. The data were analysed using non-parametric methods by frequency modalities. RESULTS Male blood donors, the youngest age group (18-20 years), those who donate blood for the first time and those with a lower educational level showed the lowest awareness of, and the most negative attitudes about, blood safety. CONCLUSIONS The study found that there is a small but, for the safety of transfusion, significant number of blood donors who do not have a positive attitude or awareness of their own impact on safe transfusion therapy and who are not discovered during standard selection procedures.
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Affiliation(s)
- S Bogdanović
- Blood Transfusion Institute of Vojvodina, Novi Sad, Serbia
| | - P Đurić
- Queen Margaret University, Edinburgh, Institute for Global Health and Development, Scotland, UK
| | - R Jovanović
- Blood Transfusion Institute of Vojvodina, Novi Sad, Serbia.,Faculty of Medicine Novi Sad, University of Novi Sad, Novi Sad, Serbia
| | - J Bogdanović
- Faculty of Medicine Novi Sad, University of Novi Sad, Novi Sad, Serbia
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18
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Beele H, van Wijk MJ, Wulff B, Holsboer N, de Bruijn M, Segerström C, Trias E. Report of the clinical donor case workshop of the European Association of Tissue Banks annual meeting 2014. Cell Tissue Bank 2016; 17:353-60. [PMID: 27460878 DOI: 10.1007/s10561-016-9571-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2016] [Accepted: 07/14/2016] [Indexed: 11/28/2022]
Abstract
The European Association of Tissue Banks (EATB) donor case workshop is a forum held within the program of the EATB annual congress. The workshop offers an opportunity to discuss and evaluate possible approaches taken to challenging situations regarding donor selection. Donor case workshops actively engage participants with diverging background and experience in an informal, secure and enjoyable setting. The resulting discussion with peers promotes consensus development in deciding tissue donor acceptability, especially when donor health issues are not conclusively addressed in standards and regulations. Finally the workshop serves to strengthen the professional tissue banking networks across Europe and beyond. This report reflects some of the discussion at the workshop during the annual congress in Lund, Sweden, in 2014. The cases presented demonstrate that the implications of various donor illnesses, physical findings and behaviours on the safety of tissue transplantation, may be interpreted in a different way by medical directors and other professionals of different tissue facilities. This will also result in diverging preventive measures and decisions taken by the tissue facilities. Some of the donor cases illustrate varied responses from participants and demonstrate that operating procedures, regulations and standards cannot comprehensively cover all tissue donor illnesses, medical histories and circumstances surrounding the cause of death. For many of the issues raised, there is a lack of published scientific evidence. In those cases, tissue bank medical director judgement is critical to guarantee transplantation safety. This judgement should be based on a proper and documented risk assessment case by case. Conditions or parameters taken into account for risk assessment are amongst others, the type of tissue, the type of processing, the characteristics of the final product, and the availability of an adequate sterilisation methodology. By publishing these difficult donor suitability cases, and the resulting discussions, we provide information for future similar cases and we identify needs for future literature review and scientific research. In this way the donor case workshops play a role in optimizing the quality and security of tissue donation.
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Affiliation(s)
- Hilde Beele
- Tissue Bank, Ghent University Hospital, De Pintelaan 185, 9000, Ghent, Belgium.
| | | | - Birgit Wulff
- Institute of Legal Medicine, UMC Hamburg, Hamburg, Germany
| | - Noor Holsboer
- Dutch Transplant Organisation, Leiden, The Netherlands
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19
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Willson S, Miller K, Seem D, Kuehnert MJ. Cognitive evaluation of the AABB Uniform Donor History Questionnaire. Transfusion 2016; 56:1662-7. [PMID: 27060456 DOI: 10.1111/trf.13587] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2015] [Revised: 02/04/2016] [Accepted: 02/04/2016] [Indexed: 11/29/2022]
Abstract
BACKGROUND This article reports key findings of an evaluation of the AABB Uniform Donor History Questionnaire (a self-administered form completed before blood donation). The purpose of the study was to examine how respondents understand the questions and assess the nature of inaccurate responses. Another goal was to determine whether men who have sex with men (MSM) interpreted questions differently from non-MSM and whether questions were interpreted differently in various regions of the country. STUDY DESIGN AND METHODS Cognitive interviewing was used for the study. This is a qualitative method that investigates how survey questions perform. It consists of semistructured interviews that explore whether respondents understand questions as intended and whether they can provide accurate answers. A total of 166 interviews were conducted. RESULTS Respondents had an overwhelmingly similar understanding of the purpose of the questionnaire as assessing the safety of their blood for donation. This understanding framed respondents' interpretations such that each question was understood as asking the same thing; that is, "Is my blood safe to donate?" This interpretation did not vary among MSM versus non-MSM or by region. CONCLUSION Respondents understood the questionnaire as assessing the safety of their blood. This interpretation served as the backdrop for the question-response process for each individual question. Specifically, rationale for answers was framed as much or more by the questionnaire's general purpose as by the specific topic of individual questions. This pattern of interpretation was the key factor responsible for both false-positive and false-negative response errors and did not vary by demographic, including in MSM.
