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Goldman M. MSM and blood donation: shifting to individualized risk assessment. HEMATOLOGY. AMERICAN SOCIETY OF HEMATOLOGY. EDUCATION PROGRAM 2023; 2023:294-298. [PMID: 38066878 PMCID: PMC10727087 DOI: 10.1182/hematology.2023000482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
Deferring donors at higher risk for transfusion transmissible infections is an important part of ensuring blood safety. The deferral for gay, bisexual, and other men who have sex with men (gbMSM) was implemented in the 1980s in many countries, since they were identified as a high-risk group for AIDS/HIV. With the introduction of increasingly sensitive HIV antibody testing, augmented by nucleic acid testing, the window period for HIV infection-when a donor may be infectious but have negative test results-has shrunk dramatically. In Canada, this has led to progressively shorter deferral periods for gbMSM, decreasing from a permanent deferral for sex with another male since 1977 to a 5-year, 12-month, and eventually 3-month deferral period. These time-based deferrals maintained safety; however, they are seen as stigmatizing by many and still result in the deferral of sexually active gbMSM. More recently, several countries have moved to a donor screening approach based on assessing sexual risk behaviors in all donors. This article outlines research supporting changes in policy, current eligibility screening policies in several countries, and preliminary results postimplementation of new eligibility policies in Canada in September 2022.
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Affiliation(s)
- Mindy Goldman
- Medical Affairs & Innovation, Canadian Blood Services, and Department of Pathology and Laboratory Medicine, University of Ottawa, Ottawa, ON, Canada
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2
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Schroyens N, Borra V, Compernolle V, Vandekerckhove P, De Buck E. Men who have sex with men and risk for transfusion-transmissible infections in blood donors in Western countries: A systematic review update. Vox Sang 2023; 118:709-720. [PMID: 37322809 DOI: 10.1111/vox.13482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Revised: 03/21/2023] [Accepted: 05/26/2023] [Indexed: 06/17/2023]
Abstract
BACKGROUND AND OBJECTIVES This systematic review update summarizes evidence concerning transfusion-transmissible infections (TTIs) in male blood donors reporting sex with another man (MSM) or after easing the MSM deferral period. MATERIALS AND METHODS We searched five databases, including studies comparing MSM versus non-MSM donors (Type I), MSM deferral periods (Type II) or infected versus non-infected donors (Type III) in Western countries, and used GRADE to determine evidence certainty. RESULTS Twenty-five observational studies were included. Four Type I studies suggest that there may be an increased risk for overall TTIs, human immunodeficiency virus (HIV), hepatitis B virus (HBV) and syphilis in MSM donors, but the evidence is very uncertain. There was insufficient evidence of MSM with low-risk sexual behaviour. A Type II study indicates that easing the MSM deferral period to 1 year may have little to no effect on TTI risk. TTI prevalence in blood donors under 5-year, 1-year, 3-month or risk-based deferral in eight other Type II studies was too low to provide clear conclusions on the effect of easing the deferral. Three Type III studies reported that MSM may be a risk factor for HIV. Increased risk of HBV, hepatitis C virus and HTLV-I/II could not be shown. The evidence from Type III studies is very uncertain. CONCLUSION There may be an increased risk of HIV in MSM blood donors. Shortening the deferral from permanent to 1 year may have little to no effect on TTI risk. However, there is limited, unclear evidence from observational studies concerning the impact of introducing 3-month or risk-based deferrals.
