1
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Maddox V, Vallely P, Brailsford SR, Harvala H. Virological safety of the UK blood supply in the era of individual risk assessments and HIV PrEP. Transfus Med 2023; 33:372-378. [PMID: 37668150 DOI: 10.1111/tme.12993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 08/17/2023] [Accepted: 08/18/2023] [Indexed: 09/06/2023]
Abstract
A more individualised donor selection policy was implemented in the UK in 2021, which replaced the previous 3-month deferral for men who have sex with men (MSM). Other blood services have a variety of policies in place to ensure the virological safety of blood components, ranging from an indefinite ban on MSM, to a defined period of exclusion, or to an individualised risk assessment that is not based on gender or sexual orientation. Justification of these policies should be based on scientific evidence including assessment of lengths of virological window periods, infectious disease epidemiology within donor populations and donation screening assay sensitivities. Developments in molecular technology and assays which can detect both antibodies and antigens in the very early stages of infection have significantly reduced the risk in most developed countries. However, the increasing usage of pre-exposure prophylaxis (PrEP) to prevent acquisition of HIV infection after possible high-risk sexual contact within the UK blood donor population has been recently noted. It has brought with it new diagnostic challenges within blood screening, notably possible non-detection of HIV RNA and serological markers following PrEP use despite potential infectivity. The use of other testing strategies such as detection of HIV DNA and screening for non-declared PrEP usage should be investigated further.
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Affiliation(s)
| | - Pamela Vallely
- Division of Evolution, Infection and Genomics Science, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | | | - Heli Harvala
- Microbiology Services, NHS Blood and Transplant, London, UK
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2
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Affiliation(s)
- Evan M Bloch
- Johns Hopkins University School of Medicine, Department of Pathology, Baltimore, MD, USA.
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3
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Castillo G, Vesnaver E, Gibson E, Butler-Foster T, Goldman M, Hill NE, Rosser A, Lapierre D, Rubini KA, MacDonagh R, Miguel G, Palumbo A, MacPherson P, Randall T, Osbourne-Sorrell W, O'Brien SF, Bridel W, Otis J, Greaves M, Al-Bakri TB, Reid M, Labrecque M, Germain M, Orvis S, Clapperton AT, Devine D, Presseau J. Staff perspectives on barriers and enablers to implementing alternative source plasma eligibility criteria for gay, bisexual, and other men who have sex with men. Transfusion 2022; 62:1571-1582. [PMID: 35834537 PMCID: PMC9544875 DOI: 10.1111/trf.17000] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 05/12/2022] [Accepted: 05/12/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Canadian Blood Services introduced new eligibility criteria that allows some sexually active gay, bisexual, and other men who have sex with men (gbMSM) to donate source plasma, marking a significant change from time-based deferral criteria. We aimed to identify potential barriers and enablers to implementing the new criteria from the perspective of donor center staff. STUDY DESIGN AND METHODS We conducted Theoretical Domains Framework-informed interviews with staff from two source plasma donation centers in Canada. RESULTS We completed 28 interviews between June 2020 and April 2021. Three themes representing eight domains captured key tensions. Valuing inclusive eligibility criteria: staff support inclusive criteria; many were concerned the new criteria remained discriminatory. Investing in positive donor experiences: staff wished to foster positive donor experiences; however, they worried gbMSM donors would express anger and disappointment regarding the new criteria, staff would experience unease over using stigmatizing criteria and convey nonverbal cues of discomfort, and recurring plasma donors may behave inappropriately. Supporting education, training, and transparency of eligibility criteria: participants believed providing in-person training (i.e., to explain criteria rationale, address discomfort, practice responding to donor questions) and ensuring donors and the public were well-informed of the upcoming changes would improve implementation. DISCUSSION Participant views emphasize the importance of supporting staff through training and transparent communication to optimize the delivery of world-class equitable care for a new cohort of donors who have previously been excluded from plasma donation. Findings inform which staff supports to consider to improve implementation as policies continue to shift internationally.