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Affiliation(s)
- Stephanie Willson
- Centers for Disease Control and Prevention, National Center for Health Statistics, Hyattsville, Maryland
| | - Kristen Miller
- Centers for Disease Control and Prevention, National Center for Health Statistics, Hyattsville, Maryland
| | - Debbie Seem
- Department of Health and Human Services, Office of the Assistant Secretary for Health, Office of HIV/AIDS and Infectious Disease Policy, Washington, DC
| | - Matthew J Kuehnert
- Division of Healthcare Quality Promotion, Office of Blood, Organ, and Other Tissue Safety, Centers for Disease Control and Prevention, National Center for Emerging and Zoonotic Infectious Diseases, Atlanta, Georgia
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20
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Slot E, Janssen MP, Marijt-van der Kreek T, Zaaijer HL, van de Laar TJ. Two decades of risk factors and transfusion-transmissible infections in Dutch blood donors. Transfusion 2015; 56:203-14. [PMID: 26355711 DOI: 10.1111/trf.13298] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2015] [Revised: 07/21/2015] [Accepted: 07/27/2015] [Indexed: 12/29/2022]
Abstract
BACKGROUND Risk behavior-based donor selection procedures are widely used to mitigate the risk of transfusion-transmissible infections (TTIs), but their effectiveness is disputed in countries with low residual risks of TTIs. STUDY DESIGN AND METHODS In 1995 to 2014, Dutch blood donors infected with hepatitis B virus (HBV), hepatitis C virus (HCV), human immunodeficiency virus (HIV), human T-lymphotropic virus (HTLV), or syphilis were interviewed by trained medical counselors to identify risk factors associated with TTIs. Trends in the prevalence and incidence of TTIs were analyzed using binomial regression models. RESULTS A total of 972 new donors and 381 repeat donors had TTIs. New donors had higher rates of TTIs compared to repeat donors. Although the HBV and HCV prevalence gradually decreased over time, the incidence of all five TTIs remained stable during the past two decades. In new donors the TTIs had the following risk profiles: "blood-blood contact" for HCV, "unprotected sex" for HIV and syphilis, and "country of birth" for HBV and HTLV. In infected repeat donors, sexual risk factors predominated for all TTIs. At posttest counseling, 28% of infected repeat donors admitted to risk factors leading to permanent donor exclusion if revealed during the donor selection procedure (predominantly male-to-male sex and recent diagnosis of syphilis). CONCLUSION The prevalence and incidence of TTIs among Dutch blood donors are six- to 60-fold lower than in the general Dutch population, illustrating the effectiveness of donor selection procedures. However, at least a quarter of infected donors appeared noncompliant to the donor health questionnaire (DHQ), suggesting that DHQs, or the way donor questioning is implemented, can be improved.
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Affiliation(s)
- Ed Slot
- Department of Blood-Borne Infections, Division Research, Sanquin Blood Supply Foundation, Amsterdam
| | - Mart P Janssen
- Department of Transfusion Technology Assessment, Division Research, Blood Supply Foundation, Amsterdam, the Netherlands.,Julius Centre for Health Sciences and Primary Care, University Medical Centre, Utrecht, the Netherlands
| | | | - Hans L Zaaijer
- Department of Blood-Borne Infections, Division Research, Sanquin Blood Supply Foundation, Amsterdam.,Department of Clinical Virology (CINIMA), Academic Medical Centre/University of Amsterdam, Amsterdam, the Netherlands
| | - Thijs J van de Laar
- Department of Blood-Borne Infections, Division Research, Sanquin Blood Supply Foundation, Amsterdam.,Department of Virology, Division Diagnostics, Sanquin Blood Supply Foundation, Amsterdam
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21
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Hughes S, Sheon N, Siedle-Khan B, Custer B. Saving lives, maintaining safety, and science-based policy: qualitative interview findings from the Blood Donation Rules Opinion Study (Blood DROPS). Transfusion 2015; 55:2835-2841. [PMID: 26271755 DOI: 10.1111/trf.13268] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2015] [Revised: 07/14/2015] [Accepted: 07/15/2015] [Indexed: 11/29/2022]
Abstract
BACKGROUND Indefinite deferral from donation for any man who discloses having had sex with another man even once since 1977 (MSM77) is the US FDA's standing policy. This qualitative component of the Blood Donation Rules and Opinion Study was designed to provide insight into the perceptions and practices of current or previous donors with MSM history. STUDY DESIGN AND METHODS Forty human immunodeficiency virus (HIV)-negative MSM completed an online survey, indicating that they had donated blood and were willing to be interviewed. Semistructured, individual interviews with these key informants covered donation experience and motivations, perceptions of MSM77, policy change preferences, and possible impact of a change to a time-limited deferral. Transcripts were coded deductively and inductively, following a modified Grounded Theory approach. Analysis identified recurrent and divergent themes. RESULTS Ninety-five percent of participants endorsed modifying MSM77. Preferred deferral length ranged from none to 5 years; a common opinion was that a science-based deferral period would be less than 1 year. Other policy change recommendations included incorporating questions about specific HIV risk behaviors to the donor questionnaire for all potential donors. Interviewees recognized HIV infection rates are higher in MSM than the general US population, but participants considered themselves low-risk for HIV, donated blood "to save lives," and justified their recommendations as being more effective ways to identify donors at risk for HIV. CONCLUSION Results suggest that MSM donors are concerned with blood safety; they can be appealed to as such. Communications about a new deferral policy should include scientific explanations and acknowledge altruistic motivations of potential donors.
