Risk behaviors in volunteer blood donors who seroconverted for HIV, Abidjan, Côte d'Ivoire 1997 to 2005

Updated characteristics of blood services, donors and blood products in 11 French-speaking African countries

BACKGROUND AND OBJECTIVES

The Francophone Africa Transfusion Research Network conducted the first large and comprehensive surveys on the status of blood safety in francophone African countries in 2009 and 2012. Since then, there has been substantial investment in blood safety but little is known about progress made in the region.

MATERIALS AND METHODS

This multicentre cross-sectional study describes characteristics of blood services, donors and blood products and compares results with previous data. A web-based questionnaire collected data of 2016 from 38 blood facilities in 11 French-speaking countries. Data were analysed according to type of blood services and compared to similar studies conducted in 2009 and 2012.

RESULTS

The study included data on 572 933 donations from 366 844 donors. Compared to 2012, there was an increase in the median proportion of voluntary nonremunerated blood donation (+22%) (P = 0·004), and a reduction from 2·1 to 0·9 (P = 0·01), from 10·3 to 6·7 (P = 0·00), from 3·2 to 1·3 (P = 0·006) and from 1 to 0·4 (P = 0·03) in median seroprevalences of HIV, HBV, HCV and syphilis, respectively. The median proportion of blood orders fulfilled decreased (-18·2%) (P = 0·001). The number of technical staff per 1000 donations ranged from 1 to 54 with hospital-based blood transfusion services having 12-fold more staff than National and Regional services.

CONCLUSION

Several indicators have improved in Francophone Africa Blood services during the last 5 years and national and regional services likely have better indicators than hospital-based services. These findings may support the need for ongoing blood safety initiatives.

Risk factors for human immunodeficiency virus among blood donors in Cameroon: evidence for the design of an Africa-specific donor history questionnaire

BACKGROUND

In sub-Saharan Africa improving the deferral of at-risk blood donors would be a cost-effective approach to reducing transfusion-transmitted human immunodeficiency virus (HIV) infections. We performed a pilot case-control study to identify the risk factors for HIV infection and to develop an adapted donor history questionnaire (DHQ) for sub-Saharan Africa.

STUDY DESIGN AND METHODS

We recruited 137 HIV-positive donors (cases) and 256 HIV-negative donors (controls) and gathered risk factor data using audio computer-assisted self-interview. Variables with univariate associations were entered into a logistic regression model to assess independent associations. A scoring scheme to distinguish between HIV-positive and HIV-negative donors was developed using receiver operating characteristics curves.

RESULTS

We identified 16 risk factors including sex with sex worker, past history or treatment for sexually transmitted infections, and having a partner who used injected or noninjected illegal drugs. Two novel risks were related to local behavior: polygamy (odds ratio [OR], 22.7; 95% confidence interval [CI], 5.9-86.7) and medical or grooming treatment on the street (OR, 1.8; 95% CI, 1.0-3.0). Using the 16 selected items the mean scores (>100) were 82.6 ± 6.7 (range, 53.2-95.1) and 85.1 ± 5.2 for HIV-negative donors versus 77.9 ± 6.8 for HIV-positive ones (p = 0.000). Donors who scored between 80 and 90 were more likely to be HIV negative than those who scored less (OR, 31.4; 95% CI, 3.1-313.9).

CONCLUSION

We identified both typical and novel HIV risk factors among Cameroonian blood donors. An adapted DHQ and score that discriminate HIV-negative donors may be an inexpensive means of reducing transfusion-transmitted HIV through predonation screening.