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Affiliation(s)
- Gisell Castillo
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
| | - Elisabeth Vesnaver
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada.,School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada
| | - Emily Gibson
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
| | | | - Mindy Goldman
- Medical Affairs and Innovation, Canadian Blood Services, Ottawa, Canada.,Department of Pathology and Laboratory Medicine, University of Ottawa, Ottawa, Canada
| | - Nolan E Hill
- Centre for Sexuality, Calgary, Canada.,Local Advisory Group, Calgary, Canada
| | | | - Don Lapierre
- Medical Affairs and Innovation, Canadian Blood Services, Ottawa, Canada
| | | | | | | | - Amelia Palumbo
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
| | - Paul MacPherson
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada.,Department of Medicine, The Ottawa Hospital, Ottawa, Canada.,Department of Biochemistry, Microbiology and Immunology, University of Ottawa, Ottawa, Canada
| | | | | | - Sheila F O'Brien
- Medical Affairs and Innovation, Canadian Blood Services, Ottawa, Canada
| | | | - Joanne Otis
- Department of Sexology, Université du Québec À Montréal, Montreal, Canada
| | | | | | | | | | - Marc Germain
- Héma-Québec, Medical Affairs, Quebec City, Canada
| | | | | | - Dana Devine
- Canadian Blood Services, Vancouver, Canada.,Centre for Blood Research, University of British Columbia, Vancouver, Canada
| | - Justin Presseau
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada.,School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada.,School of Psychology, University of Ottawa, Ottawa, Canada
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4
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Hofkirchner A, Kohut T, O'Brien SF, Fisher WA. Assessing unintentional creation of bias against men who have sex with men as a function of exposure to blood donor screening questionnaire: A national randomized controlled trial. Transfusion 2022; 62:1399-1407. [PMID: 35621117 DOI: 10.1111/trf.16930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Revised: 04/24/2022] [Accepted: 04/26/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Canadian Blood Services (CBS) screens donors based on group status (e.g., men who have sex with men, MSM) instead of specific, high-risk sexual practices (e.g., occurrence of condomless sex). The MSM screening question is embedded in a cluster of questions about stigmatized attributes such as history of imprisonment and illicit substance use. This juxtaposition of the "MSM question" and stigmatized attributes may unintentionally cause blood donors to perceive MSM more negatively. The aim of this research is to determine whether the CBS donor eligibility questionnaire generates negative bias against MSM. STUDY DESIGN AND METHODS A national, randomized online study of 903 CBS donors was conducted. Participants completed either the existing blood donor eligibility questionnaire or a modified donor questionnaire that repositioned the MSM question among neutral questions. After completing the existing or modified questionnaire, bias against MSM was measured using the sexuality implicit association test (IAT) and Modern Homonegativity Scale - Gay Men (MHS-G). Lastly, participants estimated prevalence rates among MSM of certain stigmatized behaviors. RESULTS Participants who completed the existing donor eligibility questionnaire more strongly associated gay men with negative attributes on the IAT (pone-tailed = .045), suggesting question position generated implicit negative bias toward MSM. Responses to the MHS-G (pone-tailed = .506) and prevalence estimation task (p = .443) indicated that question order had no significant impact on explicit bias. DISCUSSION Positioning the MSM screening question among stigmatizing questions creates implicit negative bias against MSM. Policy makers should be mindful of question positioning when designing donor questionnaires.
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Affiliation(s)
| | - Taylor Kohut
- Department of Psychology, Western University, London, Ontario, Canada
| | - Sheila F O'Brien
- Department of Epidemiology & Surveillance, Canadian Blood Services, Ottawa, Ontario, Canada
| | - William A Fisher
- Department of Psychology, Western University, London, Ontario, Canada.,Department of Obstetrics and Gynaecology, Western University, London, Ontario, Canada
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5
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Hahn B, Quee F, Prinsze FJ, Gregoire Y, O'Brien SF, Germain M, van de Laar T, Zaaijer HL, van den Hurk K. Balancing non-discriminatory donor selection and blood safety in the Netherlands: Evaluation of an individual risk assessment of sexual behavior. Transfusion 2022; 62:1241-1250. [PMID: 35502143 DOI: 10.1111/trf.16896] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 04/15/2022] [Accepted: 04/15/2022] [Indexed: 01/05/2023]
Abstract
BACKGROUND To better balance the safety of the blood supply and the inclusion of men who have sex with men (MSM), further improvements are needed to the risk management strategy employed in the Netherlands to reduce transfusion-transmissible infections (TTIs). A gender-neutral individual risk assessment could provide a solution by determining donor eligibility based on sexual behaviors known to increase the risk of TTIs. Our objective is to estimate the proportion of blood donors that would be deferred by such an assessment, as well as their discomfort answering such questions. STUDY DESIGN AND METHODS Two surveys were distributed in May 2020 to assess sexual behavior in blood donors in the last 4, 6, and 12 months, as well as their discomfort reporting such information. A combination of both surveys measured the extent to which discomfort was associated with reporting sexual behavior. A high-risk sexual behavior pattern was defined as having had multiple sexual partners and having engaged in anal sex, without consistent condom use. RESULTS Of all 2177 participating whole blood donors, 0.8% report engaging in high-risk sexual behaviors over the last 4 months and would therefore be ineligible to donate. When accounting for the additional proportion of donors that reported such questions would stop them from donating, 2.0% and 3.2% of female and male donors, respectively, would be lost. DISCUSSION Gender-neutral eligibility criteria based on high-risk sexual behaviors may reduce the overall number of eligible donors in the Netherlands, but could make blood donation more accessible to a broader group of donors.
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Affiliation(s)
- Brett Hahn
- Athena Institute, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands.,Department of Donor Medicine Research, Sanquin Research, Amsterdam, the Netherlands
| | - Franke Quee
- Department of Donor Medicine Research, Sanquin Research, Amsterdam, the Netherlands
| | - Femmeke J Prinsze
- Department of Donor Medicine Research, Sanquin Research, Amsterdam, the Netherlands
| | | | | | | | - Thijs van de Laar
- Department of Donor Medicine Research, Sanquin Research, Amsterdam, the Netherlands.,Laboratory of Medical Microbiology, OLVG, Amsterdam, the Netherlands
| | - Hans L Zaaijer
- Department of Donor Medicine Research, Sanquin Research, Amsterdam, the Netherlands.,Department of Clinical Virology, Amsterdam UMC, Amsterdam, the Netherlands
| | - Katja van den Hurk
- Department of Donor Medicine Research, Sanquin Research, Amsterdam, the Netherlands
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Fisayo T. Science in action? A critical view of UK blood donation deferral policy and men who have sex with men. Int J Health Plann Manage 2021; 36:1207-1222. [PMID: 33834528 DOI: 10.1002/hpm.3167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 01/30/2021] [Accepted: 03/21/2021] [Indexed: 11/06/2022] Open
Abstract
The rules that govern blood donation vary globally. Some potential blood donors are ineligible for immediate blood donation, and as such are deferred until such time that they become eligible. This practice, the blood donation deferral period, is intended to reduce the risk of blood-borne infections being transfused into a blood product-recipient. As blood screening technologies improve, the risk of an infected blood product remaining undetected decreases-and so too have the deferral periods for certain donors. Much has been made of the importance of an evidence-based, scientific approach to protecting blood product-recipients. However, these deferrals are controversial. What exactly determines the blood donation deferral period? This article argues that blood donation deferral periods are not merely the result of enacting empirical data. Instead, the deferral periods represent a negotiation between scientific evidence, experts, politically expedient narratives, institutionalised risk aversion, as well as more mundane concerns such as operational feasibility. As a case study, I examine how the UK Advisory Committee on the Safety of Blood, Tissues and Organs changed the 12-month deferral period for blood donation from men who have sex with men to a 3-month deferral period.
