101
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Janssen MP, van Hulst M, Custer B. An assessment of differences in costs and health benefits of serology and NAT screening of donations for blood transfusion in different Western countries. Vox Sang 2017. [DOI: 10.1111/vox.12543] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Affiliation(s)
- M. P. Janssen
- Julius Center for Health Sciences and Primary Care; UMC Utrecht; Utrecht The Netherlands
- Transfusion Technology Assessment Department; Sanquin Research; Sanquin Blood Supply Foundation; Amsterdam The Netherlands
| | - M. van Hulst
- Department of Clinical Pharmacy and Toxicology; Martini Hospital; Groningen The Netherlands
- Department of PharmacoTherapy, -Epidemiology & -Economics; Department of Pharmacy; University of Groningen; Groningen The Netherlands
| | - B. Custer
- Blood Systems Research Institute; San Francisco CA USA
- Department of Laboratory Medicine; UCSF; San Francisco CA USA
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102
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Custer B, Janssen MP, Hubben G, Vermeulen M, van Hulst M. Development of a web-based application and multicountry analysis framework for assessing interdicted infections and cost-utility of screening donated blood for HIV, HCV and HBV. Vox Sang 2017; 112:526-534. [PMID: 28597489 DOI: 10.1111/vox.12538] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2016] [Revised: 03/06/2017] [Accepted: 04/25/2017] [Indexed: 01/20/2023]
Abstract
BACKGROUND AND OBJECTIVES Most countries test donations for HIV, HCV and HBV using serology with or without nucleic acid testing (NAT). Cost-utility analyses provide information on the relative value of different screening options. The aim of this project was to develop an open access risk assessment and cost-utility analysis web-tool for assessing HIV, HCV and HBV screening options (http://www.isbtweb.org/working-parties/transfusion-transmitted-infectious-diseases/). An analysis for six countries (Brazil, Ghana, the Netherlands, South Africa, Thailand and USA) was conducted. MATERIALS AND METHODS Four strategies; (1) antibody assays (Abs) for HIV and HCV + HBsAg, (2) antibody assays that include antigens for HIV and HCV (Combo) + HBsAg, (3) NAT in minipools of variable size (MP NAT) and (4) individual donation (ID) NAT can be evaluated using the tool. Country-specific data on donors, donation testing results, recipient outcomes and costs are entered using the online interface. Results obtained include the number infections interdicted using each screening options, and the (incremental and average) cost-utility of the options. RESULTS In each of the six countries evaluated, the use of antibody assays is cost effective or even cost saving. NAT has varying cost-utility depending on the setting, and where adopted, the incremental cost-utility exceeds any previously defined or proposed threshold in each country. CONCLUSION The web-tool allows an assessment of infectious units interdicted and value for money of different testing strategies. Regardless of gross national income (GNI) per capita, countries appear willing to dedicate healthcare resources to blood supply safety in excess of that for other sectors of health care.
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Affiliation(s)
- B Custer
- Blood Systems Research Institute, San Francisco, CA, USA.,Department of Laboratory Medicine, University of California San Francisco, San Francisco, CA, USA
| | - M P Janssen
- Julius Center for Health Sciences and Primary Care, UMC Utrecht, Utrecht, The Netherlands.,Transfusion Technology Assessment Department, Sanquin Research, Sanquin Blood Supply Foundation, Amsterdam, The Netherlands
| | | | - M Vermeulen
- South African National Blood Service, Johannesburg, South Africa
| | - M van Hulst
- Department of PharmacoTherapy, Epidemiology & Economics, University of Groningen, Groningen, The Netherlands.,Department of Clinical Pharmacy and Toxicology, Martini Hospital, Groningen, The Netherlands
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103
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Capuani L, Bierrenbach AL, Pereira Alencar A, Mendrone A, Ferreira JE, Custer B, P. Ribeiro AL, Cerdeira Sabino E. Mortality among blood donors seropositive and seronegative for Chagas disease (1996-2000) in São Paulo, Brazil: A death certificate linkage study. PLoS Negl Trop Dis 2017; 11:e0005542. [PMID: 28545053 PMCID: PMC5436632 DOI: 10.1371/journal.pntd.0005542] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2016] [Accepted: 03/31/2017] [Indexed: 12/03/2022] Open
Abstract
Background Individuals in the indeterminate phase of Chagas disease are considered to have mortality rates similar to those of the overall population. This study compares mortality rates among blood donors seropositive for Chagas disease and negative controls in the city of São Paulo, Brazil. Methodology/principal findings This is a retrospective cohort study of blood donors from 1996 to 2000: 2842 seropositive and 5684 seronegative for Chagas disease. Death status was ascertained by performing probabilistic record linkage (RL) with the Brazil national mortality information system (SIM). RL was assessed in a previous validation study. Cox Regression was used to derive hazard ratios (HR), adjusting for confounders. RL identified 159 deaths among the 2842 seropositive blood donors (5.6%) and 103 deaths among the 5684 seronegative (1.8%). Out of the 159 deaths among seropositive donors, 26 had the 10th International Statistical Classification of Diseases and Related Health Problems (ICD-10) indicating Chagas disease as the underlying cause of death (B57.0/B57.5), 23 had ICD-10 codes (I42.0/I42.2/I47.0/I47.2/I49.0/I50.0/I50.1/ I50.9/I51.7) indicating cardiac abnormalities possibly related to Chagas disease listed as an underlying or associated cause of death, with the others having no mention of Chagas disease in part I of the death certificate. Donors seropositive for Chagas disease had a 2.3 times higher risk of death due to all causes (95% Confidence Interval (95% CI), 1.8–3.0) than seronegative donors. When considering deaths due to Chagas disease or those that had underlying causes of cardiac abnormalities related to Chagas disease, seropositive donors had a risk of death 17.9 (95% CI, 6.3–50.8) times greater than seronegative donors. Conclusions/significance There is an excess risk of death in donors seropositive blood for Chagas disease compared to seronegative donors. Chagas disease is an under-reported cause of death in the Brazilian mortality database. Chagas disease is classified as one of the 17 most important neglected diseases by the World Health Organization (WHO). The majority of infected individuals live in 21 countries of Central and South America. Estimates of mortality attributable to Chagas disease vary considerably (between 0.2% and 19.2% annually). To improve the measurement of disease burden and policy decision-making in regard to treatment availability, more accurate estimates of mortality, especially among otherwise asymptomatic seropositive individuals are needed,. This study compares mortality rates and causes of death of asymptomatic blood donors who tested seropositive for Chagas disease and seronegative for all screening tests conducted in Brazil. Mortality status was ascertained by linking donor names with the Brazilian national mortality information system (SIM). The study found that donors who tested Chagas disease seropositive had risk of death from all causes 2.3 (95% CI, 1.8–3.0) times greater than seronegative ones. The data also suggest that the SIM may underestimate the total number of deaths attributable to Chagas disease in Brazil.
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Affiliation(s)
- Ligia Capuani
- Department of Infectious Diseases, School of Medicine—University of Sao Paulo—FMUSP, Sao Paulo, Sao Paulo, Brazil
- * E-mail:
| | - Ana Luiza Bierrenbach
- Institute of Education and Research, Hospital Sirio Libanes, Sao Paulo, Sao Paulo, Brazil
| | - Airlane Pereira Alencar
- Department of Statistics, Institute of Mathematics and Statistics, University of Sao Paulo—IME-USP, Sao Paulo, Sao Paulo, Brazil
| | - Alfredo Mendrone
- Fundação Pró-Sangue—Hemocenter of Sao Paulo, Sao Paulo, Sao Paulo, Brazil
| | - João Eduardo Ferreira
- Department of Computer Science, Institute of Mathematics and Statistics, University of Sao Paulo—IME-USP, Sao Paulo, Sao Paulo, Brazil
| | - Brian Custer
- Epidemiology and Health Policy Research, Blood Systems Research Institute—BSRI, San Francisco, California, United States of America
| | - Antonio Luiz P. Ribeiro
- Hospital das Clínicas and School of Medicine, Universidade Federal de Minas Gerais—UFMG, Belo Horizonte, Minas Gerais, Brazil
| | - Ester Cerdeira Sabino
- Department of Infectious Diseases, School of Medicine and Tropical Medicine Institute—University of Sao Paulo—FMUSP, Sao Paulo, Sao Paulo, Brazil
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104
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Betsem E, Kaidarova Z, Stramer SL, Shaz B, Sayers M, LeParc G, Custer B, Busch MP, Murphy EL. Correlation of West Nile Virus Incidence in Donated Blood with West Nile Neuroinvasive Disease Rates, United States, 2010-2012. Emerg Infect Dis 2017; 23:212-219. [PMID: 27935796 PMCID: PMC5324803 DOI: 10.3201/eid2302.161058] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Over the past decade, West Nile virus (WNV) has spread across the United States. We aggregated blood donor data from 2010–2012 and then calculated the incidence of WNV RNA–positive donations and compared the incidence with neuroinvasive disease (NID) case data from the ArboNET surveillance system. Of 10,107,853 donations, 640 were confirmed positive. The seasonal WNV incidence rate per 100,000 persons was 33.4 (95% CI 22–45) in 2010, 25.7 (95% CI 15–34) in 2011, and 119.9 (95% CI 98–141) in 2012. NID to blood donor ratios were 1 in 164 (95% CI 152–178) in 2010, 1 in 158 (95% CI 145–174) in 2011, and 1 in 131 (95% CI 127–136) in 2012. We updated estimates of the ratio of NID to WNV infection rates, demonstrating stable disease penetrance over the study period. Blood donor WNV RNA screening is a valuable public health tool for WNV surveillance.