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Affiliation(s)
- Shana Hughes
- UCSF Center for AIDS Prevention Studies, San Francisco, CA
| | - Nicolas Sheon
- UCSF Center for AIDS Prevention Studies, San Francisco, CA
| | | | - Brian Custer
- Blood Systems Research Institute, San Francisco, CA.,Department of Laboratory Medicine, UCSF, San Francisco, CA
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22
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Smith BD, Yartel AK, Krauskopf K, Massoud OI, Brown KA, Fallon MB, Rein DB. Hepatitis C virus antibody positivity and predictors among previously undiagnosed adult primary care outpatients: cross-sectional analysis of a multisite retrospective cohort study. Clin Infect Dis 2015; 60:1145-52. [PMID: 25595745 DOI: 10.1093/cid/civ002] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Hepatitis C virus (HCV) testing guidance issued by the Centers for Disease Control and Prevention in 1998 recommends HCV antibody (anti-HCV) testing for persons with specified risk factors. The purpose of this study was to determine the prevalence and predictors of anti-HCV positivity among primary care outpatients and estimate the proportion of unidentified anti-HCV-positive (anti-HCV+) persons using risk-based testing. METHODS We analyzed electronic medical record data from a 4-site retrospective study. Patients were aged ≥18 years, utilized ≥1 outpatient primary care service(s) between 2005 and 2010, and had no documented evidence of prior HCV diagnosis. Among persons tested for anti-HCV, we fit a multilevel logistic regression model to identify patient-level independent predictors of anti-HCV positivity. We estimated the proportion of unidentified anti-HCV+ persons by using multiple imputation to assign anti-HCV results to untested patients. RESULTS We observed 209 076 patients for a median of 5 months (interquartile range, 1-23 months). Among 17 464 (8.4%) patients who were tested for anti-HCV, 6.4% (n=1115) were positive. We identified history of injection drug use (adjusted odds ratio [95% confidence interval], 6.3 [5.2-7.6]), 1945-1965 birth cohort (4.4 [3.8-5.1]), and elevated alanine aminotransferase levels (4.8 [4.2-5.6]) as independently associated with anti-HCV positivity. We estimated that 81.5% (n=4890/6005) of anti-HCV+ patients were unidentified using risk-based testing. CONCLUSIONS In these outpatient primary care settings, risk-based testing may have missed 4 of 5 newly enrolled patients who are anti-HCV+. Without knowing their status, unidentified anti-HCV+ persons cannot receive further clinical evaluation or antiviral treatment, and are unlikely to benefit from secondary prevention recommendations to limit disease progression and mortality.
