The impact of the new tick-box questionnaire, and the personal donor interview, on donor deferrals in the East of Scotland

What are blood donors telling us about injecting drug use?

BACKGROUND AND OBJECTIVES

Injecting drug use (IDU), a permanent deferral for blood donors, was included in a review of donor selection criteria completed in 2017. Here, we describe what is known about IDU in blood donors in the United Kingdom (UK).

MATERIALS AND METHODS

Data were obtained from routine surveillance of donation testing and confirmed positive donors and a 2013/2014 UK survey of behaviour and compliance in screen-negative donors.

RESULTS

Between 2009 and 2018, of 22 UK million donations screened, IDU was self-reported at the post-test discussion in 5% (86/1777) of donors with confirmed positive donations. Recent injecting within 12 months was reported in 8 HCV-positive donors, but only in 1/14 donors where it was clear HCV infection had been acquired in the previous 12 months. Of 65 439 survey responders, 25 reported IDU, which when weighted to the donor population gave 99·95% compliance. Most of the 111 donors reporting IDU felt it was not important to their donation, mainly because their injecting was in the past, while three HCV-positive recent injectors reported not sharing needles so presumably felt safe to donate.

CONCLUSION

Compliance with the permanent deferral appeared extremely high with low levels of injecting reported by donors, mainly in the past. This agreed with the low-incident HCV infection observed in UK donors. These data contributed to a recommendation to reduce the deferral to 1 year. Ways of improving compliance in those few donors at current increased risk of infection need to be investigated.

A Systematic Review of Interventions Used to Increase Blood Donor Compliance with Deferral Criteria

Background and Objectives

Pre-donation screening of potential blood donors is critical for ensuring the safety of the donor blood supply, and donor deferral as a result of risk factors is practised worldwide. This systematic review was conducted in the context of an expert review convened by the Australian Red Cross Lifeblood in 2013 to consider Lifeblood's injecting drug use (IDU)-related policies and aimed to identify studies assessing interventions to improve compliance with deferral criteria in blood donation settings.

Materials and Methods

MEDLINE/PubMed, OVID Medline, OVID Embase, LILACS, and the Cochrane Library (CENTRAL and DARE) databases were searched for studies conducted within blood donation settings that examined interventions to increase blood donor compliance with deferral criteria. Observational and experimental studies from all geographical areas were considered.

Results

Ten studies were identified that tested at least one intervention to improve blood donor compliance with deferral criteria, including computerized interviews or questionnaires, direct and indirect oral questioning, educational materials, and a combination of a tickbox questionnaire and a personal donor interview. High-quality evidence from a single study was provided for the effectiveness of a computerized interview in improving detection of HIV risk behaviour. Low-quality evidence for the effectiveness of computerized interviews was provided by 3 additional studies. Two studies reported a moderate effect of direct questioning in increasing donor deferral, but the quality of the evidence was low.

Conclusion

This review identified several interventions to improve donor compliance that have been tested in blood donation settings and provided evidence for the effectiveness of computerized interviews in improving detection of risk factors.

Preventing transfusion-transmitted HIV infection in Latin America and the Caribbean: issues associated with blood donor interviews and sex between men

BACKGROUND

Blood-borne transmission is the most efficient route for acquiring HIV infection, particularly through transfusion. Availability of noninfectious blood units for hemotherapy is a necessary condition for efficient functioning of health services. They have the obligation to ensure that the blood supply is safe, which includes interviewing potential donors to ascertain whether they might be at risk of being HIV infected. The interview procedures demand that blood services staff inquire potential blood donors about sexual practices associated to HIV transmission. Assumptions and misconceptions may unnecessary exclude adequate donors.

METHODS

Review of published and unpublished country reports in Latin America regarding blood safety and deferral criteria related to same sexual behavior among males.

RESULTS

An analysis of criteria for deferral of potential blood donors shows inconsistencies that may impact the necessary safe blood supply.

CONCLUSIONS

The blood donor deferral criteria should be revised according to relevant epidemiological evidence and social legitimacy. Personnel in blood banks and hemotherapy services should be educated to conduct appropriate interviews for accepting or deferring potential donors. Potential donors and the public should be knowledgeable for them to understand the reasons why some individuals may be deferred. Health authorities should work to reduce the stigma associated with HIV, prioritize building strong and meaningful partnerships with civil society, and engage diverse sectors in the national AIDS response.

The donor health assessment questionnaire: potential for format change and computer-assisted self-interviews to improve donor attention

BACKGROUND

The Canadian donor health assessment questionnaire (DHAQ) has developed gradually over many years. The purpose of this study was to determine whether the format and method of administration of the DHAQ influences donor attentiveness.

