Face-to-face interviewing in predonation screening: lack of effect on detected human immunodeficiency virus and hepatitis C virus infections

Implementation of a script for predonation interviews: impact on human immunodeficiency virus risk in South African blood donors

BACKGROUND

The way in which the donor history questionnaire is conducted plays a crucial role in the self-disclosure of behavioral risk factors for human immunodeficiency virus (HIV) infection by prospective donors. The South African National Blood Service changed its policy on the process of donor assessment in May 2015 by implementing a compulsory interviewer script used to assess donor eligibility.

STUDY DESIGN AND METHODS

A pre- and postevaluation study to determine the impact of scripted interviews on high-risk deferrals and recently acquired HIV infections. We used historical data to compare 18 months before and after the implementation of the script.

RESULTS

We recorded a total of 3,169,656 donor presentations during the two 18-months periods, of which 52.2% (1,655,352) were made during the scripted period. A multivariable logistic regression analysis adjusting for donor and demographic characteristics found the odds of high-risk deferral to be slightly greater (odds ratio [OR], 1.06; 95% confidence interval [CI], 1.05-1.07) during the scripted period. A separate multivariate logistic regression model, also adjusting for donor and demographic characteristics, showed that the odds of recently acquired HIV infection were significantly lower (OR, 0.88; 95% CI, 0.79-0.97) during the scripted period.

CONCLUSION

This study showed that implementation of a scripted interview was associated with increased HIV risk deferral and decreased recent HIV infection. This study indicates potential improvement in blood safety with the implementation of a scripted donor interview and has relevance to blood safety in other sub-Saharan African countries.

Selecting the Right Donors - Still a Challenge: Development of a Uniform Donor Questionnaire in Germany

The selection of blood donors includes the assessment of the individual's health and medical history by using a donor questionnaire (DQ) in order to identify persons whose donation could present a health risk to recipients or to themselves. This way, DQs provide one layer of blood safety and contribute to the high safety profile of blood components currently available in Germany. This review reports the development of a new uniform questionnaire in Germany and its first evaluation using a field test approach. This development is set in context with the international experiences regarding donor selection and prospective challenges.

Evaluation of selective screening of donors for antibody to Trypanosoma cruzi: seroprevalence of donors who answer "no" to risk questions

BACKGROUND

Selective testing of donors for Trypanosoma cruzi infection relies on identification of at-risk donors with screening questions. Using risk modeling and a seroprevalence study, we evaluated the risk of questions failing to identify T. cruzi antibody-positive donors.

STUDY DESIGN AND METHODS

The rate of donors with unreported risk was estimated by a telephone survey of 2677 donors who answered "no" to risk questions. The number of T. cruzi antibody-positive donors missed by risk questions was estimated from the product of this rate and the selective testing T. cruzi antibody-positive rate. The 95% confidence interval (CI) was estimated by Monte Carlo simulation. To test the model, 60,132 donors were tested for T. cruzi antibody (26% of donors in selected regions, Phase I). In Winnipeg, Manitoba, the highest-risk region, 26,915 donors were tested (92.5% of donors, Phase II).

RESULTS

In the telephone survey, 21 (0.8%) donors reported risk factors that would have identified them for selective testing. Seven were born in Mexico or Central or South America, five had travel risk, and nine had mother or maternal grandmother risk. The 95% CI for predicted number of T. cruzi antibody-positive donors answering "no" to risk questions was 0.71 to 4.38. In Phase I, one Winnipeg donor confirmed positive but had answered risk questions correctly. No other positive donations were identified.

CONCLUSION

The estimated risk of T. cruzi-positive donors who answer "no" to risk questions is low and is confirmed by the seroprevalence among these donors.

Transfusion safety in francophone African countries: an analysis of strategies for the medical selection of blood donors

BACKGROUND

The goal of selecting a healthy blood donor is to safeguard donors and reduce the risks of infections and immunologic complications for recipients.

STUDY DESIGN AND METHODS

To evaluate the blood donor selection process, a survey was conducted in 28 blood transfusion centers located in 15 francophone African countries. Data collected included availability of blood products, risk factors for infection identified among blood donor candidates, the processing of the information collected before blood collection, the review process for the medical history of blood donor candidates, and deferral criteria for donor candidates.

RESULTS

During the year 2009, participating transfusion centers identified 366,924 blood donor candidates. A mean of 13% (range, 0%-36%) of the donor candidates were excluded based solely on their medical status. The main risk factors for blood-borne infections were having multiple sex partners, sexual intercourse with occasional partners, and religious scarification. Most transfusion centers collected this information verbally instead of having a written questionnaire. The topics least addressed were the possible complications relating to the donation, religious scarifications, and history of sickle cell anemia and hemorrhage. Only three centers recorded the temperature of the blood donors. The deferral criteria least reported were sickle cell anemia, piercing, scarification, and tattoo.

CONCLUSIONS

The medical selection process was not performed systemically and thoroughly enough, given the regional epidemiologic risks. It is essential to identify the risk factors specific to francophone African countries and modify the current medical history questionnaires to develop a more effective and relevant selection process.