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Affiliation(s)
- Bryce D Smith
- Division of Viral Hepatitis, Centers for Disease Control and Prevention
| | - Anthony K Yartel
- Centers for Disease Control and Prevention Foundation, Atlanta, Georgia
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23
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Smith BD, Yartel AK. Comparison of hepatitis C virus testing strategies: birth cohort versus elevated alanine aminotransferase levels. Am J Prev Med 2014; 47:233-41. [PMID: 25145616 PMCID: PMC5759754 DOI: 10.1016/j.amepre.2014.05.011] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2013] [Revised: 04/12/2014] [Accepted: 05/06/2014] [Indexed: 02/06/2023]
Abstract
BACKGROUND Hepatitis C virus (HCV) infection is unidentified in an estimated 40%-85% of infected adults. Surveillance and modeling data have found significant increases in HCV-associated morbidity and mortality. PURPOSE To compare two HCV antibody (anti-HCV) testing strategies based on (1) elevated alanine aminotransferase levels (ALT) and (2) a birth cohort approach for people born during 1945-1965. METHODS Data from 19,055 adults aged 20-70 years who completed the National Health and Nutrition Examination Survey in 1999-2008 were analyzed in 2013. Two independent models were evaluated, based on membership in the 1945-1965 birth cohort or elevated ALT, to compare the number of identified anti-HCV-positive (anti-HCV+) individuals; proportion of total identified cases; and the number of people that would be tested using either strategy. RESULTS The prevalence of anti-HCV among adults aged 20-70 years was estimated at 2.0% (95% CI=1.8%, 2.3%), representing about 3.6 million people. The birth cohort strategy would result in testing about 85.4 million people and identifying nearly 2.8 million anti-HCV+ people with a sensitivity of 76.6%. The ALT strategy would test about 21.5 million adults and identify approximately 1.8 million anti-HCV+ people with a sensitivity of 50.0%. Implementing both strategies concurrently would identify 87.3% of anti-HCV+ adults. CONCLUSIONS The birth cohort strategy, which is recommended by both the CDC and the U.S. Preventive Services Task Force, would identify 1 million more anti-HCV+ people than the elevated ALT approach. Concurrent implementation would identify an even larger number of individuals ever infected.
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Kapeluto JE, Kadatz M, Wormsbecker A, Sidhu K, Yoshida EM. Screening, detecting and enhancing the yield of previously undiagnosed hepatitis B and C in patients with acute medical admissions to hospital: a pilot project undertaken at the Vancouver General Hospital. Can J Gastroenterol Hepatol 2014; 28:315-8. [PMID: 24945186 PMCID: PMC4072230 DOI: 10.1155/2014/190210] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2013] [Accepted: 04/28/2014] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Hepatitis B virus (HBV) and hepatitis C virus (HCV) represent an increasing health burden and morbidity in Canada. Viral hepatitis, specifically HCV, has high prevalence among persons born between 1945 and 1965, with 45% to 85% of infected adults asymptomatic and unaware of their infection. Screening has been shown to be cost effective in the detection and treatment of viral hepatitis. OBJECTIVE To quantify incidence and identify undocumented HBV and HCV infection in hospitalized patients at a single centre with secondary analysis of risk factors as part of a quality improvement initiative. METHODS A one-time antibody test was conducted in patients admitted to the acute medicine and gastroenterology services. RESULTS Over a 12-week period, hospital screening for HBV and HCV was performed in 37.3% of 995 admitted patients. There was identification of 15 previously undiagnosed cases of HCV (4%) and 36 undocumented cases of occult (ie, antihepatitis B core antigen seropositive) or active (ie, hepatitis B surface antigen seropositive) HBV (9.7%). Among patients with positive screens, 60% of seropositive HCV patients had no identifiable risk factors. CONCLUSIONS The prevalence of HBV and HCV infection among hospitalized patients in Vancouver was higher than that of the general population. Risk factors for contraction are often not identified. These results can be used as part of an ongoing discussion regarding a 'seek and treat' approach to the detection and treatment of chronic blood-borne viral illnesses.
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Affiliation(s)
- Jordanna E Kapeluto
- Department of Medicine, University of British Columbia, Vancouver, British Columbia
| | - Matthew Kadatz
- Department of Medicine, University of British Columbia, Vancouver, British Columbia
| | - Andrew Wormsbecker
- Department of Medicine, University of British Columbia, Vancouver, British Columbia
| | - Kiran Sidhu
- Department of Medicine, University of British Columbia, Vancouver, British Columbia
| | - Eric M Yoshida
- Division of Gastroenterology, University of British Columbia, Vancouver, British Columbia
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Lucky TTA, Seed CR, Waller D, Lee JF, McDonald A, Wand H, Wroth S, Shuttleworth G, Keller AJ, Pink J, Wilson DP. Understanding noncompliance with selective donor deferral criteria for high-risk behaviors in Australian blood donors. Transfusion 2014; 54:1739-49. [PMID: 24720444 DOI: 10.1111/trf.12554] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2013] [Revised: 11/27/2013] [Accepted: 11/27/2013] [Indexed: 11/27/2022]
Abstract
BACKGROUND Using a predonation screening questionnaire, potential blood donors are screened for medical or behavioral factors associated with an increased risk for transfusion-transmissible infection. After disclosure of these risks, potential donors are deferred from donating. Understanding the degree of failure to disclose full and truthful information (termed noncompliance) is important to determine and minimize residual risk. This study estimates the prevalence of, and likely reasons for, noncompliance among Australian donors with the deferrals for injecting drug use, sex with an injecting drug user, male-to-male sex, sex worker activity or contact, and sex with a partner from a high-HIV-prevalence country. STUDY DESIGN AND METHODS An anonymous, online survey of a nationally representative sample of Australian blood donors was conducted. Prevalence of noncompliance with deferrable risk categories was estimated. Factors associated with noncompliance were determined using unadjusted and adjusted odds ratios. RESULTS Of 98,044 invited donors, 30,790 donors completed the survey. The estimated prevalence of overall noncompliance (i.e., to at least one screening question) was 1.65% (95% confidence interval CI, 1.51%-1.8%). Noncompliance with individual deferrals ranged from 0.05% (sex work) to 0.54% (sex with an injecting drug user). The prevalences of the disclosed exclusionary risk behaviors were three to 14 times lower than their estimated prevalence in the general population. CONCLUSION The prevalence of noncompliance is relatively low but our estimate is likely to be a lower bound. The selected high-risk behaviors were substantially less common in blood donors compared to the general population suggesting that self-deferral is effective. Nevertheless, a focus on further minimization should improve the blood safety.