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105
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Porto-Ferreira FA, de Almeida-Neto C, Murphy EL, Montebello SDC, Nogueira FAH, Koga da Silva EM, MacFarland W, Custer B. A randomized trial to evaluate the use of text messaging, letter, and telephone call reminders to improve return of blood donors with reactive serologic tests. Transfusion 2016; 57:102-107. [PMID: 27774609 DOI: 10.1111/trf.13882] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2016] [Revised: 08/26/2016] [Accepted: 08/26/2016] [Indexed: 11/28/2022]
Abstract
BACKGROUND Low return rates for notification and counseling among donors with reactive serologic screening tests have been reported worldwide. A randomized trial to test the effectiveness of text message, letter, or telephone call reminders to improve return among nonresponding first-time blood donors with reactive serologic tests was conducted. STUDY DESIGN AND METHODS Donors with serologically reactive screening test results who had a cell phone and resided in the metropolitan telephone area code of São Paulo in the period from August 2013 through July 2014 were eligible. A consecutive sample of first-time donors with reactive screening tests who had not responded to a standard letter requesting the donor return to the blood center were randomly assigned to receive a text, a new letter, or a telephone call requesting return for notification and counseling. Return rates were measured over the subsequent 30 days. RESULTS The return rate after a phone call reminder was better than that for a text message (39.8% vs. 28.4%; odds ratio [OR], 1.66; 95% confidence interval [CI], 1.05-2.64) but not better than that for a letter (39.8% vs. 34.4%; OR, 1.26; 95% CI, 0.80-1.99). Older age was a predictor of higher rate of return with each year increase in age associated with a 2% increase in the odds of return (OR, 1.02; 95% CI, 1.01-1.04). CONCLUSION In nonresponding serologic reactive donors, telephone call led to a higher return rate than text message. The results of this study suggest that use of text messages, while attractive for its simplicity, will not lead to increased donor notification success after serologically reactive marker results from blood donation in Brazil.
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Affiliation(s)
| | - Cesar de Almeida-Neto
- Fundação Pró-Sangue Hemocentro de São Paulo.,Department of Medical Science, Faculty of Medicine, University of São Paulo, São Paulo, SP, Brazil
| | - Edward L Murphy
- Blood Systems Research Institute.,University of California, San Francisco, California
| | | | | | - Edina Mariko Koga da Silva
- Department of Emergency Medicine Based on Evidences, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | | | - Brian Custer
- Blood Systems Research Institute.,University of California, San Francisco, California
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106
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Kelly S, Quirolo K, Marsh A, Neumayr L, Garcia A, Custer B. Erythrocytapheresis for chronic transfusion therapy in sickle cell disease: survey of current practices and review of the literature. Transfusion 2016; 56:2877-2888. [DOI: 10.1111/trf.13800] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2016] [Revised: 05/04/2016] [Accepted: 06/13/2016] [Indexed: 12/26/2022]
Affiliation(s)
- Shannon Kelly
- Blood Systems Research Institute; San Francisco California
- University of California San Francisco Benioff Children's Hospital Oakland; Oakland California
| | - Keith Quirolo
- University of California San Francisco Benioff Children's Hospital Oakland; Oakland California
| | - Anne Marsh
- University of California San Francisco Benioff Children's Hospital Oakland; Oakland California
| | - Lynne Neumayr
- University of California San Francisco Benioff Children's Hospital Oakland; Oakland California
| | - Alicia Garcia
- University of California San Francisco Benioff Children's Hospital Oakland; Oakland California
| | - Brian Custer
- Blood Systems Research Institute; San Francisco California
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107
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Bruhn R, Moreno E, Sabino EC, Ferreira NAF, Carneiro-Proietti ABF, Lopes MED, Sampaio D, Loureiro P, Custer B, Goncalez TT. Self-reported historic human immunodeficiency virus (HIV) testing in a Brazilian blood donor HIV case-control study. Transfusion 2016; 56:2857-2867. [PMID: 27716930 DOI: 10.1111/trf.13792] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2016] [Revised: 06/06/2016] [Accepted: 06/28/2016] [Indexed: 01/09/2023]
Abstract
BACKGROUND There has been increased worldwide emphasis on the many benefits of human immunodeficiency virus (HIV) serostatus awareness for both infection prevention and improved treatment outcomes. Previous studies indicate that donors may use blood donation to be tested; the objectives of this analysis were to assess, among donors with previously undisclosed risk behavior in the 12 months before donation, the frequency of those who have previously been tested for HIV and the demographic and behavioral factors associated with such testing. STUDY DESIGN AND METHODS In this secondary analysis from an HIV case-control study of blood donors in Brazil, we analyzed the response to the question, "Other than blood donation, have you ever been tested for HIV?" Demographic and disclosed risk behaviors associated with previous testing were determined. RESULTS The study included 341 HIV-positive cases and 791 HIV-negative controls (1:2 case/control ratio). Overall, 31% of blood donors (40% of cases and 26% of controls) reported having been tested for HIV outside of blood donation. History of HIV testing varied according to sex, HIV status, and reported sexual risk behavior. CONCLUSION Although it is encouraging that previous testing was more frequent in donors with acknowledged sexual risk behavior in Brazil, 60% still had not been tested for HIV outside of the blood donation setting. Educating donors on the importance of not using blood centers as a means to get tested for HIV in Brazil, especially if they engage in higher risk behaviors, and seeking alternate testing venues instead could improve the safety of donated blood.
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Affiliation(s)
- Roberta Bruhn
- Blood Systems Research Institute, Epidemiology, San Francisco, California
| | - Elizabeth Moreno
- Fundação Hemominas/Hemocentro de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Ester C Sabino
- Institute of Tropical Medicine, Universidade de São Paulo, São Paulo, Brazil.,Department of Infectious Disease, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | | | | | | | - Divaldo Sampaio
- Fundação Hemope/Hemocentro de Pernambuco, Recife, Pernambuco, Brazil
| | - Paula Loureiro
- Fundação Hemope/Hemocentro de Pernambuco, Recife, Pernambuco, Brazil.,University of Pernambuco, FCM, Fundação Hemope, Recife, Pernambuco, Brazil
| | - Brian Custer
- Blood Systems Research Institute, Epidemiology, San Francisco, California
| | - Thelma T Goncalez
- Blood Systems Research Institute, Epidemiology, San Francisco, California
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108
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Custer B, Johnson ES, Sullivan SD, Hazlet TK, Ramsey SD, Murphy EL, Busch MP. Community Blood Supply Model: Development of a New Model to Assess the Safety, Sufficiency, and Cost of the Blood Supply. Med Decis Making 2016; 25:571-82. [PMID: 16160212 DOI: 10.1177/0272989x05280557] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background. Through a combination of predonation donor screening and donated unit testing, the blood supply is safer than ever. However, as a result of increasingly stringent screening measures, one of the greatest threats may be an insufficient supply. The balance between safety and adequacy of the blood supply has not received enough attention. Study Design and Methods. The authors developed a model to allow for empirical investigation of the determinants of a safe and sufficient supply. The model is a cohort simulation of allogeneic whole-blood donation, with the population of presenting donors stratified into 8 age and gender groups because the probability of donor and donation deferral varies by these characteristics. Parameters are estimated from year 2000 Blood Centers of Pacific (BCP) data. The model includes cost parameters, which were estimated using BCP expenditure data. The main outcomes are the number of transfusable units of blood and the unit cost of procurement. Results. The model tracks the production of a supply of blood, highlighting the influence of demographic characteristics, predonation deferral, underweight collection of blood units, and associated costs. The authors sought to establish model validity by showing that modeled results closely mimic the outcomes and costs observed by blood bank administrators. Conclusion. The model was developed to evaluate blood safety and policy decisions; it can be used to assess the impact of predonation deferrals, such as expanded European travel deferral for variant Creutzfeldt-Jakob disease, or the impact of new testing strategies, such as nucleic acid testing for West Nile virus.
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Affiliation(s)
- Brian Custer
- Pharmaceutical Outcomes Research and Policy Program, University of Washington, Seattle, USA.
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109
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Dodd RY, Notari EP, Nelson D, Foster GA, Krysztof DE, Kaidarova Z, Milan-Benson L, Kessler DA, Shaz BH, Vahidnia F, Custer B, Stramer SL. Development of a multisystem surveillance database for transfusion-transmitted infections among blood donors in the United States. Transfusion 2016; 56:2781-2789. [DOI: 10.1111/trf.13759] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Revised: 06/13/2016] [Accepted: 06/20/2016] [Indexed: 11/28/2022]
Affiliation(s)
- Roger Y. Dodd
- Scientific Affairs, Holland Laboratory, American Red Cross; Rockville Maryland
| | - Edward P. Notari
- Scientific Affairs, Holland Laboratory, American Red Cross; Rockville Maryland
| | - Diane Nelson
- Scientific Affairs, Holland Laboratory, American Red Cross; Rockville Maryland
| | | | | | | | | | | | | | | | - Brian Custer
- Blood Systems Research Institute; San Francisco California
- Department of Laboratory Medicine; University of California at San Francisco; San Francisco California
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110
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Murphy EL, Bloch EM, Custer B, Shiboski C, Sabino E, Carneiro-Proietti AB, McFarland W, P. Busch M, Laperche S. Developing human capital in clinical research: Impact on reducing
transfusion-transmitted HIV and hepatitis virus infections in Africa. Ann Glob Health 2016. [DOI: 10.1016/j.aogh.2016.04.326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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111
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Vahidnia F, Stramer SL, Kessler D, Shaz B, Leparc G, Krysztof DE, Glynn SA, Custer B. Recent viral infection in US blood donors and health-related quality of life (HRQOL). Qual Life Res 2016; 26:349-357. [DOI: 10.1007/s11136-016-1392-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/11/2016] [Indexed: 01/16/2023]
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112
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Vahidnia F, Stramer SL, Kessler D, Gonçalez TT, Shaz BH, Leparc G, Krysztof DE, Dodd RY, Glynn SA, Custer B. Motivations for donating and attitudes toward screening policies in US blood donors with viral infection. Transfusion 2016; 56:2013-20. [PMID: 27351292 DOI: 10.1111/trf.13678] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2016] [Revised: 04/11/2016] [Accepted: 04/21/2016] [Indexed: 11/26/2022]
Abstract
BACKGROUND Differences in motivating factors that contribute to the decision to donate blood between infected and uninfected donors may help to identify areas for improving donor education. STUDY DESIGN AND METHODS As part of a risk factor study, confirmed-positive donors (cases) based on serology-only (human T-lymphotropic virus [HTLV]) or serology and nucleic acid testing (NAT) or NAT-only (human immunodeficiency virus [HIV], hepatitis B virus [HBV], hepatitis C virus [HCV]), and serology-unconfirmed, NAT-negative false-positive donors (controls) were asked about motivations and opinions toward blood donation. "Test seeking" was inferred if a donor answered "yes" to "I wanted to get my test results" and one of the following: "blood center testing is confidential," "free," "more accurate than other test centers," or "tests will identify problems with my blood." Cases were compared to controls using descriptive and multivariable analyses. RESULTS Whether a case or control, the most common donation reason was "to help someone in need" (>90% in each group). After adjusting for demographic characteristics, test seeking was not significantly associated with infection status. Test seeking was more common in first-time, younger males and nonwhite, non-Hispanic donors. Of donors with HIV, 13% considered selection policies to be unfair, compared with 1, 2, 0.5, and 6% of donors with HBV, HCV, and HTLV and controls, respectively (adjusted odds ratio for HIV cases vs. controls, 3.9; 95% confidence interval, 2.3-6.7). CONCLUSIONS Most donors give to help those in need, including HIV-positive donors. Our results establish a baseline from which additional studies can be compared focused on alternate ways to reduce noncompliance and improved messaging to ensure that high-risk potential donors understand the reasons for blood donor screening policies.