[The francophone Africa blood transfusion research network: a five-year report]

There has been little blood safety research in sub-Saharan Africa, often consisting of local efforts whose findings had limited impact The "Francophone Africa Transfusion Research Network" was created in May 2007 with the objective of developing common evidence-based blood safety policies that may be adapted to each country's situation. The Group's activities to date have focused mainly on obtaining epidemiological and laboratory data on blood transfusion and on suggesting blood safety strategies, particularly in the field of TTIs. To carry out such research activities, the group works closely with the National Blood Transfusion Services (NBTS), the Regional Blood Transfusion Services (RBTS), the hospital blood banks (HBB) and collection stations. For the first 5years, four research priorities were identified: (i) descriptive studies of the characteristics of francophone African blood donors and blood centers; (ii) estimation of the residual risk of transfusion-transmitted major viral infections; (iii) an analysis of blood donor deferral strategies; and (iv) a description of TTI screening strategies and an external quality assurance system (EQAS) project. During this period, seven projects have been implemented at the national level and published and five multicenter studies were conducted and published. The present review reports the main observations and recommendations from those studies that could improve blood safety statute in Africa.

HIV Seroconversion in blood donors from the coordinating blood bank in the State of Pará

BACKGROUND

Transfusion of Human immunodeficiency virus (HIV) infected blood is probably the most effective means of transmission of this disease. Despite intense efforts and investment to ensure safety, transmission of HIV still remains a real possibility in the transfusion service due to the fact that routine laboratory tests in most Brazilian government blood banks rely on the detection of antibodies. This leaves an immunological window period of from 16 to 22 days, which could be minimized to approximately 9 to 11 days if nucleic acid amplification tests were employed in screening.

OBJECTIVE

To analyze the profile of blood donors who seroconverted to HIV positive from 2008 to 2010 in the coordinating blood bank of the State of Pará in respect to gender, age, marital status and educational level.

METHODS

HIV seroconversion cases of blood donors who donated on more than one occasion at the coordinating blood bank of the State of Pará were investigated. Records from 2008 and 2010 were analyzed in respect to gender, marital status, schooling and age.

RESULTS

Among the 157,432 donations in this period, 45 HIV seroconversions were confirmed. Of these, 95.56% were men, of which 86.67% were single, 53.33% had completed high school and 40% were between 23 and 29 years old.

CONCLUSIONS

In order to improve the quality of blood and reduce the residual risk of HIV transmission in blood banks, it is necessary to know the profiles of donors who most frequently seroconvert and use nucleic acid amplification tests as routine screening.

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.

The challenges of meeting the blood transfusion requirements in Sub-Saharan Africa: the need for the development of alternatives to allogenic blood

As a resource, allogenic blood has never been more in demand than it is today. Escalating elective surgery, shortages arising from a fall in supply, a lack of national blood transfusion services, policies, appropriate infrastructure, trained personnel, and financial resources to support the running of a voluntary nonremunerated donor transfusion service, and old and emerging threats of transfusion-transmitted infection, have all conspired to ensure that allogenic blood remains very much a vital but limited asset to healthcare delivery particularly in Sub-Saharan Africa. This is further aggravated by the predominance of family replacement and commercially remunerated blood donors, rather than regular benevolent, nonremunerated donors who give blood out of altruism. The demand for blood transfusion is high in Sub-Saharan Africa because of the high prevalence of anemia especially due to malaria and pregnancy-related complications. All stakeholders in blood transfusion have a significant challenge to apply the best available evidenced-based medical practices to the world-class management of this precious product in a bid to using blood more appropriately. Physicians in Sub-Saharan Africa must always keep in mind that the first and foremost strategy to avoid transfusion of allogenic blood is their thorough understanding of the pathophysiologic mechanisms involved in anemia and coagulopathy, and their thoughtful adherence to the evidenced-based good practices used in the developed world in a bid to potentially reduce the likelihood of allogenic blood transfusion in many patient groups. There is an urgent need to develop innovative ways to recruit and retain voluntary low-risk blood donors. Concerns about adverse effects of allogenic blood transfusion should prompt a review of transfusion practices and justify the need to search for transfusion alternatives to decrease or avoid the use of allogenic blood. These strategies should include the correction of anemia using pharmacological measures (use of antifibrinolytics to prevent bleeding and the use of erythropoietin and oral and intravenous iron to treat anemia) use of nonpharmacologic measures (preoperative autologous blood transfusion, perioperative red blood cell salvage and normothermia to reduce blood loss in surgical patients). All these strategies will help optimize the use of the limited blood stocks.