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Affiliation(s)
- Tarana T A Lucky
- The Kirby Institute, The University of New South Wales, Sydney, New South Wales, Australia
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Smith BD, Beckett GA, Yartel A, Holtzman D, Patel N, Ward JW. Previous exposure to HCV among persons born during 1945-1965: prevalence and predictors, United States, 1999-2008. Am J Public Health 2014; 104:474-81. [PMID: 24432883 DOI: 10.2105/ajph.2013.301549] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
OBJECTIVES We examined HCV exposure prevalence and predictors among persons in the United States born during 1945-1965. METHODS With data from the 1999-2008 National Health and Nutrition Examination Survey, we calculated the proportion of persons born during 1945-1965 who tested positive for HCV antibody (anti-HCV) and analyzed the prevalence by sociodemographic and behavioral risk factors. RESULTS Anti-HCV prevalence in the 1945-1965 birth cohort was 3.2% (95% confidence interval [CI] = 2.8%, 3.8%), substantially higher than among other adults (0.9%). Within the cohort, anti-HCV prevalence was higher among non-Hispanic Blacks (6.4%; 95% CI = 5.3%, 7.7%), persons with injection drug use histories (56.8%; 95% CI = 48.4%, 64.8%), and persons with elevated alanine aminotransferase levels (12.7%; 95% CI = 10.7%, 15.1%). Injection drug use (adjusted odds ratio = 98.4; 95% CI = 58.8, 164.5) was the strongest anti-HCV prevalence predictor. Among anti-HCV-positive persons, 57.8% reported having 2 or more alcoholic drinks daily. CONCLUSIONS With the high prevalence of HCV among persons born during 1945-1965, the increasing morbidity and mortality associated with HCV, and reductions in liver cancer and HCV-related mortality when HCV is eradicated, it is critically important to identify persons with HCV and link them to appropriate care.
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Affiliation(s)
- Bryce D Smith
- Bryce D. Smith, Geoff A. Beckett, Deborah Holtzman, and John W. Ward are with the Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, GA. Anthony Yartel and Nita Patel are with the Centers for Disease Control and Prevention Foundation, Atlanta, GA
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Miranda C, Moreno E, Bruhn R, Larsen NM, Wright DJ, Oliveira CDL, Carneiro-Proietti ABF, Loureiro P, de Almeida-Neto C, Custer B, Sabino EC, Gonçalez TT. Knowledge of HIV testing and attitudes towards blood donation at three blood centres in Brazil. Vox Sang 2013; 106:344-53. [PMID: 24313562 DOI: 10.1111/vox.12114] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2013] [Revised: 10/08/2013] [Accepted: 10/17/2013] [Indexed: 11/28/2022]
Abstract
BACKGROUND Reducing risk of HIV window period transmission requires understanding of donor knowledge and attitudes related to HIV and risk factors. STUDY DESIGN AND METHODS We conducted a survey of 7635 presenting blood donors at three Brazilian blood centres from 15 October through 20 November 2009. Participants completed a questionnaire on HIV knowledge and attitudes about blood donation. Six questions about blood testing and HIV were evaluated using maximum likelihood chi-square and logistic regression. Test seeking was classified in non-overlapping categories according to answers to one direct and two indirect questions. RESULTS Overall, respondents were male (64%) repeat donors (67%) between 18 and 49 years old (91%). Nearly 60% believed blood centres use better HIV tests than other places; however, 42% were unaware of the HIV window period. Approximately 50% believed it was appropriate to donate to be tested for HIV, but 67% said it was not acceptable to donate with risk factors even if blood is tested. Logistic regression found that less education, Hemope-Recife blood centre, replacement, potential and self-disclosed test-seeking were associated with less HIV knowledge. CONCLUSION HIV knowledge related to blood safety remains low among Brazilian blood donors. A subset finds it appropriate to be tested at blood centres and may be unaware of the HIV window period. These donations may impose a significant risk to the safety of the blood supply. Decreasing test-seeking and changing beliefs about the appropriateness of individuals with behavioural risk factors donating blood could reduce the risk of transfusing an infectious unit.