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Affiliation(s)
| | | | | | | | | | | | | | - Roger Y Dodd
- American Red Cross, Holland Laboratory, Rockville, Maryland
| | - Simone A Glynn
- National Heart, Lung, and Blood Institute, Bethesda, Maryland
| | - Brian Custer
- Blood Systems Research Institute, San Francisco, California.,University of California at San Francisco, San Francisco, California
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113
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Custer B, Stramer SL, Glynn S, Williams AE, Anderson SA. Transfusion-transmissible infection monitoring system: a tool to monitor changes in blood safety. Transfusion 2016; 56:1499-502. [DOI: 10.1111/trf.13632] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2016] [Accepted: 03/30/2016] [Indexed: 12/18/2022]
Affiliation(s)
- Brian Custer
- Blood Systems Research Institute, Epidemiology and Health Policy Research, Laboratory Medicine; UCSF, San Francisco CA
| | | | - Simone Glynn
- Blood Epidemiology and Clinical Therapeutics Branch, Division of Blood Diseases and Resources; National Heart, Lung, and Blood Institute; Bethesda MD
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114
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Busch MP, Sabino EC, Brambilla D, Lopes ME, Capuani L, Chowdhury D, McClure C, Linnen JM, Prince H, Simmons G, Lee TH, Kleinman S, Custer B. Duration of Dengue Viremia in Blood Donors and Relationships Between Donor Viremia, Infection Incidence and Clinical Case Reports During a Large Epidemic. J Infect Dis 2016; 214:49-54. [PMID: 27302934 DOI: 10.1093/infdis/jiw122] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2015] [Accepted: 03/22/2016] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Dengue viruses (DENV-1-4) pose a transfusion-transmission risk. This study estimated the dengue RNA detection period in asymptomatic blood donors and relationships between donor viremia and dengue incidence during a large epidemic. METHODS Donor samples from the 2012 dengue transmission season in Rio de Janeiro, Brazil, were tested for DENV RNA by a transcription-mediated amplification (TMA) assay, with DENV types and viral loads determined by polymerase chain reaction. Samples collected during the first and last weeks of enrollment were tested for DENV immunoglobulin (Ig) G and IgM to estimate incidence during the study period, which was analyzed relative to nucleic acid amplification technology (NAT) yield to estimate the duration of NAT-detectable viremia and compared with reported clinical dengue cases in Rio. RESULTS Samples from 16 241 donations were tested; 87 (0.54%) were confirmed as DENV-4 RNA positive. Dengue IgM-positive/IgG-positive reactivity increased from 2.8% to 8.8%, indicating a 6.2% incidence (95% confidence interval [CI], 3.2%-9.1%) during the study period. Based on these data, we estimated a 9.1-day period (95% CI, 4.4-13.9 days) of RNA detectable with TMA. With 100 475 reported cases of clinical dengue, 1 RNA-positive donation was identified per 800 DENV cases. CONCLUSIONS These parameters allow projections of dengue incidence from donor NAT yield data and vice versa, and suggest that viremic donations will be rare relative to clinical disease cases.
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Affiliation(s)
- Michael P Busch
- Blood Systems Research Institute Department of Laboratory Medicine, University of California, San Francisco
| | - Ester C Sabino
- Department of Infectious Diseases and Institute of Tropical Medicine, University of Sao Paulo
| | | | | | - Ligia Capuani
- Department of Infectious Diseases and Institute of Tropical Medicine, University of Sao Paulo
| | | | | | | | - Harry Prince
- Focus Diagnostics, San Juan Capistrano, California
| | - Graham Simmons
- Blood Systems Research Institute Department of Laboratory Medicine, University of California, San Francisco
| | | | | | - Brian Custer
- Blood Systems Research Institute Department of Laboratory Medicine, University of California, San Francisco
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115
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Goodell AJ, Bloch E, Simon MS, Shaz B, Custer B. Babesia screening: the importance of reporting and calibration in cost-effectiveness models. Transfusion 2016; 56:774-5. [PMID: 26954454 DOI: 10.1111/trf.13436] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2015] [Revised: 10/20/2015] [Accepted: 10/30/2015] [Indexed: 11/27/2022]
Affiliation(s)
- Alex J Goodell
- UC Berkeley-UCSF Joint Medical Program, School of Public Health, Berkeley, CA
| | - Evan Bloch
- Blood Systems Research Institute, San Francisco, CA.,Department of Laboratory Medicine, UCSF, San Francisco, CA
| | - Matthew S Simon
- Medical Programs & Services, New York Blood Center, New York, NY
| | - Beth Shaz
- Department of Medicine, Weill Cornell Medical College, New York, NY
| | - Brian Custer
- Blood Systems Research Institute, San Francisco, CA.,Department of Laboratory Medicine, UCSF, San Francisco, CA
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116
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Vahidnia F, Stramer SL, Kessler DA, Krysztof DE, Dodd RY, Notari E, Glynn S, Custer B. Risk factors and epidemiology of human T-lymphotropic virus types 1 and 2 in US blood donors. Retrovirology 2015. [PMCID: PMC4577738 DOI: 10.1186/1742-4690-12-s1-p84] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Sykes W, Coleman C, Beck G, Mhlanga J, Hlela C, Custer B, Murphy EL, Vermeulen M. Cost-effectiveness analysis of introducing HTLV-1 testing in South Africa. Retrovirology 2015. [PMCID: PMC4578686 DOI: 10.1186/1742-4690-12-s1-p81] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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118
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Custer B, Sheon N, Siedle-Khan B, Pollack L, Spencer B, Bialkowski W, D'Andrea P, Sullivan M, Glynn S, Williams A. Blood donor deferral for men who have sex with men: the Blood Donation Rules Opinion Study (Blood DROPS). Transfusion 2015. [PMID: 26202349 DOI: 10.1111/trf.13247] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND In the United States, any man who discloses having had sex with another man (MSM) even once since 1977 is currently deferred from donating blood. A study was conducted to assess noncompliance with the policy at four geographically dispersed blood centers. STUDY DESIGN AND METHODS Male donors 18+ years of age with e-mail addresses were randomly selected and invited to complete a confidential online survey between August and October 2013. No additional recruitment e-mails were sent. Survey content included demographics, sexual history, donation history, compliance with the policy, and opinions about current and modified policies. RESULTS Response rate was 11.5% but varied by center (6.3% to 21.7%). Of 3183 completed surveys, 2.6% of respondents (95% confidence interval, 2.1%-3.2%) reported donation after male-male sex. Noncompliance was not statistically different among the centers (p = 0.1), but was related to age with 5.7, 4.6, 2.5, and 1.0% of donors 18 to 24, 25 to 34, 35 to 54, and 50+ years of age, respectively, reporting noncompliance (p < 0.001). Of all respondents, 6.8% reported at least six female and 0.3% reported at least six male sex partners in the past 5 years. Opinions about the current MSM policy were mixed with noncomplying donors more supportive of change than complying donors. Approximatey half of noncompliers indicated they would adhere to a 1-year deferral. CONCLUSION Noncompliance with the MSM policy is evident and may be increasing compared to earlier data. Any change from the current policy will require close monitoring to determine whether it affects residual risk of HIV in the US blood supply.
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Affiliation(s)
- Brian Custer
- Blood Systems Research Institute, San Francisco, California.,Department of Laboratory Medicine, UCSF, San Francisco, California
| | - Nicolas Sheon
- UCSF Center for AIDS Prevention Studies, San Francisco, California
| | - Bob Siedle-Khan
- UCSF Center for AIDS Prevention Studies, San Francisco, California
| | - Lance Pollack
- UCSF Center for AIDS Prevention Studies, San Francisco, California
| | - Bryan Spencer
- American Red Cross, New England Region, Dedham, Massachusetts
| | | | - Pam D'Andrea
- Institute for Transfusion Medicine, Pittsburgh, Pennsylvania
| | | | - Simone Glynn
- National Heart, Lung and Blood Institute (NHLBI), Bethesda, Maryland
| | - Alan Williams
- US Food and Drug Administration, Silver Spring, Maryland
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Sabino EC, Loureiro P, Lopes ME, Capuani L, McClure C, Chowdhury D, Di-Lorenzo-Oliveira C, Oliveira LC, Linnen JM, Lee TH, Gonçalez T, Brambilla D, Kleinman S, Busch MP, Custer B. Transfusion-Transmitted Dengue and Associated Clinical Symptoms During the 2012 Epidemic in Brazil. J Infect Dis 2015; 213:694-702. [PMID: 26908780 DOI: 10.1093/infdis/jiv326] [Citation(s) in RCA: 95] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2015] [Accepted: 04/16/2015] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND A linked donor-recipient study was conducted during epidemics in 2 cities in Brazil to investigate transfusion-transmitted (TT) dengue virus (DENV) by DENV RNA-positive donations. METHODS During February-June 2012, samples were collected from donors and recipients and retrospectively tested for DENV RNA by transcription-mediated amplification. Recipient chart review, using a case (DENV positive)-control (DENV negative and not known to be exposed) design, was conducted to assess symptoms. RESULTS Of 39 134 recruited blood donors, DENV-4 viremia was confirmed in 0.51% of donations from subjects in Rio de Janeiro and 0.80% of subjects in Recife. Overall, 42 DENV RNA-positive units were transfused into 35 recipients. Of these, 16 RNA-positive units transfused into 16 susceptible recipients were identified as informative: 5 cases were considered probable TT cases, 1 possible TT case, and 10 nontransmissions. The TT rate was 37.5% (95% confidence interval [CI], 15.2%-64.6%), significantly higher than the viremia rate of 0.93% (95% CI, .11%-3.34%) in nonexposed recipients (P < .0001). Chart review did not find significant differences between cases and controls in symptoms or mortality. CONCLUSIONS During a large epidemic of DENV-4 infection in Brazil, >0.5% of donations were RNA positive, and approximately one third of components resulted in TT. However, no significant clinical differences were evident between RNA-positive and RNA-negative recipients.