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Affiliation(s)
- Temitope Fisayo
- King's College London School of Medicine, Guy's Campus, London, UK
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7
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Abstract
What purpose can be served by empirically unsubstantiated speculation in ethics? In answering that question, we need to distinguish between the major branches of ethics. In foundational moral philosophy, the use of speculative examples is warranted to the extent that ethical principles and theories are assumed to be applicable even under the extreme circumstances referred to in these examples. Such an assumption is in need of justification, and it cannot just be taken for granted. In applied ethics, the use of unrealistic scenarios is more difficult to justify. It can be positively harmful if it diverts our attention from more urgent issues. Neuroethics is one of the areas of applied ethics where speculative scenarios have taken up much of the attention that could instead have been devoted to problems that are relevant for the treatment and care of patients. Speculative ethics has often been defended with mere possibility arguments that may at first hand seem difficult to refute. It is shown with examples how such claims can be defeated with a combination of science and argumentation analysis.
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8
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van Bilsen WPH, Zaaijer HL, Matser A, van den Hurk K, Slot E, Schim van der Loeff MF, Prins M, van de Laar TJW. Infection Pressure in Men Who Have Sex With Men and Their Suitability to Donate Blood. Clin Infect Dis 2020; 68:1001-1008. [PMID: 30052873 DOI: 10.1093/cid/ciy596] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2018] [Accepted: 07/24/2018] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Deferral of men who have sex with men (MSM) from blood donation is highly debated. We therefore investigated their suitability to donate blood. METHODS We compared the antibody prevalence of 10 sexually and transfusion-transmissible infections (TTIs) among 583 MSM and 583 age-matched repeat male blood donors. MSM were classified as low risk (lr) or medium-to-high risk (hr) based on self-reported sexual behavior and as qualified or unqualified using Dutch donor deferral criteria. Infection pressure (IP) was defined as the number of antibody-reactive infections, with class A infections (human immunodeficiency virus-1/2, hepatitis B virus, hepatitis C virus, human T-cell lymphotropic virus-1/2, syphilis) given double weight compared to class B infections (cytomegalovirus, herpes simplex virus-1/2, human herpesvirus 8, hepatitis E virus, parvovirus B19). RESULTS Donors had a lower median IP than qualified lr-MSM and qualified hr-MSM (2 [interquartile range {IQR}, 1-2] vs 3 [IQR, 2-4]; P < .001). Low IP was found in 76% of donors, 39% of qualified lr-MSM, and 27% of qualified hr-MSM. The prevalence of class A infections did not differ between donors and qualified lr-MSM but was significantly higher in qualified hr-MSM and unqualified MSM. Recently acquired class A infections were detected in hr-MSM only. Compared to blood donors, human herpesviruses were more prevalent in all MSM groups (P < .001). CONCLUSIONS IP correlates with self-reported risk behavior among MSM. Although lr-MSM might form a low threat for blood safety with regard to class A infections, the high seroprevalence of human herpesviruses in lr-MSM warrants further investigation.
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Affiliation(s)
- Ward P H van Bilsen
- Department of Infectious Diseases, Research and Prevention, Public Health Service of Amsterdam, Amsterdam, The Netherlands
| | - Hans L Zaaijer
- Department of Blood-borne Infections, Sanquin Research, Amsterdam, The Netherlands.,Department of Internal Medicine, Amsterdam Infection and Immunity Institute, Academic Medical Center, Amsterdam, The Netherlands
| | - Amy Matser
- Department of Infectious Diseases, Research and Prevention, Public Health Service of Amsterdam, Amsterdam, The Netherlands
| | - Katja van den Hurk
- Department of Donor Studies, Sanquin Research, Amsterdam, The Netherlands
| | - Ed Slot
- Department of Blood-borne Infections, Sanquin Research, Amsterdam, The Netherlands
| | - Maarten F Schim van der Loeff
- Department of Infectious Diseases, Research and Prevention, Public Health Service of Amsterdam, Amsterdam, The Netherlands.,Department of Internal Medicine, Amsterdam Infection and Immunity Institute, Academic Medical Center, Amsterdam, The Netherlands
| | - Maria Prins
- Department of Infectious Diseases, Research and Prevention, Public Health Service of Amsterdam, Amsterdam, The Netherlands.,Department of Internal Medicine, Amsterdam Infection and Immunity Institute, Academic Medical Center, Amsterdam, The Netherlands
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9
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Negotiating risk-group categorization and the co-production of blood safety: the evolution of sociotechnical imaginaries mobilized in the public debate on the deferral of men who have sex with men as blood donors in Belgium. BIOSOCIETIES 2019. [DOI: 10.1057/s41292-019-00161-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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10