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Affiliation(s)
- C Miranda
- Fundação Hemominas Hemocentro de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
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Seed CR, Lucky TT, Waller D, Wand H, Lee JF, Wroth S, McDonald A, Pink J, Wilson DP, Keller AJ. Compliance with the current 12-month deferral for male-to-male sex in Australia. Vox Sang 2013; 106:14-22. [DOI: 10.1111/vox.12093] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2013] [Revised: 09/01/2013] [Accepted: 09/03/2013] [Indexed: 11/27/2022]
Affiliation(s)
- C. R. Seed
- Australian Red Cross Blood Service; Perth WA Australia
| | - T. T. Lucky
- The Kirby Institute; University of New South Wales; Sydney NSW Australia
| | - D. Waller
- Australian Red Cross Blood Service; Sydney NSW Australia
| | - H. Wand
- The Kirby Institute; University of New South Wales; Sydney NSW Australia
| | - J. F. Lee
- Australian Red Cross Blood Service; Perth WA Australia
| | - S. Wroth
- Australian Red Cross Blood Service; Perth WA Australia
| | - A. McDonald
- The Kirby Institute; University of New South Wales; Sydney NSW Australia
| | - J. Pink
- Australian Red Cross Blood Service; Brisbane Qld Australia
| | - D. P. Wilson
- The Kirby Institute; University of New South Wales; Sydney NSW Australia
| | - A. J. Keller
- Australian Red Cross Blood Service; Perth WA Australia
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Omland LH, Osler M, Jepsen P, Krarup H, Weis N, Christensen PB, Roed C, Sørensen HT, Obel N. Socioeconomic status in HCV infected patients - risk and prognosis. Clin Epidemiol 2013; 5:163-72. [PMID: 23766659 PMCID: PMC3678712 DOI: 10.2147/clep.s43926] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Background and aims It is unknown whether socioeconomic status (SES) is a risk factor for hepatitis C virus (HCV) infection or a prognostic factor following infection. Methods From Danish nationwide registries, we obtained information on three markers of SES: employment, income, and education. In a case control design, we examined HCV infected patients and controls; conditional logistic regression was employed to obtain odds ratios (ORs) for HCV infection for each of the three SES markers, adjusting for the other two SES markers, comorbidity, and substance abuse. In a cohort design, we used Cox regression analysis to compute mortality rate ratios (MRRs) for each of the three SES markers, adjusting for the other two SES markers, comorbidity level, age, substance abuse, and gender. Results When compared to employed persons, ORs for HCV infection were 2.71 (95% confidence interval [CI]: 2.24–3.26) for disability pensioners and 2.24 (95% CI: 1.83–2.72) for the unemployed. When compared to persons with a high income, ORs were 1.64 (95% CI: 1.34–2.01) for low income persons and 1.19 (95% CI: 1.02–1.40) for medium income persons. The OR was 1.35 (95% CI: 1.20–1.52) for low education (no more than basic schooling). When compared to employed patients, MRRs were 1.71 (95% CI: 1.22–2.40) for unemployed patients and 2.24 (95% CI: 1.63–3.08) for disability pensioners. When compared to high income patients, MRRs were 1.47 (95% CI: 1.05–2.05) for medium income patients and 1.64 (95% CI: 1.13–2.34) for low income patients. Educational status was not associated with mortality. Conclusion Low SES was associated with an increased risk of HCV infection and with poor prognosis in HCV infected patients.
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Affiliation(s)
- Lars Haukali Omland
- Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
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O'Brien SF, Scalia V, Goldman M, Fan W, Yi QL, Huang M, Ndao M, Fearon MA. Evaluation of selective screening of donors for antibody to Trypanosoma cruzi: seroprevalence of donors who answer "no" to risk questions. Transfusion 2013; 54:863-9. [PMID: 23614476 DOI: 10.1111/trf.12219] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2013] [Revised: 03/06/2013] [Accepted: 03/06/2013] [Indexed: 12/25/2022]
Abstract
BACKGROUND Selective testing of donors for Trypanosoma cruzi infection relies on identification of at-risk donors with screening questions. Using risk modeling and a seroprevalence study, we evaluated the risk of questions failing to identify T. cruzi antibody-positive donors. STUDY DESIGN AND METHODS The rate of donors with unreported risk was estimated by a telephone survey of 2677 donors who answered "no" to risk questions. The number of T. cruzi antibody-positive donors missed by risk questions was estimated from the product of this rate and the selective testing T. cruzi antibody-positive rate. The 95% confidence interval (CI) was estimated by Monte Carlo simulation. To test the model, 60,132 donors were tested for T. cruzi antibody (26% of donors in selected regions, Phase I). In Winnipeg, Manitoba, the highest-risk region, 26,915 donors were tested (92.5% of donors, Phase II). RESULTS In the telephone survey, 21 (0.8%) donors reported risk factors that would have identified them for selective testing. Seven were born in Mexico or Central or South America, five had travel risk, and nine had mother or maternal grandmother risk. The 95% CI for predicted number of T. cruzi antibody-positive donors answering "no" to risk questions was 0.71 to 4.38. In Phase I, one Winnipeg donor confirmed positive but had answered risk questions correctly. No other positive donations were identified. CONCLUSION The estimated risk of T. cruzi-positive donors who answer "no" to risk questions is low and is confirmed by the seroprevalence among these donors.