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Affiliation(s)
- Natalie Schroyens
- Centre for Evidence-Based Practice, Belgian Red Cross, Mechelen, Belgium
- Department of Public Health and Primary Care, Leuven Institute for Healthcare Policy, KU Leuven, Leuven, Belgium
| | - Vere Borra
- Centre for Evidence-Based Practice, Belgian Red Cross, Mechelen, Belgium
- Department of Public Health and Primary Care, Leuven Institute for Healthcare Policy, KU Leuven, Leuven, Belgium
| | - Veerle Compernolle
- Belgian Red Cross, Blood Services, Mechelen, Belgium
- Faculty of Medicine and Health Sciences, University of Ghent, Ghent, Belgium
| | - Philippe Vandekerckhove
- Department of Public Health and Primary Care, Leuven Institute for Healthcare Policy, KU Leuven, Leuven, Belgium
- Belgian Red Cross, Mechelen, Belgium
- Division of Epidemiology and Biostatistics, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa
| | - Emmy De Buck
- Centre for Evidence-Based Practice, Belgian Red Cross, Mechelen, Belgium
- Department of Public Health and Primary Care, Leuven Institute for Healthcare Policy, KU Leuven, Leuven, Belgium
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3
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Gahan L, Seed CR, Hammoud MA, Prestage G, Hoad VC, Kaldor JM. Perceived risk of HIV transmission by blood transfusion among gay, bisexual, and other men who have sex with men (gbMSM) in Australia. Transfusion 2023; 63:1528-1537. [PMID: 37300281 PMCID: PMC10953370 DOI: 10.1111/trf.17456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 05/18/2023] [Accepted: 05/18/2023] [Indexed: 06/12/2023]
Abstract
BACKGROUND In Australia, men who have sex with men (MSM) are deferred from blood donation for 3 months from last sexual contact. Internationally, deferral policies for MSM are evolving in the direction of expanded inclusivity in response to community expectations. To inform future policy options, we assessed perceptions of the risk of HIV transmission from blood transfusion among Australian MSM. STUDY DESIGN AND METHODS Flux is an online prospective cohort of Australian gay and bisexual men (cis or trans, regardless of their sexual history) and other men who have had sex with men (gbMSM). We included questions on blood donation rules, window period (WP) duration, infectivity of blood from people with HIV on treatment and attitudes to more detailed questioning of sexual practices in the regular survey of Flux participants and conducted a descriptive analysis of responses. RESULTS Of 716 Flux participants in 2019, 703 responded to the blood donation questions. The mean age was 43.7 years (SD 13.6 years). Overall, 74% were willing to confidentially respond to specific sexual behavior questions, such as the last time they had sex and the type of sex they had, in order to be considered eligible to donate blood. The majority (92%) of participants correctly assessed the duration of the WP as less than 1 month. When asked whether transfusion of blood from a donor with HIV and an undetectable viral load could transmit HIV, just under half (48%) correctly said yes. CONCLUSION Our study suggests Australian gbMSM are generally comfortable with answering more detailed questions regarding sexual activity during the assessment to donate, indicating they would do so honestly. gbMSM are knowledgeable about the WP duration, important for their ability to correctly self-assess their HIV risk. However, half of participants incorrectly assessed the transmissibility by blood transfusion from an HIV positive person with an undetectable viral load, suggesting the need for a targeted education campaign.
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Affiliation(s)
- Luke Gahan
- School of Humanities and Social Sciences, La Trobe UniversityMelbourneVictoriaAustralia
| | - Clive R. Seed
- Australian Red Cross LifebloodMelbourneVictoriaAustralia
| | - Mohamed A. Hammoud
- Kirby Institute, Faculty of Medicine, UNSW SydneySydneyNew South WalesAustralia
| | - Garrett Prestage
- Kirby Institute, Faculty of Medicine, UNSW SydneySydneyNew South WalesAustralia
| | | | - John M. Kaldor
- Kirby Institute, Faculty of Medicine, UNSW SydneySydneyNew South WalesAustralia
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4
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Lewin A, Grégoire Y, Delage G, Thibeault C, Viau C, Milot C, Parent É, Renaud C. Reported non-compliance with pre-donation screening among blood donors in Québec, Canada: A focus on the 3-month deferral for men who have sex with men. Vox Sang 2022; 117:966-970. [PMID: 35377497 DOI: 10.1111/vox.13277] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 03/08/2022] [Accepted: 03/12/2022] [Indexed: 01/31/2023]
Abstract
BACKGROUND AND OBJECTIVES In Québec (Canada), the donation deferral for men who have sex with men (MSM) has recently been shortened to 3 months. Whether this change impacted compliance with pre-donation screening is unknown. We assessed compliance with the disclosure of male-to-male sex and other behavioural risk factors for HIV amid this change. MATERIALS AND METHODS Québec residents who donated from 14 July 2020 to 30 November 2020 were invited to participate in an online survey. Donors were informed that the survey was optional and anonymous. Survey questions were those used for routine pre-donation screening. Rates of reported non-compliance were weighted based on several characteristics. RESULTS Of 21,918 contacted donors, 7113 (32.45%) participated. Among male participants (N = 3347), six (0.27% [95% confidence interval (CI) = 0.09%-0.44%]) were not compliant with a 3-month MSM deferral. Among female participants (N = 3766), two (0.06% [95% CI = 0.00%-0.13%]) were not compliant with a 3-month deferral for sex with a man who had male-to-male sex ≤12 months. Other risk factors exhibited similar or lower rates of reported non-compliance. CONCLUSION Reported non-compliance with a 3-month MSM deferral and the disclosure of other HIV behavioural risk factors was low. These results warrant the investigation of behavioural donor risk assessment approaches to further improve the inclusiveness of blood donation.
