Undisclosed Sexual Risk Exposures: Results of a Nationwide Compliance Study among Whole Blood Donors in Germany

Abstract

<b><i>Background:</i></b> Undisclosed sexual infection risks are the main reasons for transfusion transmissible infections in German blood donors that have qualified for donation by donor health interviews and questionnaires. Until now, data about compliance with deferral criteria were only available from post-donation interviews with infected donors, and information about the proportion of donors which did not disclose (sexual) risks at the donor health questionnaire was not available. <b><i>Methods:</i></b> A prospective nationwide anonymous online survey was conducted to investigate compliance of whole blood donors with deferral criteria for sexual infection risks. Twenty-one blood establishments which represent 80% of the regular whole blood-donor population invited all donors which donated blood during an 8-week period between January and March 2020. <b><i>Results:</i></b> 14,882 participants completed the questionnaire. A relevant proportion of non-compliance was shown (3.0%, 95% CI: 2.7–3.3%) – with male donors being non-compliant significantly more frequently than females (3.5% vs. 2.2%, <i>p</i> < 0.001). A quarter of the non-compliant men were MSM (0.9%, 95% CI: 0.7–1.1%). Non-compliance was strongly associated with the perception that questions about sexual risk exposures are too private. This is in line with the finding that a large proportion of donors (21%) refused to answer at least one question about sexual infection risks. <b><i>Conclusion:</i></b> The presented data, collected for the first time, is suitable for assessing the impact of changes in the donor selection process. Donor’s limited willingness to provide detailed information about sexual risk behaviour has to be kept in mind when further strategies for fair appraisal of individual sexual infection risks will be discussed.

Compliance of blood donors in Germany with non‐sexual deferral criteria

“…The age-dependent non-compliance in our study is consistent with the observed higher non-disclosure of sexual risk exposures in donors younger than 35 years [3]. However, male and female donors differ in their compliance to sexual and non-sexual deferral criteria.…”

“…However, male and female donors differ in their compliance to sexual and non‐sexual deferral criteria. Non‐disclosure of sexual risks is more pronounced in male donors [3], whereas non‐sexual risk exposures were less frequently indicated by women. Therefore, gender‐specific donor education might help to reduce non‐disclosure of risk exposures that are relevant for donor selection.…”

“…We conducted an anonymous online survey among whole‐blood donors in Germany, as has already been described in detail [3]. Briefly, 21 blood establishments (BEs), which represent approximately 80% of the German donor population, invited all non‐deferred donors within an 8‐week period between January and March 2020 by handing over an invitation flyer immediately after donation.…”

“…So far, no data exist for the extent of non-disclosure of non-sexual-risk exposures among whole-blood donors in Germany. We have therefore included questions about recent travel, body modifications, intravenous drug use (IVDU) and mild and febrile infections in a compliance study, which primarily focused on sexual risks [3]. Data analysis aimed to identify donor populations that may need intensified donor education.…”

Men who have sex with men and risk for transfusion‐transmissible infections in blood donors in Western countries: A systematic review update

“…The current systematic review focuses on observational studies concerning TTI risk in MSM blood donors and after easing the MSM deferral. When informing policy-making, other sources of currently available information should be used as well, including findings on compliance and donor comfort when using alternative questions [11,53,54], modelling studies [48][49][50] and surveillance reports [55,56]. In addition, other criteria, including the feasibility and cost-effectiveness of alternative deferral periods, should be further examined and considered when making decisions.…”