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Affiliation(s)
- Sheila F O'Brien
- Canadian Blood Services, Ottawa, Ontario, Canada; Department of Epidemiology & Community Medicine, Department of Pathology & Laboratory Medicine, University of Ottawa, Ottawa, Ontario, Canada; Department of Pathology & Laboratory Medicine, University of Toronto, Toronto, Ontario, Canada; National Reference Center for Parasitology, McGill University, Montreal, Quebec, Canada
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Ramsey G. Blood component recalls and market withdrawals: frequency, reasons, and management in the United States. Transfus Med Rev 2013; 27:82-90. [PMID: 23375736 PMCID: PMC7127789 DOI: 10.1016/j.tmrv.2012.11.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
In a previous article, we reviewed the management of blood component recalls and withdrawals (G. Ramsey. Transfusion Med Rev 2004;18:36-45). Since then, US rates of recall and biological product deviation for blood components have improved significantly, particularly with regard to reduced recalls for donor infectious disease risks or testing. However, analysis of the current data from the US Food and Drug Administration suggests that 1 (0.4%) in 250 blood components is involved in market withdrawals and quarantines, with 1 in 5800 components formally recalled. Most of these units, unfortunately, had already have been transfused. The U.S. Food and Drug Administration has issued several recent guidances that address transfusion service actions for dealing with specific infectious disease problems. This present article updates our 2004 recommendations as to when to notify physicians about transfused nonconforming blood components.
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Affiliation(s)
- Glenn Ramsey
- Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA.
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Salamat N. Effectiveness of blood donor questionnaire directed at risk factor for transfusion transmitted infections in Pakistani population. Asian J Transfus Sci 2012; 6:169-73. [PMID: 22988384 PMCID: PMC3439758 DOI: 10.4103/0973-6247.98929] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background: Deferring blood donors who admit to high-risk behavior on questioning are likely to eliminate those in window period for transfusion transmitted infections (TTI). However, many questions have been implemented in some countries as part of donor history questionnaire, based on precautionary principle and not on evidence, and can result in increased donor losses. This study aims to identify effective risk-directed questions having high predictive value, in local context which can form part of blood donor deferral policies. For this, a case control study in a hospital blood bank having donation services was carried out prospectively over a period of three years. Materials and Methods: Two hundred and twenty donors, who were repeatedly reactive for HBsAg, anti-HCV, anti-HIV with EIA, and syphilis with TPHA, were the cases. Eight hundred and eighty four controls were the donors who tested negative for all TTI test. All donors answered seven hepatitis risk directed questions and their responses and reactivity status for TTI were used for statistical analysis with SPSS ver. 15. Results: Positive predictive value for history of jaundice at any age for HBsAg was 20%, while PPV for history of surgery in previous six months for both HBsAg and anti-HCVHCV was also around 20%, based on pretest probability of 7%. The post-test probability for these questions was around 30%. Odds ratios with 95% CI did not reveal any significant association of hepatitis with any of seven questions. Donor losses after deferring on basis of two questions were 5.3% per year, while deferral rate after all seven questions was 20%. Conclusions: Donors should be permanently deferred if there is history of jaundice at any age, while deferral period after surgery should be one year. Other risk-directed questions should not be used to defer donors. Donor deferral policies should be evidence based and questions with proven efficacy should be made part of donor history questionnaire to minimize donor losses.