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Affiliation(s)
- Ester C Sabino
- Departamento de Moléstias Infecciosas e Parasitárias, Instituto de Medicina Tropical, Universidade de São Paulo
| | - Paula Loureiro
- Faculdade de Ciências Médicas-UPE/Fundação Hemope, Recife
| | | | - Ligia Capuani
- Departamento de Moléstias Infecciosas e Parasitárias, Instituto de Medicina Tropical, Universidade de São Paulo
| | | | | | | | - Lea C Oliveira
- Departamento de Moléstias Infecciosas e Parasitárias, Instituto de Medicina Tropical, Universidade de São Paulo
| | | | - Tzong-Hae Lee
- Blood Systems Research Institute, San Francisco, California
| | | | | | - Steve Kleinman
- Blood Systems Research Institute, San Francisco, California University of British Columbia, Vancouver, Canada
| | - Michael P Busch
- Blood Systems Research Institute, San Francisco, California Department of Laboratory Medicine, University of California-San Francisco
| | - Brian Custer
- Blood Systems Research Institute, San Francisco, California Department of Laboratory Medicine, University of California-San Francisco
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121
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Remesar M, Sabino EC, Del Pozo A, Mayer A, Busch MP, Custer B. Bimodal distribution of Trypanosoma cruzi antibody levels in blood donors from a highly endemic area of Argentina: what is the significance of low-reactive samples? Transfusion 2015; 55:2499-504. [PMID: 26014113 DOI: 10.1111/trf.13180] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2015] [Revised: 04/08/2015] [Accepted: 04/08/2015] [Indexed: 11/26/2022]
Abstract
BACKGROUND Low-level seroreactive donor samples that are inconsistently detected by different Trypanosoma cruzi immunoassays are common, but the population distribution has not been reported in an endemic region. The objective was to understand the distribution of low-level reactive samples using highly sensitive immunoassays and the relationship with epidemiologic evidence of exposure to T. cruzi. STUDY DESIGN AND METHODS Blood donors (BDs) were recruited in two blood banks located in Chaco province, in northeastern Argentina, from June 2006 to March 2007. Donors completed a Chagas exposure questionnaire and provided blood samples. All samples were tested in parallel with five contemporary and commercially available enzyme immunoassays for T. cruzi and a subgroup by a chemiluminescent assay. RESULTS Of the 1423 enrolled donors, 304 (21.4%) tested positive on all assays while 93 (6.5%) were reactive on at least one assay (inconclusive). Epidemiologic evidence of exposure to T. cruzi was significantly higher among positive and inconclusive donors compared to seronegative BD (p values range from 0.01 to <0.001 depending on the exposure). Histograms of the signal-to-cutoff values from all positive samples showed clear bimodal distributions for the whole parasite lysate assays, but not for the one recombinant antigen-based assay. Low antibody level responses were present in 30% to 40% of the reactives, depending on the assay. CONCLUSION The population of individuals exposed to T. cruzi in highly endemic regions has a bimodal distribution of antibody response to the parasite. Although the clinical significance of low-level reactivity is not fully established, these results may reflect evolving seroreversions after spontaneously resolved infections.
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Affiliation(s)
- Mirta Remesar
- Centro Regional de Hemoterapia, Hospital de Pediatría Prof Dr J.P. Garrahan, Buenos Aires, Argentina
| | - Ester C Sabino
- Department of Infectious Disease, Institute of Tropical Medicine, University of Sao Paulo, Sao Paulo, Brazil
| | - Ana Del Pozo
- Centro Regional de Hemoterapia, Hospital de Pediatría Prof Dr J.P. Garrahan, Buenos Aires, Argentina
| | - Allen Mayer
- Blood Systems Research Institute, San Francisco, California
| | | | - Brian Custer
- Blood Systems Research Institute, San Francisco, California
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Agapova M, Lachert E, Brojer E, Letowska M, Grabarczyk P, Custer B. Introducing Pathogen Reduction Technology in Poland: A Cost-Utility Analysis. Transfus Med Hemother 2015; 42:158-65. [PMID: 26195929 PMCID: PMC4483292 DOI: 10.1159/000371664] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2014] [Accepted: 11/19/2014] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Mirasol® pathogen reduction technology (PRT) uses UV light and riboflavin to chemically inactivate pathogens and white blood cells in blood components. In the EU, Mirasol PRT is CE-marked for both plasma and platelet treatment. In Poland, the decision to introduce PRT treatment of the national supply of fresh frozen plasma has spurred interest in evaluating the cost-effectiveness of this strategy. METHODS A decision-analytic model evaluated the incremental costs and benefits of introducing PRT to the existing blood safety protocols in Poland. RESULTS Addition of PRT treatment of plasma to current screening in Poland is estimated to cost 2.595 million PLN per quality-adjusted life year (QALY) (610,000 EUR/QALY); treating both plasma and platelet components in addition to current safety interventions had a lower cost of 1.480 million PLN/QALY (348,000 EUR/QALY). CONCLUSIONS The results suggest that in Poland the cost per QALY of PRT is high albeit lower than found in previous economic analyses of PRT and nucleic acid testing in North America. Treating both platelets and plasma components is more cost-effective than treating plasma alone. Wide confidence intervals indicate high uncertainty; to improve the precision of the health economic evaluation of PRT, additional hemovigilance data are needed.
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Affiliation(s)
- Maria Agapova
- Pharmaceutical Outcomes Research and Policy Program, University of Washington, Seattle, WA, USA
| | - Elzbieta Lachert
- Institute of Haematology and Transfusion Medicine, Warsaw, Poland
| | - Ewa Brojer
- Institute of Haematology and Transfusion Medicine, Warsaw, Poland
| | | | - Piotr Grabarczyk
- Institute of Haematology and Transfusion Medicine, Warsaw, Poland
| | - Brian Custer
- Blood Systems Research Institute, San Francisco, CA, USA
- Laboratory Medicine, University of California, San Francisco, San Francisco, CA, USA
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123
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Bravo M, Shaz BH, Kamel H, Vanderpool S, Tomasulo P, Custer B, Townsend M. Detection of bacterial contamination in apheresis platelets: is apheresis technology a factor? Transfusion 2015; 55:2113-22. [DOI: 10.1111/trf.13107] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2014] [Revised: 02/20/2015] [Accepted: 02/20/2015] [Indexed: 11/28/2022]
Affiliation(s)
| | | | | | | | | | - Brian Custer
- Blood Systems Research Institute
- University of California at San Francisco; San Francisco California
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124
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Custer B, Janssen MP. Health economics and outcomes methods in risk-based decision-making for blood safety. Transfusion 2015; 55:2039-47. [DOI: 10.1111/trf.13080] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2014] [Revised: 02/05/2015] [Accepted: 02/10/2015] [Indexed: 01/05/2023]
Affiliation(s)
- Brian Custer
- Blood Systems Research Institute and
- Department of Laboratory Medicine; University of California; San Francisco California
| | - Mart P. Janssen
- Transfusion Technology Assessment Unit; Sanquin Research; Amsterdam the Netherlands
- Julius Center for Health Sciences and Primary Care; University Medical Centre Utrecht; Utrecht the Netherlands
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125
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Sabino EC, Ribeiro AL, Lee TH, Oliveira CL, Carneiro-Proietti AB, Antunes AP, Menezes MM, Ianni BM, Salemi VM, Nastari L, Fernandes F, Sachdev V, Carrick DM, Deng X, Wright D, Gonçalez TT, Murphy EL, Custer B, Busch MP. Detection of Trypanosoma cruzi DNA in blood by PCR is associated with Chagas cardiomyopathy and disease severity. Eur J Heart Fail 2015; 17:416-23. [PMID: 25678239 DOI: 10.1002/ejhf.220] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2014] [Revised: 10/30/2014] [Accepted: 11/07/2014] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND The significance of detection of Trypanosoma cruzi DNA in blood of antibody-positive patients for risk of development of Chagas heart disease is not well established. The objective of this study was to compare detection of T. cruzi DNA with known clinical and laboratory markers of Chagas cardiomyopathy (CC) severity. METHODS This is a case-control study nested within a retrospective cohort developed in Brazil to understand the natural history of Chagas disease. The study enrolled 499 T. cruzi seropositive blood donors (SP-BD) and 488 frequency matched seronegative control donors (SN-BD) who had donated between 1996 and 2002, and 101 patients with clinically diagnosed CC. In 2008-2010 all enrolled subjects underwent a health questionnaire, medical examination, electrocardiograms and echocardiograms and polymerase chain reaction (PCR) analyses. A blinded panel of three cardiologists adjudicated the outcome of CC. Trypanosoma cruzi kinetoplast minicircle sequences were amplified by real-time PCR using an assay with a sensitivity of one parasite per 20 mL of blood. All testing was performed on coded samples. RESULTS Rates of PCR detection of T. cruzi DNA were significantly (P = 0.003) higher in CC patients and SP-BD diagnosed with CC (79/105 [75.2 %]) compared with SP-BD without CC (143/279 [51.3%]). The presence of parasitaemia was significantly associated with known markers of disease progression such as QRS and QT interval duration, lower left ventricular ejection fraction, higher left ventricular index mass, and elevated troponin and NTpro-BNP levels. CONCLUSION Trypanosoma cruzi PCR positivity is associated with presence and severity of cardiomyopathy, suggesting a direct role of parasite persistence in disease pathogenesis.