STUDY DESIGN AND METHODS

Between May 2004 and September 2005, a total of 1,397 donors participated in the study by completing the DHAQ by one of three methods: the current Canadian Blood Services (CBS) format and method of administration, which is partly self-administered and partly interviewer-administered (Method 1); the DHAQ reformatted to the AABB Uniform Donor Health Questionnaire format and self-administered (Method 2); and an audiovisual computer-assisted self-interview (CASI; Method 3). This was followed by a short, scripted interview assessing recall of 17 specific items queried on the DHAQ. Time to completion of the DHAQ and degree of familiarity with computer use were also assessed.

RESULTS

The percentages of donors identifying all 17 items correctly were 9.4, 20.9, and 34.8 percent and the mean percentages recall of items were 53.9, 56.0, and 69.8 percent with DHAQ administration Methods 1, 2, and 3, respectively (p < 0.0001). This difference was largely attributable to the poor recall of items queried as part of a list in Method 1. Mean times to complete the DHAQ were 3.1, 3.8, and 8.1 minutes for Methods 1, 2, and 3, respectively. More than 95 percent of donors had used a personal computer in the past year.

CONCLUSION

The current format of the Canadian DHAQ is not optimal for donor attention to specific questions asked as part of a list. Attention was improved by use of AABB uniform donor history questionnaire format and was best with use of a CASI format.

The Canadian donor health assessment questionnaire: can it be improved?

BACKGROUND

The donor health assessment questionnaire (DHAQ) plays an important role in ensuring blood safety. The Canadian DHAQ has been developed over many years on an ad hoc basis and has never been evaluated in light of cognitive science principles. In addition, donor attitudes about its mode of administration have not been assessed.

STUDY DESIGN AND METHODS

Between May and August 2005, a total of 456 donors participated in the study by completing the DHAQ, followed by a short, scripted interview assessing recall (as an indicator of attention to the questions) of 17 specific items queried on the DHAQ and attitudes toward interviewer or self-administration of the DHAQ.

RESULTS

Overall, 7.5 percent of donors were able to correctly identify all 17 items. Recall was best for questions asked as individual items (87%-99%) and decreased substantially for items that are part of a list (55%-91%). Position effects were demonstrated, with items at the end of a list being the most frequently forgotten. Twenty percent of repeat donors favored the current practice of interviewer administration of high-risk questions, whereas 80 percent were neutral or favored self-administration.

CONCLUSION

The current format of the Canadian DHAQ is not optimal for donor attention to specific questions asked as part of a list. The majority of repeat donors are ready for a change in the method of administration of the DHAQ. Studies on donor recall may help guide evidence-based changes to the DHAQ.

Comparison of prevalence rates of microbiological markers between bone/tissue donations and new blood donors in Scotland

BACKGROUND AND OBJECTIVES

Blood-borne virus prevalence rates of samples accompanying tissue donors are not widely available. This article compares the rates in Scottish bone/tissue donors with those of new blood donors for the 7-year period, 1998-2004.

MATERIALS AND METHODS

Data were collated from existing internal reports. Age distributions of the donor populations were obtained by extracting information from existing computer databases.

RESULTS

Scottish bone/tissue donors were found to have a fourfold higher prevalence for hepatitis B virus (HBV), a 1.6-fold higher prevalence for hepatitis C virus (HCV), an 11-fold higher prevalence for human T-cell lymphotropic virus (HTLV) and a 34-fold higher prevalence for syphilis compared with new blood donors. Excluding confirmed positives, the repeat-reactive rates for bone/tissue donors were similar to those of new blood donors.

CONCLUSIONS

The data demonstrated that the prevalence of blood-borne viruses in Scottish bone/tissue donors is higher than in new blood donors. We believe that the different age profiles of the two donor populations plays a significant role.

Audiovisual touch-screen computer-assisted self-interviewing for donor health histories: results from two years experience with the system

BACKGROUND

The donor history interview is an important aspect of blood safety, in part designed to identify unsuitable donors who may present a risk to blood recipients. There is evidence from behavioral science literature that use of computer-assisted interviewing may be superior to face-to-face (FTF) and paper techniques in eliciting sensitive behavioral information of interest to blood collection facilities.

STUDY DESIGN AND METHODS

Audiovisual touch-screen computer-assisted donor self-interviewing with the AABB Uniform Donor History Questionnaire was deployed for routine use in a regional blood center replacing FTF interviews. Donor and staff perception and satisfaction surveys were performed to assess acceptance of the system. Time studies of automated and manual methods were conducted. Rates of deferral of first-time donors for high-risk behaviors and rates of errors and omissions on donor interviewing for the two systems were tabulated and compared.

RESULTS

Donors and staff strongly preferred the automated system in all dimensions assessed. Donor time increased by 4 minutes but staff time declined by 5 minutes per interview. Identification of high-risk behaviors among first-time donors significantly increased. Rates of errors and omissions on donor history forms identified at audit were reduced.

CONCLUSIONS

Both blood donors and collections staff enthusiastically accepted the automated donor interviewing system. A well-designed audiovisual touch-screen donor self-interviewing system is superior to face-to-face interviewing and most likely more effective than paper interviewing.