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Grace D, Gaspar M, Lessard D, Klassen B, Brennan DJ, Adam BD, Jollimore J, Lachowsky NJ, Hart TA. Gay and bisexual men's views on reforming blood donation policy in Canada: a qualitative study. BMC Public Health 2019; 19:772. [PMID: 31208391 PMCID: PMC6580549 DOI: 10.1186/s12889-019-7123-4] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Accepted: 06/07/2019] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Researchers and activists have long called for changes to blood donation policies to end what is frequently framed as unjustified bans or deferral periods for men who have sex with men (MSM). Since 2016, in Canada, a man had to be abstinent from all sexual contact (anal or oral sex) with other men for at least 12 months in order to be an eligible blood donor. As of June 3, 2019, this deferral period was reduced to 3 months. METHODS To better understand the acceptance of existing deferral policies and possible future policy, we conducted 47 in-depth interviews with a demographically diverse sample of gay, bisexual, queer, and other men who have sex with men (GBM) in Canada's three largest cities: Vancouver, (n = 17), Toronto (n = 15), and Montreal (n = 15). Interviews were coded in NVivo 11 following an inductive thematic analysis. We focus on men's preferred policy directions and their opinions about a policy change proposed by Canada's blood operators: a 3-month deferral for all sexual activity between men. We interviewed GBM approximately one-year before this new deferral policy was approved by Health Canada. RESULTS Most participants were opposed to any deferral period in relation to MSM-specific sexual activity. A fair and safe policy was one that was the "same for everyone" and included screening for several risk factors during the blood donation process with no categorical exclusion of all sexually active MSM. Participants believed that multiple "gender blind" and HIV testing-related strategies could be integrated into the blood donation process. These preferences for a move away from MSM-specific exclusions aligned with their opinions concerning the possible change to a 3-month MSM deferral, for which participants shared three overarching perspectives: (1) step in the right direction; (2) ambivalence and uncertainty; and (3) not an improvement. CONCLUSION A predominant assertion was that a change from a 12-month to a 3-month deferral period would not resolve the fundamental issues of fairness and equity affecting blood screening practices for GBM in Canada. Many participants believed that blood donation policy should be based on more up-to-date scientific evidence concerning risk factor assessment and HIV testing.
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Affiliation(s)
- Daniel Grace
- Dalla Lana School of Public Health, University of Toronto, 155 College Street, 5th Floor, Room 556, Toronto, ON, M5T 3M7, Canada.
| | - Mark Gaspar
- Dalla Lana School of Public Health, University of Toronto, 155 College Street, 5th Floor, Room 510, Toronto, ON, M5T 3M7, Canada
| | - David Lessard
- Centre for Health Outcomes Research, McGill University Health Centre, 5252 de Maisonneuve West, Montréal, QC, H4A 3S5, Canada
| | - Benjamin Klassen
- Department of History, Simon Fraser University, 8888 University Drive, Burnaby, BC, V5A 1S6, Canada
| | - David J Brennan
- Factor-Inwentash Faculty of Social Work, University of Toronto, 246 Bloor St W, Toronto, ON, M5S 1V4, Canada
| | - Barry D Adam
- Ontario HIV Treatment Network, 1300 Yonge Street #600, Toronto, ON, M4T 1X3, Canada
| | - Jody Jollimore
- Community-Based Research Centre, 1007-808 Nelson Street, Vancouver, BC, V6Z 2H2, Canada
| | - Nathan J Lachowsky
- School of Public Health & Social Policy, Faculty of Human & Social Development, University of Victoria, Michael Smith Foundation for Health Research Scholar, P.O. Box 1700, STN CSC, Victoria, BC, V8W 2Y2, Canada
| | - Trevor A Hart
- HIV Prevention Lab, Department of Psychology, Ryerson University, 350 Victoria St, Toronto, ON, M5B 2K3, Canada
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11
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Sturrock BRH, Mucklow S. What is the evidence for the change in the blood -donation deferral period for high-risk groups and does it go far enough? Clin Med (Lond) 2018; 18:304-307. [PMID: 30072554 PMCID: PMC6334046 DOI: 10.7861/clinmedicine.18-4-304] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
In November 2017, the deferral on blood donations from high-risk groups in Great Britain was changed to 3 months from last at-risk sexual contact following recommendations from the Advisory Committee on the Safety of Blood, Tissues and Organs. This represented a reduction from 12 months for men who have sex with men, and from a lifetime ban for sex workers. This is a step forward for equality and for reducing stigma around these groups. However, one argument for deferral is the prevalence of infections, which may not be identified due to the fallibility of current testing approaches. Clearly it is vital that the welfare of blood transfusion recipients is prioritised and they are not exposed to unacceptable risks. However, with the increasingly sophisticated technology used to screen blood, it can be argued that the evidence shows that the reduction in deferral does not go far enough.