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Affiliation(s)
- E C Sabino
- Department of Infectious Disease and Institute of Tropical Medicine, University of São Paulo, São Paulo, Brazil; Fundação Pró-Sangue Hemocentro de Sao Paulo, São Paulo, Brazil
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126
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Bruhn R, Custer B, Vanderpool S, Townsend M, Kamel H, Tomasulo P. Impact of increasing sample volume from 4 ml to 8 ml on bacterial detection rates in apheresis platelets: a meta-analysis. Vox Sang 2014; 108:318-20. [DOI: 10.1111/vox.12225] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2014] [Revised: 10/22/2014] [Accepted: 10/28/2014] [Indexed: 11/29/2022]
Affiliation(s)
- R. Bruhn
- Blood Systems Research Institute; San Francisco CA USA
| | - B. Custer
- Blood Systems Research Institute; San Francisco CA USA
| | | | | | - H. Kamel
- Blood Systems, Inc.; Scottsdale AZ USA
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127
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Custer B, Kessler D, Vahidnia F, Leparc G, Krysztof DE, Shaz B, Kamel H, Glynn S, Dodd RY, Stramer SL. Risk factors for retrovirus and hepatitis virus infections in accepted blood donors. Transfusion 2014; 55:1098-107. [PMID: 25470984 DOI: 10.1111/trf.12951] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2014] [Revised: 10/13/2014] [Accepted: 10/13/2014] [Indexed: 01/14/2023]
Abstract
BACKGROUND Risk factor surveillance among infected blood donors provides information on the effectiveness of eligibility assessment and is critical for reducing risk of transfusion-transmitted infection. STUDY DESIGN AND METHODS American Red Cross, Blood Systems, Inc., New York Blood Center, and OneBlood participated in a case-control study from 2010 to 2013. Donors with serologic and nucleic acid testing (NAT) or NAT-only confirmed human immunodeficiency virus (HIV), hepatitis B virus (HBV), hepatitis C virus (HCV), or serology-confirmed human T-lymphotropic virus (HTLV) infections (cases) and donors with false-positive results (controls) were interviewed for putative behavioral and demographic risks. Frequencies and adjusted odds ratios (AORs) from multivariable logistic regression analyses for each exposure in cases compared to controls are reported. RESULTS In the study, 196 HIV, 292 HBV, 316 HCV, and 198 HTLV cases, and 1587 controls were interviewed. For HIV, sex with an HIV+ person (AOR, 132; 95% confidence interval [CI], 27-650) and male-male sex (AOR, 62; 95% CI, 27-140) were primary risk factors. For HBV, first-time donor status (AOR, 16; 95% CI, 10-27), sex with an injection drug user (IDU; AOR, 11; 95% CI, 5-28), and black race (AOR, 11; 95% CI, 6-19) were primary. For HCV, IDU (AOR, 42; 95% CI, 13-136), first time (AOR, 18; 95% CI, 10-30), and a family member with hepatitis (AOR, 15; 95% CI, 6-40) were primary. For HTLV, sex with an IDU (AOR, 22; 95% CI, 10-48), 55 years old or more (AOR, 21; 95% CI, 8-52], and first time (AOR, 15; 95% CI, 9-24) were primary. CONCLUSIONS Despite education efforts and risk screening, individuals with deferrable risks still donate; they may fail to understand or ignore or do not believe they have risk. Recipients have potential transfusion-transmitted infection risk because of nondisclosure by donors.
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Affiliation(s)
- Brian Custer
- Blood Systems Research Institute, San Francisco, California.,Department of Laboratory Medicine, University of California San Francisco, San Francisco, California
| | | | | | | | - David E Krysztof
- Scientific Support Office, American Red Cross, Gaithersburg, Maryland
| | - Beth Shaz
- New York Blood Center, New York, New York
| | - Hany Kamel
- Blood Systems, Inc., Scottsdale, Arizona
| | - Simone Glynn
- National Heart, Lung and Blood Institute, National Institutes of Health, Rockville, Maryland
| | - Roger Y Dodd
- Holland Laboratory, American Red Cross, Rockville, Maryland
| | - Susan L Stramer
- Scientific Support Office, American Red Cross, Gaithersburg, Maryland
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128
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Lanteri MC, Vahidnia F, Tan S, Stapleton JT, Norris PJ, Heitman J, Deng X, Keating SM, Brambilla D, Busch MP, Custer B. Downregulation of Cytokines and Chemokines by GB Virus C After Transmission Via Blood Transfusion in HIV-Positive Blood Recipients. J Infect Dis 2014; 211:1585-96. [PMID: 25425697 DOI: 10.1093/infdis/jiu660] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2014] [Accepted: 11/19/2014] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND An association between GB virus C (GBV-C) and improved outcomes of human immunodeficiency virus (HIV) infection has been reported in HIV-positive individuals with active GBV-C coinfection. This study provides insights into the immune mechanisms underlying the protective role of GBV-C in HIV-infected patients. METHODS The concentrations of 64 cytokines and chemokines were measured in plasma samples obtained from the Viral Activation Transfusion Study cohort before transfusion and longitudinally from 30 patients positive for both HIV and GBV-C (hereafter, "cases") and 30 patients positive for HIV and negative for GBV-C (hereafter, "controls"). RESULTS Cases had lower HIV viral loads and higher CD4 T-cell counts than controls after acquisition of GBV-C infection. Most of the modulated cytokines and chemokines were reduced after GBV-C detection, including many proinflammatory cytokines, suggesting an overall antiinflammatory effect of GBV-C in HIV-positive subjects. Most pathways and functions of the measured cytokines were downregulated in cases, except cell death pathways, which were upregulated in various cell subsets in the 3 months after GBV-C detection. CONCLUSIONS GBV-C has a protective effect, in part through a competition mechanism leading to decreased inflammation and improved HIV disease outcome in cases. Further studies are necessary to establish whether GBV-C may have deleterious effects on the host at the cellular level, including depleting the cells that are the targets of HIV.
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Affiliation(s)
| | | | | | - Jack T Stapleton
- Iowa City Veterans Affairs Hospital University of Iowa Carver College of Medicine, Iowa City
| | - Philip J Norris
- Blood Systems Research Institute Department of Laboratory Medicine Department of Medicine, University of California-San Francisco, California
| | | | | | | | | | - Michael P Busch
- Blood Systems Research Institute Department of Laboratory Medicine
| | - Brian Custer
- Blood Systems Research Institute Department of Laboratory Medicine
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Bloch EM, Reed WF, Lee TH, Montalvo L, Shiboski S, Custer B, Barcellos L. Male microchimerism in peripheral blood leukocytes from women with multiple sclerosis. Chimerism 2014. [DOI: 10.4161/chim.15151] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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130
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Goodell AJ, Bloch EM, Krause PJ, Custer B. Costs, consequences, and cost-effectiveness of strategies forBabesia microtidonor screening of the US blood supply. Transfusion 2014; 54:2245-57. [DOI: 10.1111/trf.12805] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2014] [Revised: 06/20/2014] [Accepted: 06/24/2014] [Indexed: 12/11/2022]
Affiliation(s)
- Alex J. Goodell
- Blood Systems Research Institute; San Francisco California
- UC Berkeley-UCSF Joint Medical Program; UCSF; San Francisco California
| | - Evan M. Bloch
- Blood Systems Research Institute; San Francisco California
- Department of Laboratory Medicine; UCSF; San Francisco California
| | - Peter J. Krause
- Department of Epidemiology; Yale School of Public Health; New Haven Connecticut
| | - Brian Custer
- Blood Systems Research Institute; San Francisco California
- Department of Laboratory Medicine; UCSF; San Francisco California
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131
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Loureiro P, de Almeida-Neto C, Proietti ABC, Capuani L, Gonçalez TT, de Oliveira CDL, Leão SC, Lopes MI, Sampaio D, Patavino GM, Ferreira JE, Blatyta PF, Duarte Lopes ME, Mendrone-Junior A, Salles NA, King M, Murphy E, Busch M, Custer B, Sabino EC. [Not Available]. Rev Bras Hematol Hemoter 2014; 36:152-8. [PMID: 24790542 PMCID: PMC4005515 DOI: 10.5581/1516-8484.20140033] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2013] [Accepted: 11/26/2013] [Indexed: 11/27/2022] Open
Abstract
The Retrovirus Epidemiology Donor Study (REDS) program was established in the United States in 1989 with the purpose of increasing blood transfusion safety in the context of the HIV/AIDS and human T-lymphotropic virus epidemics. REDS and its successor, REDS-II were at first conducted in the US, then expanded in 2006 to include international partnerships with Brazil and China. In 2011, a third wave of REDS renamed the Recipient Epidemiology and Donor Evaluation Study-III (REDS-III) was launched. This seven-year research program focuses on both blood banking and transfusion medicine research in the United States of America, Brazil, China, and South Africa. The main goal of the international programs is to reduce and prevent the transmission of HIV/AIDS and other known and emerging infectious agents through transfusion, and to address research questions aimed at understanding global issues related to the availability of safe blood. This article describes the contribution of REDS-II to transfusion safety in Brazil. Articles published from 2010 to 2013 are summarized, including database analyses to characterize blood donors, deferral rates, and prevalence, incidence and residual risk of the main blood-borne infections. Specific studies were developed to understand donor motivation, the impact of the deferral questions, risk factors and molecular surveillance among HIV-positive donors, and the natural history of Chagas disease. The purpose of this review is to disseminate the acquired knowledge and briefly summarize the findings of the REDS-II studies conducted in Brazil as well as to introduce the scope of the REDS-III program that is now in progress and will continue through 2018. © 2014 Associação Brasileira de Hematologia, Hemoterapia e Terapia Celular. All rights reserved.