Surveillance of transfusion-transmissible infections comparison of systems in five developed countries

Most industrialized countries maintain surveillance programs for monitoring transmissible infection in blood donations, revising approaches to methodology and risk assessment as new threats emerge. A comparison of programs in the United States, Canada, France, the UK, and Australia indicates that they have similar function, although the structure of blood programs vary as does the extent and nature of formal ties with public health. The emergence of HIV in the late 1970s and early 1980s was key in recognizing that surveillance systems specific to blood transfusion were essential. Hence, most industrialized countries monitor transfusion-transmissible infections in donors and evaluate the impact of new testing and of predonation screening strategies. Emerging infections since HIV have had different transmission pathways and challenged blood programs to draw upon resources for a rapid and effective response, with recognition that the original focus on sexual/drug-related risk of HIV and hepatitis was inadequate. The focus of surveillance programs on new and emerging pathogens fulfills a key role in risk assessment and policy formulation. The precise nature of such activities varies by country because of the structure of the blood programs and surveillance systems, the strategic focus of the blood programs, and the epidemiology of disease in each country.

Number of recent sexual partners among blood donors in Brazil: associations with donor demographics, donation characteristics, and infectious disease markers

BACKGROUND

Brazilian blood centers ask candidate blood donors about the number of sexual partners in the past 12 months. Candidates who report a number over the limit are deferred. We studied the implications of this practice on blood safety.

STUDY DESIGN AND METHODS

We analyzed demographic characteristics, number of heterosexual partners, and disease marker rates among 689,868 donations from three Brazilian centers between July 2007 and December 2009. Donors were grouped based on maximum number of partners allowed in the past 12 months for each center. Chi-square and logistic regression analysis were conducted to examine associations between demographic characteristics, number of sex partners, and individual and overall positive markers rates for human immunodeficiency virus (HIV), human T-lymphotropic virus Types 1 and 2, hepatitis B virus, hepatitis C virus, and syphilis.

RESULTS

First-time, younger, and more educated donors were associated with a higher number of recent sexual partners, as was male sex in São Paulo and Recife (p<0.001). Serologic markers for HIV and syphilis and overall were associated with multiple partners in São Paulo and Recife (p<0.001), but not in Belo Horizonte (p=0.05, p=0.94, and p=0.75, respectively). In logistic regression analysis, number of recent sexual partners was associated with positive serologic markers (adjusted odds ratio [AOR], 1.2-1.5), especially HIV (AOR, 1.9-4.4).

CONCLUSIONS

Number of recent heterosexual partners was associated with HIV positivity and overall rates of serologic markers of sexually transmitted infections. The association was not consistent across centers, making it difficult to define the best cutoff value. These findings suggest the use of recent heterosexual contacts as a potentially important deferral criterion to improve blood safety in Brazil.

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.

Declining hepatitis C rates in first-time blood donors: insight from surveillance and case-control risk factor studies

BACKGROUND

Hepatitis C virus (HCV) rates have decreased steadily in first-time donors in Canada since testing was implemented but reasons are unclear. A description of factors that may have played a role in this decline is reported.

STUDY DESIGN AND METHODS

Descriptive analysis of first-time blood donors by HCV positivity status and year (1993--2006), sex, and age was carried out. HCV-positive first-time donors and matched controls participated in a confidential scripted telephone interview about risk factors in 1993 through 1994 and in 2005 through 2006, and risk factors independently predicting HCV positivity were determined with multiple logistic regression.

RESULTS

HCV-positive donations occurred most frequently in donors born between 1945 and 1964 and decreased in this birth cohort over time (p < 0.01). At present, most first-time donors (74%) are born after 1964. History of intravenous drug use, sex with an intravenous drug user, blood transfusion, and tattoo independently predicted (p < 0.01) HCV positivity in both periods (1993--1994 and 2005--2006).

CONCLUSION

Most HCV-positive donors were born between 1945 and 1964, and the decline in HCV rates is associated primarily with this birth cohort. The key risk factors predicting HCV positivity did not change over the 13 years of the study. With approximately two-thirds of HCV-positive Canadians in the general population having been tested for HCV, potential donors may be aware of their HCV status and be likely to self-defer. This, and an increasing proportion of first-time donors born after 1964, may contribute to declining HCV rates in first-time donors.

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 Blood Donor Health Assessment Questionnaire: Lessons From History, Application of Cognitive Science Principles, and Recommendations for Change

Over the last 20 years, the Canadian Blood Services' (CBS) Donor Health Assessment Questionnaire (DHAQ), used to screen prospective blood donors to determine their eligibility, has grown in complexity and length. Its growth is inextricably linked to the evolution of the environment within which CBS operates from unregulated collection and distribution of labile blood products to a fully regulated environment and to the need to satisfy both Health Canada and US Food and Drug Administration (FDA) requirements. Within this context, the development of the CBS DHAQ has been characterized by addition of questions and items without any periodic reevaluation of the need for retaining existing questions and/or items. In this review, we apply principles from cognitive science relating to how people think when answering questionnaires to the situation of blood donors completing the DHAQ. We show that some items that were added at different times in separate questions, for reasons that were historically relevant, could be now asked more simply with a single question. The historical development of the DHAQ, resulting in the condensing of many items into lists, the use of complex wording, and the sheer number of items included in the questionnaire make accurate retrieval of information from the donor's memory difficult. Thus, we believe that redesigning the DHAQ will improve the quality and accuracy of the donors' answers to screening questions.

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.