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Affiliation(s)
| | - Stuart Mucklow
- Department of Clinical Haematology, Royal Berkshire Hospital, Reading, UK
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12
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Romeijn B, Merz EM, Kok G, de Kort W, van Dongen A. Eligibility and willingness to donate blood in men who have (had) sex with men. Transfusion 2017; 58:710-717. [DOI: 10.1111/trf.14469] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Revised: 11/13/2017] [Accepted: 11/17/2017] [Indexed: 01/11/2023]
Affiliation(s)
- Bas Romeijn
- Department of Donor Studies; Sanquin Research; Amsterdam the Netherlands
| | - Eva-Maria Merz
- Department of Donor Studies; Sanquin Research; Amsterdam the Netherlands
- Department of Sociology; Vrije Universiteit; Amsterdam the Netherlands
| | - Gerjo Kok
- Department of Applied Social Psychology; Maastricht University; Maastricht the Netherlands
| | - Wim de Kort
- Department of Donor Studies; Sanquin Research; Amsterdam the Netherlands
- Department of Social Medicine; Academic Medical Centre; Amsterdam the Netherlands
| | - Anne van Dongen
- School of Psychology; University of New South Wales; Sydney Australia
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13
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Abstract
PURPOSE OF REVIEW The review summarizes recent publications on the contentious issue of donor deferral criterion for men who have sex with men (MSM). RECENT FINDINGS Recent studies from the United States and China demonstrated that MSM is still a frequent risk factor for HIV-positive donors. Noncompliance is an important factor in the overall risk of HIV transmission but does not appear to be affected by the length of the deferral period. A major US study found a 2.6% noncompliance rate with the current indefinite deferral for MSM; similar or lower rates were found in other jurisdictions with shorter deferral periods. Several countries have had a defined deferral period of 1 year or 5 years in place long enough to determine that increases in HIV-positive cases predicted by modeling studies did not actually occur, suggesting that the assumptions made in these models are overly conservative. SUMMARY In summary, MSM eligibility policies are slowly changing around the world, with the US FDA now permitting a 1-year deferral. Transparency, involvement of stakeholders, and careful evaluation of risk and societal benefit should be part of future policy discussions on this issue.
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14
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Reevaluating Canada's policy for blood donations from men who have sex with men (MSM). J Public Health Policy 2017; 37:428-439. [PMID: 28202924 DOI: 10.1057/s41271-016-0032-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
During the HIV/AIDS epidemic of the 1980s, most of the developed world instituted a permanent ban on blood donations from men who have sex with men (MSM). In recent years, public health agencies across Europe and North America are reconsidering and rescinding these restrictions. We examine the Canadian climate, where MSM may donate blood only after a 5-year deferral period. We review circumstances of the initial ban on MSM blood donations and recent social, legal, and economic changes that have encouraged Canadian public health officials to consider policy reform. We also review international evidence about the impact of reforming MSM blood donations. Given improvements in HIV screening technology, results from mathematical modeling studies, and empirical data from Italy, the UK, and Australia, we conclude that changing Canada's MSM blood donation policy from a 5- to a 1-year deferral would not increase the number of transfusion-transmitted HIV infections. We provide empirical support to the recently elected Liberal Canadian government's political promise to decrease restrictions on MSM blood donations.
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15
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Wilson K, Atkinson KM, Fergusson DA, Brown A, Forster A, Murphy MSQ, Tinmouth AT, Keelan J. Problems with precaution: the transfusion medicine experience. JOURNAL OF RISK RESEARCH 2017; 22:137-149. [PMID: 29348731 PMCID: PMC5770215 DOI: 10.1080/13669877.2017.1351478] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/14/2016] [Accepted: 04/20/2017] [Indexed: 06/07/2023]
Abstract
The precautionary principle is a dominant paradigm governing risk-based decision-making. Today, there are increasing pressures to re-examine aggressive precautionary approaches, and to assess how the principle should be applied in the modern system. In this paper, we examined three key applications of precautionary approaches in the field of transfusion medicine to provide insight into the risks and benefits of these approaches. The three case studies examined were the donor deferral policies to safeguard against transfusion transmission of human immunodeficiency virus, variant Creutzfeldt-Jacob disease, and, lastly, xenotropic murine leukemia virus-related virus. Characterization of precautionary applications was conducted using an embedded case study design. Our findings indicate that transfusion transmission mitigation strategies have become increasingly aggressive in the face of theoretical risks. In contrast, the review processes for implementation and reversal of precautionary policies have been slow, and historical donor deferral policies are still in place today. Application of precautionary approaches has proved challenging with both benefits and pitfalls. In light of emerging threats to the blood system, policy-makers should consider the implementation of frameworks to guide the appropriate application of precaution in transfusion medicine in the future.
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Affiliation(s)
- Kumanan Wilson
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
- Departments of Medicine, and Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, Canada
| | - Katherine M. Atkinson
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
| | - Dean A. Fergusson
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
- Departments of Medicine, Surgery, & of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, Canada
| | - Adalsteinn Brown
- Institute for Health Policy, Management & Evaluation, University of Toronto, Toronto, Canada
| | - Alan Forster
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
- Department of Medicine, University of Ottawa, Ottawa, Canada
| | - Malia S. Q. Murphy
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
| | - Alan T. Tinmouth
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
- Department of Medicine, University of Ottawa, Ottawa, Canada
| | - Jennifer Keelan
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
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16
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Karamitros G, Kitsos N, Karamitrou I. The ban on blood donation on men who have sex with men: time to rethink and reassess an outdated policy. Pan Afr Med J 2017; 27:99. [PMID: 28819520 PMCID: PMC5554671 DOI: 10.11604/pamj.2017.27.99.12891] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2017] [Accepted: 05/31/2017] [Indexed: 12/03/2022] Open
Abstract
During the 1980s the HIV/AIDS epidemic outbreak occurred. Due to the high prevalence of the disease on men who had sex with men (MSM) a lifetime ban on blood donations on men who had sex with men (MSM) was implemented. In the recent years, organizations like the European Union (EU) and the World Health Organization (WHO) have established new guidelines introducing the term of “risky sexual behavior” without any reference to the sex orientation of the potential donor, however many countries are hesitant to review the ban on men who had sex with men (MSM). Given the lack of screening methods for HIV back in the '80s the ban on men who had sex with men seemed like the only choice in order to limit the disease. However, nowadays the screening methods have advanced and the possibility of a transfusion related HIV infection is extremely low. Many countries, considering the new data available, have reformed their policies and moved from the lifetime ban to 5-year and 1-year deferrals but only a fraction of countries have adopted the guidelines for the “risky sexual behavior” assessment. The ban that forbid men who have sex with men from donating blood was implemented more than 30 years ago. During the '80s, the epidemiology was different and it seems not only hypocritical but also naïve to rely on guidelines that are far outdated and old-fashioned. The medical community has a duty to secure safe blood for every person who might need it, let us not waste safe potential donors and stigmatize them by focusing on outdated policies.