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Affiliation(s)
- Antoine Lewin
- Héma-Québec, Medical Affairs and Innovation, Montréal, Québec, Canada.,Faculté de médecine et des sciences de la santé, Université de Sherbrooke, Sherbrooke, Québec, Canada
| | - Yves Grégoire
- Héma-Québec, Medical Affairs and Innovation, Québec, Québec, Canada
| | - Gilles Delage
- Héma-Québec, Medical Affairs and Innovation, Montréal, Québec, Canada
| | | | | | | | - Éric Parent
- Héma-Québec, Regulatory Affairs, Montréal, Québec, Canada
| | - Christian Renaud
- Héma-Québec, Medical Affairs and Innovation, Montréal, Québec, Canada
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Caffrey N, Goldman M, Osmond L, Yi QL, Fan W, O'Brien SF. HIV incidence and compliance with deferral criteria over three progressively shorter time deferrals for men who have sex with men in Canada. Transfusion 2021; 62:125-134. [PMID: 34854092 DOI: 10.1111/trf.16753] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 11/10/2021] [Accepted: 11/12/2021] [Indexed: 12/30/2022]
Abstract
BACKGROUND In Canada, the deferral for men who have sex with men (MSM) has been progressively reduced from a permanent deferral for MSM since 1977, to 5 years, 1 year, and, most recently, 3 months. We estimated human immunodeficiency virus (HIV) residual risk and compliance with the MSM time deferral after each change. METHODS Four anonymous online compliance surveys were carried out before and after each change. HIV incidence and prevalence were monitored from 2010 to 2021. Residual risk was estimated using the incidence-window period model. RESULTS Human immunodeficiency virus prevalence, incidence, and residual risk did not change with incrementally shorter MSM deferrals. The residual risk per million donations post 3-month deferral was 0.05 (0.001-0.371). Men with temporally remote MSM history became eligible and, therefore, compliant as the deferral periods decreased (Cochran-Armitage p value = <.0001). However, the percentage of men with MSM history in the last 3 months with the indefinite deferral in place was similar to the percentage noncompliant, while the 3-month deferral was in place. MSM donors did not report high-risk behaviors for which they would otherwise be deferred in any survey. Following the change, an estimated 4467 MSM per year were eligible to donate, an increase from 2501 estimated eligible MSM donors following the change to the 1-year deferral. CONCLUSION With progressively shorter MSM deferral periods, HIV residual risk was unchanged. The proportion of male donors with deferrable MSM history remained low, while those with temporally remote MSM history became eligible, increasing the number of eligible MSM donors.
