Screening for high-risk sexual behavior in Canada

Assessing HIV trends among blood donors in five Brazilian blood centers: The impact of individual donor assessment

BACKGROUND

In many countries, including Brazil, time-based blood donation deferral policies for gay, bisexual, and other men who have sex with men (gbMSM) have been replaced by individual donor assessment (IDA). We examined HIV prevalence and incidence among first-time (FTD) and repeat donors (RD), comparing data from ~3.5 years before and after the IDA policy implementation in 2020.

STUDY DESIGN AND METHODS

The Recipient Epidemiology and Donor Evaluation Study-IV-Pediatric (REDS-IV-P) Brazil component collects blood donor screening data from five public centers. From January 2017 to December 2023, we report frequencies, rates, and 95% confidence interval (CI) of confirmed HIV-positive donations among FTD, HIV NAT-yield rates for FTD and RD, and the incidence of confirmed HIV among RD before and after the policy change. We also report multivariable regression analysis results.

RESULTS

Confirmed HIV prevalence in FTD was 79 per 100,000 (95% CI 72-87) before and 100 per 100,000 (95% CI 90-109) after the policy change, with differences between centers. HIV NAT-yield rates decreased for RD (p = .0025), with no change for FTD (p = .3). HIV incidence in RD did not increase (12.4 [95% CI: 11.1-13.9] vs. 10.3 [95% CI: 9-11.7] per 100,000 person-years).

DISCUSSION

Our findings showed no significant difference in HIV incidence among RD. Although HIV prevalence among FTD increased, there was no rise in HIV NAT-yield donations. The analysis highlights challenges in interpreting changes within specific groups and blood centers, underscoring the importance of multicenter monitoring of transfusion-transmitted infections.

Implementation of sexual risk behavior donor screening in Canada

BACKGROUND

The two Canadian blood suppliers, Canadian Blood Services and Héma-Québec, removed the time-based deferral for men who have sex with men and adopted criteria assessing sexual risk behaviors. We report the impact of these changes on the safety and adequacy of the Canadian blood supply.

STUDY DESIGN AND METHODS

Since 2022, all donors are asked if (1) they have had a new partner and (2) more than one sexual partner in the last 3 months. Donors answering yes to either question are asked if they had anal sex in the last 3 months; if yes, they are deferred for 3 months. We followed HIV rates for the 18 months before and 14 (Héma-Québec) or 18 months (Canadian Blood Services) post-implementation and interviewed HIV-positive whole blood donors. We assessed the number and characteristics of whole blood donors answering yes to the two first questions with or without deferral.

RESULTS

There were four HIV-positive donations out of 1,492,355 donations pre-implementation and four out of 1,447,772 post-implementation (0.27/100,000 vs. 0.28/100,000, p = 1.00). Post-implementation, one HIV-positive donor was non-compliant with multiple criteria, no risk factors were identified in the others. 3.2% of donors answered yes to questions (1) and/or (2); 0.17% were deferred for a new partner and/or more than one partner and anal sex. Deferral rates were highest in first time, younger donors, and similar in males and females.

CONCLUSION

Implementation of sexual risk behavior donor screening resulted in unchanged HIV rates to date and a manageable deferral rate.

MSM and blood donation: shifting to individualized risk assessment

Deferring donors at higher risk for transfusion transmissible infections is an important part of ensuring blood safety. The deferral for gay, bisexual, and other men who have sex with men (gbMSM) was implemented in the 1980s in many countries, since they were identified as a high-risk group for AIDS/HIV. With the introduction of increasingly sensitive HIV antibody testing, augmented by nucleic acid testing, the window period for HIV infection-when a donor may be infectious but have negative test results-has shrunk dramatically. In Canada, this has led to progressively shorter deferral periods for gbMSM, decreasing from a permanent deferral for sex with another male since 1977 to a 5-year, 12-month, and eventually 3-month deferral period. These time-based deferrals maintained safety; however, they are seen as stigmatizing by many and still result in the deferral of sexually active gbMSM. More recently, several countries have moved to a donor screening approach based on assessing sexual risk behaviors in all donors. This article outlines research supporting changes in policy, current eligibility screening policies in several countries, and preliminary results postimplementation of new eligibility policies in Canada in September 2022.

Evolving the gay, bisexual and other men who have sex with men time-based deferral to sexual risk screening for all donors: The contribution of Canadian research programmes

BACKGROUND AND OBJECTIVES

In Canada, the time deferral for gay, bisexual and other men who have sex with men (gbMSM) to donate blood has gradually decreased. In September 2022, this deferral was replaced with sexual behaviour-based screening for all donors. We investigate how data from targeted research programmes addressed knowledge gaps to support this change.

MATERIALS AND METHODS

We conducted a scoping review describing the Canadian literature available before the research programmes relating to (1) behavioural indicators of HIV risk and (2) attitudes to blood donation among gbMSM, current donors and the general population. We summarize the targeted research programmes, their outputs and impact to date.

RESULTS

For question 1, five projects met inclusion criteria. For question 2, three articles met inclusion criteria. Knowledge gaps identified were insufficient evidence of HIV incidence in gbMSM who met other donor eligibility criteria and scant data on opinions and views of blood donation and screening criteria for sexual risk behaviours. The research programmes funded 19 projects at 11 different research sites involving over 100 individual researchers/collaborators resulting in 19 peer-reviewed publications to date. Leveraging existing gbMSM cohorts yielded relevant HIV incidence data to inform safety modelling studies. Findings indicated that sexual behaviour-based screening was acceptable to gbMSM and donors, and donor discomfort around specific questions could be mitigated with clear explanations.

CONCLUSION

Targeted research programmes filled critical knowledge gaps and informed a change to gender-neutral, sexual behaviour-based screening for all donors. Findings supported successful implementation of these changes with research-informed staff training.