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Affiliation(s)
- Paula Loureiro
- Faculdade de Ciências Médicas, Universidade de Pernambuco (UPE), Recife, PE, Brazil; Fundação Hemope, Recife, PE, Brazil
| | | | | | - Ligia Capuani
- Faculdade de Medicina, Universidade de São Paulo (USP), São Paulo, SP, Brazil
| | | | | | | | | | - Divaldo Sampaio
- Faculdade de Ciências Médicas, Universidade de Pernambuco (UPE), Recife, PE, Brazil; Fundação Hemope, Recife, PE, Brazil
| | | | - João Eduardo Ferreira
- Instituto de Matemática e Estatística, Universidade de São Paulo (USP), São Paulo, SP, Brazil
| | | | | | | | | | | | - Edward Murphy
- University of California San Francisco, California, USA
| | - Michael Busch
- Blood System Research Institute, San Francisco, California, USA
| | - Brian Custer
- Blood System Research Institute, San Francisco, California, USA
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Custer B, Bravo M, Bruhn R, Land K, Tomasulo P, Kamel H. Predictors of hemoglobin recovery or deferral in blood donors with an initial successful donation. Transfusion 2014; 54:2267-75. [DOI: 10.1111/trf.12628] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2013] [Revised: 01/24/2014] [Accepted: 01/24/2014] [Indexed: 11/30/2022]
Affiliation(s)
- Brian Custer
- Blood Systems Research Institute; San Francisco California
| | | | - Roberta Bruhn
- Blood Systems Research Institute; San Francisco California
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133
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Vahidnia F, Hirschler NV, Agapova M, Chinn A, Busch MP, Custer B. Cancer Incidence and Mortality in a Cohort of US Blood Donors: A 20-Year Study. J Cancer Epidemiol 2013; 2013:814842. [PMID: 24489545 PMCID: PMC3893810 DOI: 10.1155/2013/814842] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2013] [Revised: 10/30/2013] [Accepted: 11/24/2013] [Indexed: 01/30/2023] Open
Abstract
Blood donors are considered one of the healthiest populations. This study describes the epidemiology of cancer in a cohort of blood donors up to 20 years after blood donation. Records from donors who participated in the Retroviral Epidemiology Donor Study (REDS, 1991-2002) at Blood Centers of the Pacific (BCP), San Francisco, were linked to the California Cancer Registry (CCR, 1991-2010). Standardized incidence ratios (SIR) were estimated using standard US 2000 population, and survival analysis used to compare all-cause mortality among donors and a random sample of nondonors with cancer from CCR. Of 55,158 eligible allogeneic blood donors followed-up for 863,902 person-years, 4,236 (7.7%) primary malignant cancers were diagnosed. SIR in donors was 1.59 (95% CI = 1.54,1.64). Donors had significantly lower mortality (adjusted HR = 0.70, 95% CI = 0.66-0.74) compared with nondonor cancer patients, except for respiratory system cancers (adjusted HR = 0.93, 95% CI = 0.82-1.05). Elevated cancer incidence among blood donors may reflect higher diagnosis rates due to health seeking behavior and cancer screening in donors. A "healthy donor effect" on mortality following cancer diagnosis was demonstrated. This population-based database and sample repository of blood donors with long-term monitoring of cancer incidence provides the opportunity for future analyses of genetic and other biomarkers of cancer.
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Affiliation(s)
- Farnaz Vahidnia
- Blood Systems Research Institute, San Francisco, CA 94118, USA
| | | | | | - Artina Chinn
- Blood Centers of the Pacific, San Francisco, CA 94118, USA
| | - Michael P. Busch
- Blood Systems Research Institute, San Francisco, CA 94118, USA
- Laboratory Medicine, University of California, San Francisco, CA 94143, USA
| | - Brian Custer
- Blood Systems Research Institute, San Francisco, CA 94118, USA
- Laboratory Medicine, University of California, San Francisco, CA 94143, USA
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134
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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135
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Sabino EC, Ribeiro AL, Salemi VMC, Ianni BM, Nastari L, Fernandes F, Di Lorenzo Oliveira C, Antunes AP, Menezes MM, Patavino GM, Capuani L, de Almeida-Neto C, Sachdev V, Carrick DM, Wright D, Kavounis K, Gonzalez TT, Custer B, Busch MP, Murphy EL, Carneiro-Proietti AB. Response to letters regarding article, "Ten-year incidence of Chagas cardiomyopathy among asymptomatic, Trypanosoma cruzi-seropositive former blood donors". Circulation 2013; 128:e137-8. [PMID: 23979636 DOI: 10.1161/circulationaha.113.004018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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136
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Bruhn R, Lelie N, Custer B, Busch M, Kleinman S. Prevalence of human immunodeficiency virus RNA and antibody in first-time, lapsed, and repeat blood donations across five international regions and relative efficacy of alternative screening scenarios. Transfusion 2013; 53:2399-412. [DOI: 10.1111/trf.12299] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2013] [Revised: 04/17/2013] [Accepted: 04/17/2013] [Indexed: 12/18/2022]
Affiliation(s)
- Roberta Bruhn
- Blood Systems Research Institute; Lelie Research; San Francisco California Paris France
- University of British Columbia; Canada
| | - Nico Lelie
- Blood Systems Research Institute; Lelie Research; San Francisco California Paris France
- University of British Columbia; Canada
| | - Brian Custer
- Blood Systems Research Institute; Lelie Research; San Francisco California Paris France
- University of British Columbia; Canada
| | - Michael Busch
- Blood Systems Research Institute; Lelie Research; San Francisco California Paris France
- University of British Columbia; Canada
| | - Steven Kleinman
- Blood Systems Research Institute; Lelie Research; San Francisco California Paris France
- University of British Columbia; Canada
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137
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Oliveira CDL, de Almeida-Neto C, Liu EJ, Sabino EC, Leão SC, Loureiro P, Wright D, Custer B, Gonçalez TT, Capuani L, Busch M, Proietti ABDFC. Temporal distribution of blood donations in three Brazilian blood centers and its repercussion on the blood supply. Rev Bras Hematol Hemoter 2013; 35:246-51. [PMID: 24106441 PMCID: PMC3789428 DOI: 10.5581/1516-8484.20130071] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2012] [Accepted: 01/27/2013] [Indexed: 11/27/2022] Open
Abstract
Background Seasonal distribution of blood donation hinders efforts to provide a safe and
adequate blood supply leading to chronic and persistent shortages. This study
examined whether holidays, geographical area and donation type (community versus
replacement) has any impact on the fluctuation of donations. Methods The numbers of blood donations from 2007 through 2010 in three Brazilian
Retrovirus Epidemiological Donor Study II (REDS-II) participating centers were
analyzed according to the week of donation. The weeks were classified as holiday
or non-holiday. To compare donations performed during holiday versus non-holiday
weeks, tabulations and descriptive statistics for weekly donations by blood center
were examined and time series analysis was conducted. Results The average weekly number of donations varied according to the blood center and
type of week. The average number of donations decreased significantly during
Carnival and Christmas and increased during the Brazilian National Donor Week. The
fluctuation was more pronounced in Recife and Belo Horizonte when compared to
São Paulo and higher among community donors. Conclusion National bank holidays affect the blood supply by reducing available blood
donations. Blood banks should take into account these oscillations in order to
plan local campaigns, aiming at maintaining the blood supply at acceptable
levels.
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138
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Takecian PL, Oikawa MK, Braghetto KR, Rocha P, Lucena F, Kavounis K, Schlumpf KS, Acker S, Carneiro-Proietti ABF, Sabino EC, Custer B, Busch MP, Ferreira JE. Methodological Guidelines for Reducing the Complexity of Data Warehouse Development for Transactional Blood Bank Systems. Decis Support Syst 2013; 55:728-739. [PMID: 23729945 PMCID: PMC3665424 DOI: 10.1016/j.dss.2013.02.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Over time, data warehouse (DW) systems have become more difficult to develop because of the growing heterogeneity of data sources. Despite advances in research and technology, DW projects are still too slow for pragmatic results to be generated. Here, we address the following question: how can the complexity of DW development for integration of heterogeneous transactional information systems be reduced? To answer this, we proposed methodological guidelines based on cycles of conceptual modeling and data analysis, to drive construction of a modular DW system. These guidelines were applied to the blood donation domain, successfully reducing the complexity of DW development.