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Affiliation(s)
- Niamh Caffrey
- Donation Policy & Studies, Canadian Blood Services, 1800 Alta Vista Drive, Ottawa, Ontario, K1G 4J5, Canada
| | - Mindy Goldman
- Donation Policy & Studies, Canadian Blood Services, 1800 Alta Vista Drive, Ottawa, Ontario, K1G 4J5, Canada.,Department of Pathology and Laboratory Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Lori Osmond
- Donation Policy & Studies, Canadian Blood Services, 1800 Alta Vista Drive, Ottawa, Ontario, K1G 4J5, Canada
| | - Qi-Long Yi
- Donation Policy & Studies, Canadian Blood Services, 1800 Alta Vista Drive, Ottawa, Ontario, K1G 4J5, Canada
| | - Wenli Fan
- Donation Policy & Studies, Canadian Blood Services, 1800 Alta Vista Drive, Ottawa, Ontario, K1G 4J5, Canada
| | - Sheila F O'Brien
- Donation Policy & Studies, Canadian Blood Services, 1800 Alta Vista Drive, Ottawa, Ontario, K1G 4J5, Canada.,School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
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Rapodile T, Mitchel J, Swanevelder R, Murphy EL, van den Berg K. Re-engineering the medical assessment of blood donors in South Africa: The balance between supply and safety. Transfusion 2021; 61:3361-3371. [PMID: 34643286 DOI: 10.1111/trf.16702] [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: 06/17/2021] [Revised: 08/25/2021] [Accepted: 08/26/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND The balance between ensuring blood donor and recipient safety while maintaining a sufficient blood supply can be affected by excessive deferral of blood donors. In 2018, a biannual regulatory review of donor eligibility criteria provided the South African National Blood Service (SANBS) the opportunity to review the existing criteria. Changes to these criteria were implemented in April 2019 after an extensive review. STUDY DESIGN AND METHODS We conducted a cross-sectional study of SANBS whole-blood donor presentations to determine the impact of the changed donor eligibility criteria on deferrals and blood safety. We compared donor presentations, deferrals, and HIV-positive cases for the 12-month period (April 2019-March 2020) after the implementation of the updated donor eligibility criteria to those of the previous year. RESULTS Of the 2,112,917 donor presentations, 51.1% (1079506) occurred in the post-implementation study period. Overall, deferrals decreased from 18.6% to 14.5%, whereas HIV-positive donations increased by 0.03%. A multivariable logistic regression analysis adjusted for sex, age, geographical location, donor, and clinic type showed significantly lower odds of deferral (OR 0.70; 95% CI: 0.69-0.70) and greater odds of HIV-positive cases in the study period than those in the control period (OR 1.17; 95% CI: 1.10-1.25). CONCLUSION We confirmed that the change in donor eligibility criteria was associated with a decrease in deferrals and an increase in the country's blood supply. The impact of the increased number of HIV-positive donations on blood safety in a country performing individual donation nucleic acid amplification testing requires further investigation.
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Affiliation(s)
- Thabiso Rapodile
- Medical department, Collections department, IT department, South African National Blood Service (SANBS), Johannesburg, South Africa
| | - Josephine Mitchel
- Medical department, Collections department, IT department, South African National Blood Service (SANBS), Johannesburg, South Africa
| | - Ronel Swanevelder
- Medical department, Collections department, IT department, South African National Blood Service (SANBS), Johannesburg, South Africa
| | - Edward L Murphy
- Departments of Laboratory Medicine and Epidemiology/Biostatistics, University of California San Francisco, San Francisco, California, USA.,Affiliate Investigator, Vitalant Research Institute, San Francisco, California, USA
| | - Karin van den Berg
- Medical department, Collections department, IT department, South African National Blood Service (SANBS), Johannesburg, South Africa.,Translational Research Department, Medical Division, South African National Blood Service, Roodepoort, South Africa.,Division of Clinical Haematology, Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.,Division of Clinical Haematology, University of the Free State, Bloemfontein, South Africa
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7
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Lau JYC, Lee CK, Chan CP, Leung JNS, Poon CM, Lee SS. Compliance and attitudes of blood donors following transitioning from permanent to 12-month deferral of men who have sex with men in Hong Kong. Vox Sang 2020; 116:504-512. [PMID: 33196117 DOI: 10.1111/vox.13025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 10/15/2020] [Accepted: 10/15/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND OBJECTIVES Blood safety hinges not just on the scientific rationale for deferral period but potential donors' compliance with the prevailing policy. This study aimed to investigate donors' awareness, attitudes and compliance with the two-phased policy implementation of time-limited deferral for men who have sex with men (MSM) in Hong Kong. MATERIALS AND METHODS Three rounds of questionnaire survey were conducted between July 2017 and June 2019 covering the periods of pre-implementation (Round A), post-implementation without and with pre-donation questionnaire revision (Round B and C). Chi-square test and multivariable regression analysis were performed. RESULTS Of 3085 donors recruited, 968, 1036 and 1081 completed the surveys in Round A, B and C, respectively. The non-compliance rate of MSM remained stable at 0·6% (3/497), 0·4% (2/551) and 0·5% (3/587) among male donors in Round A, B and C, respectively. Two MSM donors from Round C complying with the prevailing policy were identified. About two-thirds (60·7%) of respondents from Round B and C were unaware of the policy change. Overall, over 80% were either neutral or positive about the change. CONCLUSION Our study showed a consistently low non-compliance rate of MSM over the three periods. The generally high level of acceptance of time-limited deferral among donors lends support to science-based policy development to protect blood safety. The identification of compliant MSM donors suggests that the 12-month deferral is effective and acceptable to MSM. With a deferral period far exceeding the window period, it is a step towards a more equitable policy.