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Affiliation(s)
- Nuzhat Salamat
- Department of Pathology, Combined Military Hospital, Multan Cantt, Pakistan
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Klevens RM, Hu DJ, Jiles R, Holmberg SD. Evolving epidemiology of hepatitis C virus in the United States. Clin Infect Dis 2012; 55 Suppl 1:S3-9. [PMID: 22715211 PMCID: PMC5774980 DOI: 10.1093/cid/cis393] [Citation(s) in RCA: 153] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
The impact of hepatitis C virus (HCV) infection on health and medical care in the United States is a major problem for infectious disease physicians. Although the incidence of HCV infection has declined markedly in the past 2 decades, chronic infection in 3 million or more residents now accounts for more disease and death in the United States than does human immunodeficiency virus (HIV)/AIDS. Current trends in the epidemiology of HCV infection include an apparent increase in young, often suburban heroin injection drug users who initiate use with oral prescription opioid drugs; infections in nonhospital healthcare (clinic) settings; and sexual transmission among HIV-infected persons. Infectious disease physicians will increasingly have the responsibility of diagnosing and treating HCV patients. An understanding of how these patients were infected is important for determining whom to screen and treat.
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Affiliation(s)
- R Monina Klevens
- Division of Viral Hepatitis, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, 1600 Clifton Road NE, Atlanta, GA 30333, USA
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Wilkinson SL, Vij V, Steele WR. Donors' perspectives on their postdonation information (PDI) event: a qualitative interview study of PDI donors. Transfusion 2011; 52:1062-9. [DOI: 10.1111/j.1537-2995.2011.03430.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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O'Brien SF, Zou S, Laperche S, Brant LJ, Seed CR, Kleinman SH. Surveillance of transfusion-transmissible infections comparison of systems in five developed countries. Transfus Med Rev 2011; 26:38-57. [PMID: 21944935 PMCID: PMC7134890 DOI: 10.1016/j.tmrv.2011.07.001] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Most industrialized countries maintain surveillance programs for monitoring transmissible infection in blood donations, revising approaches to methodology and risk assessment as new threats emerge. A comparison of programs in the United States, Canada, France, the UK, and Australia indicates that they have similar function, although the structure of blood programs vary as does the extent and nature of formal ties with public health. The emergence of HIV in the late 1970s and early 1980s was key in recognizing that surveillance systems specific to blood transfusion were essential. Hence, most industrialized countries monitor transfusion-transmissible infections in donors and evaluate the impact of new testing and of predonation screening strategies. Emerging infections since HIV have had different transmission pathways and challenged blood programs to draw upon resources for a rapid and effective response, with recognition that the original focus on sexual/drug-related risk of HIV and hepatitis was inadequate. The focus of surveillance programs on new and emerging pathogens fulfills a key role in risk assessment and policy formulation. The precise nature of such activities varies by country because of the structure of the blood programs and surveillance systems, the strategic focus of the blood programs, and the epidemiology of disease in each country.
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Affiliation(s)
- Sheila F O'Brien
- National Epidemiology and Surveillance, Canadian Blood Services, 1800 Alta Vista Drive, Ottawa, Ontario, Canada K1G 4J5. sheila.o'
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Wilkinson SL, Steele WR, High PM, Wright DJ. Characteristics of post donation information donors and comparison with appropriately deferred donors. Transfusion 2011; 51:1503-10. [PMID: 21303374 DOI: 10.1111/j.1537-2995.2010.03043.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Post donation information (PDI) is the most frequently reported biological product deviation (BPD) related to donor suitability and the health history screening process. PDI occurs when a deferrable health history known by the donor is not disclosed, but is subsequently disclosed at a future donation. STUDY DESIGN AND METHODS PDI and appropriately deferred (AD) donors were identified at six US blood centers from July 1, 2006, to June 30, 2007. PDI and AD donors were categorized according to travel, medical, blood disease or exposure, and high-risk-sexual and high-risk-nonsexual deferrals. Information was obtained from BPD reports and blood center records. Predictors of PDI were identified using an adjusted logistic regression model controlling for select characteristics. RESULTS There were 2059 PDI and 36,512 AD donors. PDI donors were significantly more likely to be male, older, and more educated than AD donors. Medical and high-risk-sexual PDI donors were more likely to have more than six intervening donations before disclosure of deferrable history. PDI donors with a deferral reason due to high-risk behaviors (both sexual and nonsexual) were 2.3 and 2.6 times more likely to be PDI than the reference group (travel PDI donors). CONCLUSIONS No previous studies have described the characteristics of PDI donors or examined how PDI donors are different from AD donors for the same deferral reasons. We found that PDIs are more likely in older, male donors with higher levels of education when compared to AD donors.
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Affiliation(s)
- Susan L Wilkinson
- Hoxworth Blood Center, University of Cincinnati Academic Health Center, Cincinnati, Ohio 45267-0055, USA.
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Seed CR, Kiely P, Law M, Keller AJ. No evidence of a significantly increased risk of transfusion-transmitted human immunodeficiency virus infection in Australia subsequent to implementing a 12-month deferral for men who have had sex with men (CME). Transfusion 2010; 50:2722-30. [DOI: 10.1111/j.1537-2995.2010.02793.x] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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