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Affiliation(s)
- Pedro L. Takecian
- University of São Paulo, Inst. of Math. and Statistics, São Paulo-SP, Brazil
| | - Marcio K. Oikawa
- Center of Mathematics, Computing and Cognition, Federal University of ABC
| | - Kelly R. Braghetto
- University of São Paulo, Inst. of Math. and Statistics, São Paulo-SP, Brazil
| | | | | | | | | | | | | | - Ester C. Sabino
- Pró-Sangue Foundation, São Paulo Blood Center, São Paulo-SP, Brazil
| | - Brian Custer
- Blood Systems Research Institute, San Francisco, CA, USA
| | | | - João E. Ferreira
- University of São Paulo, Inst. of Math. and Statistics, São Paulo-SP, Brazil
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139
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Affiliation(s)
- B. Custer
- Blood Systems Research Institute; Masonic Ave; San Francisco; CA; USA
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140
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Blatyta PF, Custer B, Gonçalez TT, Birch R, Lopes ME, Lopes Ferreira MI, Carneiro Proietti AB, Sabino EC, Page K, de Almeida-Neto C. Undisclosed human immunodeficiency virus risk factors identified through a computer-based questionnaire program among blood donors in Brazil. Transfusion 2013; 53:2734-43. [PMID: 23521083 DOI: 10.1111/trf.12166] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2012] [Revised: 12/10/2012] [Accepted: 12/10/2012] [Indexed: 12/31/2022]
Abstract
BACKGROUND Human immunodeficiency virus (HIV) risk factor screening among blood donors remains a cornerstone for the safety of blood supply and is dependent on prospective donor self-disclosure and an attentive predonation interview. Audio computer-assisted structured interview (ACASI) has been shown to increase self-reporting of risk behaviors. STUDY DESIGN AND METHODS This cross-sectional study was conducted between January 2009 and March 2011 at four Brazilian blood centers to identify the population of HIV-negative eligible blood donors that answered face-to-face interviews without disclosing risks, but subsequently disclosed deferrable risk factors by ACASI. Compared to the donor interview, the ACASI contained expanded content on demographics, sexual behavior, and other HIV risk factors questions. RESULTS A total of 901 HIV-negative blood donors were interviewed. On the ACASI, 13% of donors (n = 120) declared a risk factor that would have resulted in deferral that was not disclosed during the face-to-face assessment. The main risk factors identified were recent unprotected sex with an unknown or irregular partner (49 donors), sex with a person with exposure to blood or fluids (26 donors), multiple sexual partners (19 donors), and male-male sexual behavior (10 donors). Independent factors associated with the disclosure of any risk factor for HIV were age (≥40 years vs. 18-25 years; adjusted odds ratio [AOR], 0.45; 95% confidence interval [CI], 0.23-0.88) and blood center (Hemope vs. Hemominas; AOR, 2.51; 95% CI, 1.42-4.44). CONCLUSION ACASI elicited increased disclosure of HIV risk factors among blood donors. ACASI may be a valuable modality of interview to be introduced in Brazilian blood banks.
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Affiliation(s)
- Paula Fraiman Blatyta
- Fundação Pró-Sangue Hemocentro de São Paulo, São Paulo, SP, Brazil; Blood Systems Research Institute, San Francisco, California; Westat, Rockville, Maryland; Fundação Hemorio, Rio de Janeiro, RJ, Brazil; Fundação Hemope, Recife, PE, Brazil; Fundação Hemominas, Belo Horizonte, MG, Brazil; Department of Infectious Diseases, Medical School, University of São Paulo, São Paulo, SP, Brazil; University of California at San Francisco, San Francisco, California
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141
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de Almeida-Neto C, Goncalez TT, Birch RJ, de Carvalho SMF, Capuani L, Leão SC, Miranda C, Rocha PC, Carneiro-Proietti AB, Johnson BR, Wright DJ, Murphy EL, Custer B. Risk factors for human immunodeficiency virus infection among Brazilian blood donors: a multicentre case-control study using audio computer-assisted structured interviews. Vox Sang 2013; 105:91-9. [PMID: 23517235 DOI: 10.1111/vox.12028] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2012] [Revised: 01/09/2013] [Accepted: 01/13/2013] [Indexed: 11/30/2022]
Abstract
BACKGROUND Although risk factors for HIV infection are known, it is important for blood centres to understand local epidemiology and disease transmission patterns. Current risk factors for HIV infection in blood donors in Brazil were assessed. METHODS A case-control study was conducted at large public blood centres located in four major cities between April 2009 and March 2011. Cases were persons whose donations were confirmed positive by enzyme immunoassays followed by Western blot confirmation. Audio computer-assisted structured interviews (ACASI) were completed by all cases and controls. Multivariable logistic regression was used to estimate adjusted odds ratios (AORs) and associated 95% confidence intervals (CIs). RESULTS There were 341 cases, including 47 with recently acquired infection, and 791 controls. Disclosed risk factors for both females and males were sex with an HIV-positive person AOR 11.3, 95% CI (4.1, 31.7) and being an IVDU or sexual partner of an IVDU [AOR 4.65 (1.8, 11.7)]. For female blood donors, additional risk factors were having male sex partners who also are MSM [AOR 13.5 (3.1, 59.8)] and having unprotected sex with multiple sexual partners [AOR 5.19 (2.1, 12.9)]. The primary risk factor for male blood donors was MSM activity [AOR 21.6 (8.8, 52.9)]. Behaviours associated with recently acquired HIV were being a MSM or sex partner of MSM [13.82, (4.7, 40.3)] and IVDU [11.47, (3.0, 43.2)]. CONCLUSION Risk factors in blood donors parallel those in the general population in Brazil. Identified risk factors suggest that donor compliance with selection procedures at the participating blood centres is inadequate.
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142
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Belanger GA, McFarland W, Raymond HF, Custer B. If the permanent deferral were lifted would men who have sex with men want to donate blood, and if so, who would be eligible? Transfusion 2013; 53:2729-33. [DOI: 10.1111/trf.12124] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2012] [Revised: 12/12/2012] [Accepted: 12/13/2012] [Indexed: 11/27/2022]
Affiliation(s)
- Geoffrey A. Belanger
- San Jose State University; San Jose California
- Stanford Blood Center; Palo Alto California
- HIV Epidemiology Section; San Francisco Department of Public Health; San Francisco California
- Epidemiology and Biostatistics and Laboratory Medicine; University of California at San Francisco; San Francisco California
- Blood Systems Research Institute; San Francisco California
| | - Willi McFarland
- San Jose State University; San Jose California
- Stanford Blood Center; Palo Alto California
- HIV Epidemiology Section; San Francisco Department of Public Health; San Francisco California
- Epidemiology and Biostatistics and Laboratory Medicine; University of California at San Francisco; San Francisco California
- Blood Systems Research Institute; San Francisco California
| | - H. Fisher Raymond
- San Jose State University; San Jose California
- Stanford Blood Center; Palo Alto California
- HIV Epidemiology Section; San Francisco Department of Public Health; San Francisco California
- Epidemiology and Biostatistics and Laboratory Medicine; University of California at San Francisco; San Francisco California
- Blood Systems Research Institute; San Francisco California
| | - Brian Custer
- San Jose State University; San Jose California
- Stanford Blood Center; Palo Alto California
- HIV Epidemiology Section; San Francisco Department of Public Health; San Francisco California
- Epidemiology and Biostatistics and Laboratory Medicine; University of California at San Francisco; San Francisco California
- Blood Systems Research Institute; San Francisco California
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Sabino EC, Ribeiro AL, Salemi VMC, Di Lorenzo Oliveira C, Antunes AP, Menezes MM, Ianni BM, Nastari L, Fernandes F, Patavino GM, Sachdev V, Capuani L, de Almeida-Neto C, Carrick DM, Wright D, Kavounis K, Goncalez TT, Carneiro-Proietti AB, Custer B, Busch MP, Murphy EL. Ten-year incidence of Chagas cardiomyopathy among asymptomatic Trypanosoma cruzi-seropositive former blood donors. Circulation 2013; 127:1105-15. [PMID: 23393012 DOI: 10.1161/circulationaha.112.123612] [Citation(s) in RCA: 124] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Very few studies have measured disease penetrance and prognostic factors of Chagas cardiomyopathy among asymptomatic Trypanosoma cruzi-infected persons. METHODS AND RESULTS We performed a retrospective cohort study among initially healthy blood donors with an index T cruzi-seropositive donation and age-, sex-, and period-matched seronegatives in 1996 to 2002 in the Brazilian cities of São Paulo and Montes Claros. In 2008 to 2010, all subjects underwent medical history, physical examination, ECGs, and echocardiograms. ECG and echocardiogram results were classified by blinded core laboratories, and records with abnormal results were reviewed by a blinded panel of 3 cardiologists who adjudicated the outcome of Chagas cardiomyopathy. Associations with Chagas cardiomyopathy were tested with multivariate logistic regression. Mean follow-up time between index donation and outcome assessment was 10.5 years for the seropositives and 11.1 years for the seronegatives. Among 499 T cruzi seropositives, 120 (24%) had definite Chagas cardiomyopathy, and among 488 T cruzi seronegatives, 24 (5%) had cardiomyopathy, for an incidence difference of 1.85 per 100 person-years attributable to T cruzi infection. Of the 120 seropositives classified as having Chagas cardiomyopathy, only 31 (26%) presented with ejection fraction <50%, and only 11 (9%) were classified as New York Heart Association class II or higher. Chagas cardiomyopathy was associated (P<0.01) with male sex, a history of abnormal ECG, and the presence of an S3 heart sound. CONCLUSIONS There is a substantial annual incidence of Chagas cardiomyopathy among initially asymptomatic T cruzi-seropositive blood donors, although disease was mild at diagnosis.
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Affiliation(s)
- Ester C Sabino
- Department of Infectious Disease and Institute of Tropical Medicine, University of São Paulo, São Paulo, Brazil
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144
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Abstract
BACKGROUND Blood centers rely heavily on adolescent donors to meet blood demand, but presyncope and syncope are more frequent in younger donors. Studies have suggested administration of water before donation may reduce syncope and/or presyncope in this group. STUDY DESIGN AND METHODS We conducted a randomized, controlled trial to establish the effect of preloading with 500 mL of water on the rate of syncope and presyncope in adolescent donors. School collection sites in Eastern Cape Province of South Africa were randomized to receive water or not. Incidence of syncope and presyncope was compared between randomization groups using multivariable logistic regression. RESULTS Of 2464 study participants, 1337 received water and 1127 did not; groups differed slightly by sex and race. Syncope or presyncope was seen in 23 (1.7%) of the treatment and 18 (1.6%) of the control arm subjects. After adjusting for race, sex, age, and donation history, there was no difference in outcome between the water versus no water arms (adjusted odds ratio [OR], 0.80; 95% confidence interval [CI], 0.42-1.53). Black donors had sevenfold lower odds of syncope or presyncope than their white counterparts (adjusted OR, 0.14; 95% CI, 0.04-0.47). CONCLUSION Preloading adolescent donors with 500 mL of water did not have a major effect in reducing syncope and presyncope in South African adolescent donors. Our adolescent donors had lower overall syncope and presyncope rates than similar populations in the United States, limiting the statistical power of the study. We confirmed much lower rates of syncope and presyncope among young black donors.