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Affiliation(s)
| | - Nikolaos Kitsos
- Faculty of Medicine, University of Southampton, Southampton, United Kingdom
| | - Ioanna Karamitrou
- Law School, Democritus University of Thrace (DUTH), Komotini, Greece
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Lee SS, Cheung EKH, Leung JNS, Lee CK. Non-compliance to infectious disease deferral criteria among Hong Kong's blood donors. Vox Sang 2017; 112:425-433. [PMID: 28401619 DOI: 10.1111/vox.12520] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2016] [Revised: 02/20/2017] [Accepted: 03/07/2017] [Indexed: 01/16/2023]
Abstract
BACKGROUND AND OBJECTIVES Donor screening alone cannot eliminate the risk of transfusion-transmitted HIV infection. Donor deferral according to established criteria is a supplemental strategy, which has focused largely on men who have sex with men (MSM). A study was conducted to determine the compliance of non-MSM donors with such criteria and examine its implications on blood safety. MATERIALS AND METHODS Chinese donors who have just donated blood at blood donor centres in Hong Kong were recruited. Based on the contents of the routinely administered predonation Health Screening Questionnaires, participants were requested to complete a survey to assess their practice of deferrable risk behaviours and lifestyle encounters, using tablet computers. RESULTS Over an 8-week period in mid-2016, 1614 donors (male-to-female ratio 1·23) had enrolled in the survey, accounting for 40% of donors giving blood on the survey days. The proportion of respondents who gave blood despite having deferrable HIV risk was 5%: MSM 1·2% (of the male donors); non-MSM risk behaviours 2·6%; risky lifestyle encounters 2·1%. If inconsistent declaration and suspected risk behaviours were included, the total non-compliance rate became 10·8%. Male donors had a higher prevalence of deferrable behavioural risk, even after excluding MSM. Unawareness and non-acceptability were main reasons for non-compliance. CONCLUSION The non-compliance rate of donors to deferral was high, although the ultimate infection risk might be small in the presence of universal screening. Simplification of questionnaires, focus on time-limited deferral and a reduction of deferral items may improve the deferral mechanism without compromising blood safety.
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Affiliation(s)
- S S Lee
- Stanley Ho Centre for Emerging Infectious Diseases, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - E K H Cheung
- Stanley Ho Centre for Emerging Infectious Diseases, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - J N S Leung
- Hong Kong Red Cross Blood Transfusion Service, Kowloon, Hong Kong
| | - C K Lee
- Hong Kong Red Cross Blood Transfusion Service, Kowloon, Hong Kong
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Blood donor deferral policies across Europe and characteristics of men whohave sex with men screened for human immunodeficiency virus in bloodestablishments: data from the European Men-who-have-sex-with-men Internet Survey (EMIS). BLOOD TRANSFUSION = TRASFUSIONE DEL SANGUE 2017; 16:7-16. [PMID: 28488974 DOI: 10.2450/2017.0109-16] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Received: 04/25/2016] [Accepted: 01/31/2017] [Indexed: 11/21/2022]
Abstract
BACKGROUND The predominant mode of transmission of human immunodeficiency virus (HIV) in Europe is male-to-male transmission. Men who have sex with men (MSM) are deferred from donating blood in many countries, but nevertheless do donate blood. Based on data from 34 countries, we estimated the proportion of MSM screened for HIV in the context of a blood donation and identified individual factors associated with this HIV screening in order to propose possible public health interventions. MATERIALS AND METHODS In 2010, the first European MSM Internet Survey (EMIS) collected self-reported data on HIV testing from >180,000 MSM in 38 European countries. Using logistic regression, demographic and behavioural factors associated with screening for HIV in blood establishments were identified. Stratified by European sub-region, we analysed the proportion of MSM screening in blood establishments by time elapsed since last negative HIV test. RESULTS Donor eligibility criteria for MSM vary across Europe with most countries using permanent deferral. The Western region had the lowest (2%) proportion of MSM screened in blood establishments and the Northeastern region had the highest (14%). Being <25 years old, not disclosing sexual attraction to men, never having had anal intercourse with a man, having a female partner, living in a rural area, and certain European sub-regions or countries of residence increased the likelihood of being screened in blood establishments. DISCUSSION In spite of deferral policies, MSM are screened for HIV in the context of blood donations. Gay-friendly testing services are rare in rural areas, and young men might be reluctant to disclose their sexual orientation. Recent developments, such as home sampling, might offer new testing possibilities for those not reached by established services yet wishing to know their HIV status. Donor selection procedures should be improved. Both interventions might help to further reduce the risk of transfusion-transmitted infections.
