Excluding blood donors at high risk of HIV infection in a west African city.

Abstract

Objective-To examine the potential impact of deferral ofblood donors at high risk of HIV infection in a west African city where blood is screened for HIV antibodies but no other special measures are taken to protect the blood supply. Design-Cross sectional study. Setting-National Blood Transfusion Centre and Project RETRO-CI, an international collaborative AIDS research project, Abidjan, Cote d'Ivoire. Subjects-1257 male first time blood donors. Interventions-Blood donors were interviewed about demographic and behavioural characteristics and tested for HIV antibodies by enzyme immunoassay and, ifpositive, synthetic peptide based tests. Main outcome measures-HIV antibody status in relation to presence of behavioural risk factors; calculation of sensitivity, specificity, and predictive values of specific criteria for excluding HIV infected donors. Results-The overall prevalence of HIV infection was 11.4%. The most important risk factors for HIV positivity were prostitute contact and being aged 30-39 years. For identifying seropositive donors individual criteria had sensitivity, specificity, and positive predictive values ranging from 15% to 98%, 38% to 91%, and 17% to 300/o respectively. Prostitute contact in the past five years would have excluded 31% of all donors and 730/o of HIV infected donors. 27% of those excluded would have been HIV positive. Conclusions-The widespread assumption that donor deferral is not feasible in sub-Saharan Africa needs reassessment. In Abidjan this approach was well accepted and potentially effective. Donor deferral requires evaluation as a strategy for improving blood safety in resource poor areas with high rates of HIV infection.

Intervenciones para la prevención del VIH e ITS en América Latina y Caribe: una revisión de la experiencia regional

“…La autoexclusión de donantes según factores de riesgo ha sido también una práctica habitual, atendiendo al período ventana entre infección y seroconversión. En contextos de mayor prevalencia de infección, estos programas pueden eliminar a una buena proporción de donantes seropositivos antes de realizar el tamizaje 94 , aunque, por incidir en preguntas de historia personal referidas a la "pertenencia a grupos de riesgo", ha sido vista por algunos como violadora de derechos 95 .…”

Epidemiology and Prevention of Transfusion-Associated Human Immunodeficiency Virus Transmission in Sub-Saharan Africa

“…Commonly reported risk factor exclusion criteria included: history of multiple partners, genital ulcers, commercial sex work, injection dmg use and having an HIV-infected partner. Recent publi cations indicate that several African nations have been de veloping specific HIV risk factor exclusion strategies [51,61,73,74], Other publications recommend that certain demographically defined populations in sub-Saharan Africa should be avoided (such as persons aged 30-39 years) and others actively recruited (such as secondary school boys) for donation [8,75], infections are concentrated in a limited number of 'trans mission categories', HIV risk factor exclusion is likely to reduce contamination due to laboratory false-negatives, hu man error and window period donations.…”

“…In Africa, HIV infections are not concentrated in a few transmission categories and occur to a far greater extent in the general population. Another concern is that risk factor exclusion might result in the loss of too many potential donors in a region experiencing chronic shortages of blood [8,14,36,37,42,[60][61][62]. Moreover, many blood donations in Africa are made by patients' relatives or friends [14,15,19].…”

“…Unfortunately, these strategies have not been uni versally implemented. Many facilities performing transfu sions in Africa have been unable to establish antibody screening of donated blood [1][2][3][4][5][6][7][8]. Unnecessary use of blood in Africa continues [5,[9][10][11][12][13][14][15][16][17][18][19][20][21][22], Moreover, the efficacy of HIV risk factor exclusion strategies in Africa has been ques tioned [10,14,[23][24][25][26][27].…”

Donor Selection and Microbial Screening

“…The likelihood of HIV infection in potential donors has been addressed in Côte d'Ivoire. Using behavioural char acteristics a large proportion of donors who were most likely to be HIV-infected were identified [1] with the con sequent loss of 1/3 of prospective donors. Doubt has therefore been cast on the widespread belief that it is impractical to exclude donors at high risk of HIV infec tion in Africa!…”