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145
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Gonçalez TT, Di Lorenzo Oliveira C, Carneiro-Proietti ABF, Moreno EC, Miranda C, Larsen N, Wright D, Leão S, Loureiro P, de Almeida-Neto C, Lopes MI, Proietti FA, Custer B, Sabino E. Motivation and social capital among prospective blood donors in three large blood centers in Brazil. Transfusion 2012; 53:1291-301. [PMID: 22998740 DOI: 10.1111/j.1537-2995.2012.03887.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Studies analyzing motivation factors that lead to blood donation have found altruism to be the primary motivation factor; however, social capital has not been analyzed in this context. Our study examines the association between motivation factors (altruism, self-interest, and response to direct appeal) and social capital (cognitive and structural) across three large blood centers in Brazil. STUDY DESIGN AND METHODS We conducted a cross-sectional survey of 7635 donor candidates from October 15 through November 20, 2009. Participants completed self-administered questionnaires on demographics, previous blood donation, human immunodeficiency virus testing and knowledge, social capital, and donor motivations. Enrollment was determined before the donor screening process. RESULTS Among participants, 43.5 and 41.7% expressed high levels of altruism and response to direct appeal, respectively, while only 26.9% expressed high levels of self-interest. More high self-interest was observed at Hemope-Recife (41.7%). Of participants, 37.4% expressed high levels of cognitive social capital while 19.2% expressed high levels of structural social capital. More high cognitive and structural social capital was observed at Hemope-Recife (47.3 and 21.3%, respectively). High cognitive social capital was associated with high levels of altruism, self-interest, and response to direct appeal. Philanthropic and high social altruism were associated with high levels of altruism and response to direct appeal. CONCLUSION Cognitive and structural social capital and social altruism are associated with altruism and response to direct appeal, while only cognitive social capital is associated with self-interest. Designing marketing campaigns with these aspects in mind may help blood banks attract potential blood donors more efficiently.
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Affiliation(s)
- Thelma T Gonçalez
- Department of Epidemiology, Blood Systems Research Institute, San Francisco, California 94118, USA.
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146
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Blatyta PF, Custer B, Liu J, Mendrone-Junior A, Wright DJ, Leão SC, Lopes MI, Carneiro-Proietti AB, Sabino EC, de Almeida-Neto C. The impact of policies to restrict the use of plasma containing products and apheresis platelets from female donors to mitigate transfusion related acute lung injury (TRALI) in Brazil. Transfus Apher Sci 2012; 48:15-20. [PMID: 22985535 DOI: 10.1016/j.transci.2012.07.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2011] [Accepted: 07/31/2012] [Indexed: 11/24/2022]
Abstract
BACKGROUND AND OBJECTIVES Although the incidence of TRALI is unknown in Brazil, some blood centers have adopted strategies to prevent TRALI. We evaluated the impact of three policies to mitigate TRALI on the supply of blood products: to divert the production of whole blood-derived plasma from female donors; to defer all female donors from apheresis platelet collections, and to defer only multiparous female donors from apheresis platelet collections. MATERIALS AND METHODS Data from allogeneic whole blood and apheresis platelet donations from April 2008 to December 2009 were collected in three Brazilian blood centers and the impact of the aforementioned strategies was evaluated. RESULTS Of 544,814 allogeneic blood donations, 30.8% of whole blood plasma and 24.1% of apheresis platelet donations would be reduced if only male donor plasma was issued for transfusion and all female donors were deferred from apheresis donation, respectively. If only multiparous donors were deferred from apheresis donation, there would be a 5% decrease of all apheresis platelet collections. CONCLUSION Restricting the use of whole blood derived plasma to male-only donors and deferring all female apheresis platelet donors would impact two out of three Brazilian blood centers. A deferral policy on multiparous apheresis platelet donors may be acceptable as a temporary measure, but may cause more stress on a system that is already working at its limit.
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Oliveira CDL, Goncalez T, Wright D, Rocha PC, Miranda C, Capuani L, Carneiro-Proietti AB, Proietti FA, de Almeida-Neto C, Larsen NM, Sampaio D, Custer B. Relationship between social capital and test seeking among blood donors in Brazil. Vox Sang 2012; 104:100-9. [PMID: 22892075 DOI: 10.1111/j.1423-0410.2012.01643.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND OBJECTIVES Higher risk of HIV infection could be associated with test seeking, which is one motivation for donating blood. Cognitive social capital is defined as the social support, trust and co-operation that guide community behaviour. Structural social capital refers to an individual's participation in institutions and organizations. The association between social capital and test seeking was assessed. MATERIALS AND METHODS A survey of over 7500 donors in three Brazilian blood centres was conducted. Test seeking was classified into four non-overlapping categories (non-test seeker, possible, presumed and self-disclosed test seekers) using one direct and two indirect questions. Social capital was summarized into cognitive and structural categorizations. Multivariable logistic regression analysis was performed. RESULTS Compared with non-test seekers (62% of survey respondents), cognitive social capital was higher for each category of test seeking (OR=1.1, 7.4, 7.1, P<0.05 respectively). Male gender, lower education and lower income were also significantly associated with test seeking. CONCLUSION As test seekers appear to have strong social networks, blood banks may leverage this to convince them to seek testing at other locations.
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Affiliation(s)
- C D L Oliveira
- Universidade Federal de São João del-Rei, Minas Gerais, Brazil.
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148
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Gonçalez TT, Sabino EC, Schlumpf KS, Wright DJ, Mendrone A, Lopes M, Leão S, Miranda C, Capuani L, Carneiro-Proietti ABF, Basques F, Ferreira JE, Busch M, Custer B. Analysis of donor deferral at three blood centers in Brazil. Transfusion 2012; 53:531-8. [PMID: 22845775 DOI: 10.1111/j.1537-2995.2012.03820.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND The safety of the blood supply is ensured through several procedures from donor selection to testing of donated units. Examination of the donor deferrals at different centers provides insights into the role that deferrals play in transfusion safety. STUDY DESIGN AND METHODS A cross-sectional descriptive study of prospective allogeneic blood donors at three large blood centers located in São Paulo, Belo Horizonte, and Recife, Brazil, from August 2007 to December 2009 was conducted. Deferrals were grouped into similar categories across the centers, and within each center frequencies out of all presentations were determined. RESULTS Of 963,519 prospective blood donors at the three centers, 746,653 (77.5%) were accepted and 216,866 (22.5%) were deferred. Belo Horizonte had the highest overall deferral proportion of 27%, followed by Recife (23%) and São Paulo (19%). Females were more likely to be deferred than males (30% vs. 18%, respectively). The three most common deferral reasons were low hematocrit or hemoglobin, medical diagnoses, and higher-risk behavior. CONCLUSION The types and frequencies of deferral vary substantially among the three blood centers. Factors that may explain the differences include demographic characteristics, the order in which health history and vital signs are taken, the staff training, and the way deferrals are coded by the centers among other policies. The results indicate that blood donor deferral in Brazil has regional aspects that should be considered when national policies are developed.
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Affiliation(s)
- Thelma T Gonçalez
- Blood Systems Research Institute, San Francisco, California; the Fundação Pró-Sangue Hemocentro de São Paulo, São Paulo, Brazil.
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149
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Carson PJ, Borchardt SM, Custer B, Prince HE, Dunn-Williams J, Winkelman V, Tobler L, Biggerstaff BJ, Lanciotti R, Petersen LR, Busch MP. Neuroinvasive disease and West Nile virus infection, North Dakota, USA, 1999-2008. Emerg Infect Dis 2012; 18:684-6. [PMID: 22469465 PMCID: PMC3309699 DOI: 10.3201/eid1804.111313] [Citation(s) in RCA: 75] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
To determine risk for West Nile virus (WNV) neuroinvasive disease in North Dakota, we tested plasma samples from blood donors for WNV IgG and compared infection rates with reported WNV neuroinvasive disease incidence. We estimate that 1 in 244 WNV infections leads to neuroinvasive disease; risk is substantially increased among men and older persons.
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Affiliation(s)
- Paul J Carson
- University of North Dakota School of Medicine and Health Sciences, Grand Forks, North Dakota, USA
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150
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Vahidnia F, Petersen M, Stapleton JT, Rutherford GW, Busch M, Custer B. Acquisition of GB virus type C and lower mortality in patients with advanced HIV disease. Clin Infect Dis 2012; 55:1012-9. [PMID: 22752515 DOI: 10.1093/cid/cis589] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND GB virus type C (GBV-C) is transmitted by sexual or parenteral exposure and is prevalent among patients receiving blood products. GBV-C is associated with lower human immunodeficiency virus (HIV) RNA and better survival among HIV-infected patients. Open questions are the presence and the direction of any causal relationship between GBV-C infection and HIV disease markers in the context of highly active antiretroviral therapy (HAART). METHODS We used a limited access database obtained from the National Heart, Lung, and Blood Institute's Viral Activation Transfusion Study (VATS), a randomized controlled trial of leukoreduced vs nonleukoreduced transfusions to HIV-infected transfusion-naive patients. Blood samples from 489 subjects were tested for GBV-C markers. Cox regression models and inverse probability of treatment weights were used to examine the association between GBV-C coinfection and mortality in the VATS cohort. RESULTS We found a significant reduction in mortality among GBV-C coinfected VATS subjects, after adjusting for HAART status, HIV RNA level, and CD4 cell count at baseline. Acquisition of GBV-C RNA (n = 39) was associated with lower mortality in 294 subjects who were GBV-C negative at baseline, adjusting for baseline covariates (hazard ratio = 0.22, 95% confidence interval [CI]: .08-.58) and in models in which weights were used to control for time-updated covariates (odds ratio = 0.21, 95% CI: .08-.60). CONCLUSIONS GBV-C viremia is associated with lower mortality, and GBV-C acquisition via transfusion is associated with a significant reduction in mortality in HIV-infected individuals, controlling for HIV disease markers. These findings provide the first evidence that incident GBV-C infection alters mortality in HIV-infected patients.
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Affiliation(s)
- Farnaz Vahidnia
- Blood Systems Research Institute, Epidemiology, San Francisco, CA 94118, USA.
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