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Wilson K, Atkinson K. Toward Neo-Precaution: A New Approach to Applying the Precautionary Principle to Public Health. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2017; 17:44-46. [PMID: 28207356 DOI: 10.1080/15265161.2016.1274792] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
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Kramer K, Zaaijer HL, Verweij MF. The Precautionary Principle and the Tolerability of Blood Transfusion Risks. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2017; 17:32-43. [PMID: 28207362 DOI: 10.1080/15265161.2016.1276643] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Tolerance for blood transfusion risks is very low, as evidenced by the implementation of expensive blood tests and the rejection of gay men as blood donors. Is this low risk tolerance supported by the precautionary principle, as defenders of such policies claim? We discuss three constraints on applying (any version of) the precautionary principle and show that respecting these implies tolerating certain risks. Consistency means that the precautionary principle cannot prescribe precautions that it must simultaneously forbid taking, considering the harms they might cause. Avoiding counterproductivity requires rejecting precautions that cause more harm than they prevent. Proportionality forbids taking precautions that are more harmful than adequate alternatives. When applying these constraints, we argue, attention should not be restricted to harms that are human caused or that affect human health or the environment. Tolerating transfusion risks can be justified if available precautions have serious side effects, such as high social or economic costs.
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Affiliation(s)
- Koen Kramer
- a Sanquin Blood Supply Foundation and Wageningen University and Research Center
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Arora KS. Righting Anachronistic Exclusions: The Ethics of Blood Donation by MSM. JOURNAL OF GAY & LESBIAN SOCIAL SERVICES 2017; 29:87-90. [PMID: 29308005 PMCID: PMC5753789 DOI: 10.1080/10538720.2016.1261385] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Recently, the FDA announced that it would soon lift the long-standing lifetime ban on blood donation by men who have sex with men (MSM). Re-examining blood donation by MSM, it is clear that there are several ethical goods that must be balanced. Through balancing the primary duty to safety with the imperatives to craft a policy that is formally equal, upholds the public's trust, and is non-discriminatory, an ethical blood donation deferral guideline may be advanced, both for MSM and the population at large.
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Affiliation(s)
- Kavita Shah Arora
- Reproductive Biology and Bioethics at MetroHealth Medicine Center, Case Western Reserve University, Cleveland, Ohio
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Yang YT, Wiley E, Duvivier RJ. US policy on blood donation by men who have sex with men. Lancet 2016; 388:2236-2237. [PMID: 27825503 DOI: 10.1016/s0140-6736(16)32073-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2016] [Accepted: 09/12/2016] [Indexed: 10/20/2022]
Affiliation(s)
- Y Tony Yang
- Department of Health Administration and Policy, George Mason University, Fairfax, VA 22030-4444, USA.
| | - Elizabeth Wiley
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Robbert J Duvivier
- School of Medicine and Public Health, University of Newcastle, Newcastle, NSW, Australia
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Béranger A, Bellis R, Bracconi M, Mouysset A. [Blood transfusion and homosexuality: Ethical considerations]. Transfus Clin Biol 2016; 23:145-50. [PMID: 27449719 DOI: 10.1016/j.tracli.2016.06.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Since the context of the contaminated blood affair in 1983, the homosexual male were excluded from the blood donation in France. This exclusion is often called into question in several countries and is an actual lively debate. In France, reform process is ongoing for a practical change. Three issues make up the discussion: the infectious risk bound to sexual behavior, the feasibility of the powerful biological tests but having a silent window and the protection of the blood recipient. The infectious risk in the homosexual male is higher for the human immunodeficiency virus (HIV) than in the rest of the population. Even if every person has his/her own individual risk depending on his/her habits, everyone is confronted to the same law. The challenge is to build a consensus, along with the precautionary principle, the non-discrimination policy, and the individual and collective responsibilities.
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Affiliation(s)
- A Béranger
- EA 4569, Laboratoire d'éthique médicale et de médecine légale, faculté de médecine, université Paris-Descartes, 45, rue des Saints-Pères, 75006 Paris, France.
| | - R Bellis
- EA 4569, Laboratoire d'éthique médicale et de médecine légale, faculté de médecine, université Paris-Descartes, 45, rue des Saints-Pères, 75006 Paris, France
| | - M Bracconi
- EA 4569, Laboratoire d'éthique médicale et de médecine légale, faculté de médecine, université Paris-Descartes, 45, rue des Saints-Pères, 75006 Paris, France; Faculté de chirurgie dentaire, département de santé publique, université Paris-Descartes, 1, rue Maurice-Arnoux, 92120 Montrouge, France
| | - A Mouysset
- EA 4569, Laboratoire d'éthique médicale et de médecine légale, faculté de médecine, université Paris-Descartes, 45, rue des Saints-Pères, 75006 Paris, France
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Romeijn B, van Dongen A, Kok G. Reasons for noncompliance in donor risk reporting regarding male-to-male sex. Transfusion 2016; 56:1899-906. [DOI: 10.1111/trf.13627] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2015] [Revised: 03/02/2016] [Accepted: 03/24/2016] [Indexed: 11/28/2022]
Affiliation(s)
- Bas Romeijn
- Department of Donor Studies; Sanquin Research; Amsterdam the Netherlands
| | - Anne van Dongen
- Department of Donor Studies; Sanquin Research; Amsterdam the Netherlands
| | - Gerjo Kok
- Department of Applied Social Psychology; Maastricht University; Maastricht the Netherlands
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Yang H, Anderson SA, Forshee R, Williams A, Epstein JS, Marks PW. Modeling complete removal of risk assessment questions in the USA predicts the risk of HIV exposure in blood recipients could increase despite the use of nucleic acid testing. Vox Sang 2016; 110:324-8. [PMID: 26765975 DOI: 10.1111/vox.12375] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2015] [Revised: 12/07/2015] [Accepted: 12/08/2015] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND OBJECTIVES The safety of the blood supply in a number of countries is achieved by interventions that include behaviour-based time-limited or indefinite deferrals and screening of donated units for transfusion-transmitted infections. The relatively high sensitivity of nucleic acid testing (NAT) used in blood donor screening has raised the question of whether such time-based deferrals can be eliminated in favour of individual risk assessment. MATERIALS AND METHODS Data on the annual number of incident human immunodeficiency virus (HIV) infections associated with various behaviours and on the performance characteristics of NAT applied to donor screening were used to model the number of potentially infected units that might escape detection in the worst-case scenario in which individual risk assessment was implemented, but was not effective as a screening tool, and donors did not otherwise self-select for lower risk. RESULTS In the absence of effective individual risk-based screening or donor self-selection, the model predicts that in the United States, an additional 39 (95% CI 35-43) HIV-infected units would escape detection by nucleic acid testing, potentially capable of exposing approximately 68 (95% CI 61-75) individuals to the risk of HIV infection through the administration of prepared blood components. CONCLUSION Despite some inherent uncertainty, the worst-case scenario of completely ineffective individual risk assessment, absence of donor self-selection and increased reliance on NAT for blood screening is estimated to be associated with an approximately fourfold increase in the risk of HIV exposure through transfusion in the United States.