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Affiliation(s)
- Janice Ying-Chui Lau
- Stanley Ho Centre for Emerging Infectious Diseases, The Chinese University of Hong Kong, Hong Kong, People's Republic of China
| | - Cheuk-Kwong Lee
- Hong Kong Red Cross Blood Transfusion Service, Hospital Authority, Hong Kong, People's Republic of China
| | - Chin-Pok Chan
- Stanley Ho Centre for Emerging Infectious Diseases, The Chinese University of Hong Kong, Hong Kong, People's Republic of China
| | - Jennifer Ngar-Sze Leung
- Hong Kong Red Cross Blood Transfusion Service, Hospital Authority, Hong Kong, People's Republic of China
| | - Chin-Man Poon
- Stanley Ho Centre for Emerging Infectious Diseases, The Chinese University of Hong Kong, Hong Kong, People's Republic of China
| | - Shui-Shan Lee
- Stanley Ho Centre for Emerging Infectious Diseases, The Chinese University of Hong Kong, Hong Kong, People's Republic of China
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8
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Germain M. Men having sex with men and blood donation: is there a game changer on the horizon? Transfusion 2020; 60:437-440. [PMID: 32128837 DOI: 10.1111/trf.15706] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Accepted: 01/27/2020] [Indexed: 12/22/2022]
Affiliation(s)
- Marc Germain
- Héma-Québec, Medical Affairs and Innovation Quebec City, Canada
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9
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Blanco S, Carrizo LH, Moyano RW, Mangeaud A, Gallego SV. Gender-neutral donor deferral policies: experience in Argentina implementing individual risk-assessment policies. Vox Sang 2020; 115:548-554. [PMID: 32364276 DOI: 10.1111/vox.12933] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Revised: 03/29/2020] [Accepted: 04/07/2020] [Indexed: 12/21/2022]
Abstract
BACKGROUND In Argentina, with the aim of moving to a safe supportive and inclusive National Blood System, in September 2015 the Ministry of Health stipulated that eligibility criteria for blood donation should only take into account the so-called 'risk practices', focusing on a 'gender-neutral' policy. The aim of this study is to demonstrate the impact of such regulation on the prevalence of STI in the population of blood donors in Argentina, through the analysis of the scientific evidence obtained from 174 074 donors from a large central region of the country, focused on a regional Blood Bank for a 6-year period (pre- and post-entry into force of the regulations). MATERIALS AND METHODS To analyse the evolution of prevalence rates of STI, two periods of 3 years each were evaluated: The first period (P1) lasted from 16 September 2012 to 15 September 2015 (prior to the entry into force of the law) and the second one (P2) from 16 September 2015 to 15 September 2018 (after the entry into force of the law). RESULTS A total of 82 838 subjects were enrolled in P1 and 91 236 in P2. The results show a significantly lower prevalence of HCV (P = 0·029), HBV (P = 0·028) and syphilis (P = 0·001) in P2, while no difference was observed for HIV infection (P = 0·60). CONCLUSION This study evidenced that the implementation of a 'gender-neutral' policy based on individual risk-assessment deferral criteria maintained the safety of blood supply and decreased the prevalence of STI among blood donors.