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Affiliation(s)
- H Yang
- Center for Biologics Evaluation and Research, US Food and Drug Administration, Silver Spring, MD, USA
| | - S A Anderson
- Center for Biologics Evaluation and Research, US Food and Drug Administration, Silver Spring, MD, USA
| | - R Forshee
- Center for Biologics Evaluation and Research, US Food and Drug Administration, Silver Spring, MD, USA
| | - A Williams
- Center for Biologics Evaluation and Research, US Food and Drug Administration, Silver Spring, MD, USA
| | - J S Epstein
- Center for Biologics Evaluation and Research, US Food and Drug Administration, Silver Spring, MD, USA
| | - P W Marks
- Center for Biologics Evaluation and Research, US Food and Drug Administration, Silver Spring, MD, USA
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Slot E, Janssen MP, Marijt-van der Kreek T, Zaaijer HL, van de Laar TJ. Two decades of risk factors and transfusion-transmissible infections in Dutch blood donors. Transfusion 2015; 56:203-14. [PMID: 26355711 DOI: 10.1111/trf.13298] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2015] [Revised: 07/21/2015] [Accepted: 07/27/2015] [Indexed: 12/29/2022]
Abstract
BACKGROUND Risk behavior-based donor selection procedures are widely used to mitigate the risk of transfusion-transmissible infections (TTIs), but their effectiveness is disputed in countries with low residual risks of TTIs. STUDY DESIGN AND METHODS In 1995 to 2014, Dutch blood donors infected with hepatitis B virus (HBV), hepatitis C virus (HCV), human immunodeficiency virus (HIV), human T-lymphotropic virus (HTLV), or syphilis were interviewed by trained medical counselors to identify risk factors associated with TTIs. Trends in the prevalence and incidence of TTIs were analyzed using binomial regression models. RESULTS A total of 972 new donors and 381 repeat donors had TTIs. New donors had higher rates of TTIs compared to repeat donors. Although the HBV and HCV prevalence gradually decreased over time, the incidence of all five TTIs remained stable during the past two decades. In new donors the TTIs had the following risk profiles: "blood-blood contact" for HCV, "unprotected sex" for HIV and syphilis, and "country of birth" for HBV and HTLV. In infected repeat donors, sexual risk factors predominated for all TTIs. At posttest counseling, 28% of infected repeat donors admitted to risk factors leading to permanent donor exclusion if revealed during the donor selection procedure (predominantly male-to-male sex and recent diagnosis of syphilis). CONCLUSION The prevalence and incidence of TTIs among Dutch blood donors are six- to 60-fold lower than in the general Dutch population, illustrating the effectiveness of donor selection procedures. However, at least a quarter of infected donors appeared noncompliant to the donor health questionnaire (DHQ), suggesting that DHQs, or the way donor questioning is implemented, can be improved.
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Affiliation(s)
- Ed Slot
- Department of Blood-Borne Infections, Division Research, Sanquin Blood Supply Foundation, Amsterdam
| | - Mart P Janssen
- Department of Transfusion Technology Assessment, Division Research, Blood Supply Foundation, Amsterdam, the Netherlands.,Julius Centre for Health Sciences and Primary Care, University Medical Centre, Utrecht, the Netherlands
| | | | - Hans L Zaaijer
- Department of Blood-Borne Infections, Division Research, Sanquin Blood Supply Foundation, Amsterdam.,Department of Clinical Virology (CINIMA), Academic Medical Centre/University of Amsterdam, Amsterdam, the Netherlands
| | - Thijs J van de Laar
- Department of Blood-Borne Infections, Division Research, Sanquin Blood Supply Foundation, Amsterdam.,Department of Virology, Division Diagnostics, Sanquin Blood Supply Foundation, Amsterdam
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Abstract
Kumanan Wilson and colleagues explain how the rapid response to XMRV as a novel pathogen has highlighted some challenges pertaining to policy-making and editorial responsibilities. The impact on policy and the propagation of the initial scientific information may not cease if the evidence is disproven and retracted from the peer-reviewed literature, which creates a challenge for regulators and scientific journals. Please see later in the article for the Editors' Summary.
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Affiliation(s)
- Kumanan Wilson
- Departments of Medicine and of Epidemiology and Community Medicine, University of Ottawa, Ottawa, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
- * E-mail:
| | - Katherine Atkinson
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
| | - Jennifer Keelan
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
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