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Affiliation(s)
- Sebastián Blanco
- Fundación Banco Central de Sangre, Córdoba, Argentina.,Instituto de Virología Dr. J.M. Vanella, Facultad de Ciencias Médicas, Universidad Nacional de Córdoba, Córdoba, Argentina
| | | | | | - Arnaldo Mangeaud
- Cátedra de Bioestadística. Facultad de Ciencias Exactas, Físicas y Naturales, Universidad Nacional de Córdoba, Córdoba, Argentina
| | - Sandra Verónica Gallego
- Fundación Banco Central de Sangre, Córdoba, Argentina.,Instituto de Virología Dr. J.M. Vanella, Facultad de Ciencias Médicas, Universidad Nacional de Córdoba, Córdoba, Argentina
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Clackett S, Seed CR, Prestage G, Hammoud MA, Hoad V, Saxton P, Haire B, Holt M, Jin F, Bourne A, Maher L, Kaldor J. Attitudes and willingness to donate blood among gay and bisexual men in Australia. Transfusion 2020; 60:965-973. [PMID: 32359217 DOI: 10.1111/trf.15768] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2020] [Revised: 02/20/2020] [Accepted: 02/20/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Men who have sex with men in Australia are currently ineligible to donate blood (are "deferred") for 12 months since last oral or anal sexual contact with another man. In Australia and overseas, there has been limited research on attitudes and perceptions related to blood donation in this population. STUDY DESIGN AND METHODS Questions on blood donation histories and attitudes toward the deferral policy were included in the questionnaire of an online prospective cohort of gay and bisexual men (GBM) living in Australia. RESULTS In 2018, 1595 GBM responded to the survey. In this sample, 28.7% reported previously donating blood. Among the remaining men who had never donated blood, 64.5% expressed an interest in doing so. Nearly all men indicated they were not willing to abstain from sex with another man for 12 months in order to donate, and the vast majority believed the rule was unfair, too strict, and homophobic. Three-quarters (77.7%) said that if the policy changed, they would likely donate blood. Age and openness about one's sexuality were independently associated with one's willingness to donate blood in the absence of the deferral. CONCLUSION There was a high level of willingness and desire to donate blood among GBM. However, rather than abstaining from sex in order to donate, many men comply with the deferral policy and do not donate. A less conservative deferral policy may increase donations from GBM.
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Affiliation(s)
- Shawn Clackett
- Kirby Institute, UNSW Sydney, Kensington, New South Wale, Australia
| | - Clive R Seed
- Australian Red Cross Lifeblood, Perth, Western Australia, Australia
| | - Garrett Prestage
- Kirby Institute, UNSW Sydney, Kensington, New South Wale, Australia
| | | | - Veronica Hoad
- Australian Red Cross Lifeblood, Perth, Western Australia, Australia
| | - Peter Saxton
- School of Population Health, University of Auckland, Auckland, New Zealand
| | - Bridget Haire
- Kirby Institute, UNSW Sydney, Kensington, New South Wale, Australia
| | - Martin Holt
- Centre for Social Research in Health, UNSW Sydney, Sydney, New South Wales, Australia
| | - Fengyi Jin
- Kirby Institute, UNSW Sydney, Kensington, New South Wale, Australia
| | - Adam Bourne
- Australian Research Centre in Sex, Health & Society, La Trobe University, Melbourne, Victoria, Australia
| | - Lisa Maher
- Kirby Institute, UNSW Sydney, Kensington, New South Wale, Australia
| | - John Kaldor
- Kirby Institute, UNSW Sydney, Kensington, New South Wale, Australia
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11
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Van Remoortel H, Matthysen W, Avau B, Compernolle V, Vandekerckhove P, De Buck E. Is sexual risk behaviour associated with an increased risk of transfusion-transmissible infections in blood donors from Western and Pacific countries? A systematic review and meta-analysis. Vox Sang 2019; 115:107-123. [PMID: 31823386 DOI: 10.1111/vox.12874] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Revised: 09/13/2019] [Accepted: 11/14/2019] [Indexed: 12/15/2022]
Abstract
BACKGROUND AND OBJECTIVES The donor medical questionnaire is designed to aid blood establishments in supporting a safe blood supply. According to blood donor deferral policies, sexual risk behaviour (SRB) leads to a (temporary) deferral from blood donation. This systematic review aimed to scientifically underpin these policies by identifying the best available evidence on the association between SRB and the risk of transfusion transmissible infections (TTIs). MATERIALS & METHODS Studies from three databases investigating the link between SRB (excluding men who have sex with men (MSM)) and TTIs (HBV, HCV, HIV, Treponema pallidum) in donors from Western and Pacific countries were obtained and assessed on eligibility by two reviewers independently. The association between SRB and TTIs was expressed by calculating pooled effect measures via meta-analyses. The GRADE methodology (Grades of Recommendation, Assessment, Development and Evaluation) was used to assess the quality of evidence. RESULTS We identified 3750 references and finally included 15 observational studies. Meta-analyses showed that there is a significant (P < 0·05) positive association between the following SRB and HBV and/or HCV infection: having sex with an intravenous drug user (high-certainty evidence), receiving money or goods for sex (moderate-high certainty evidence), having a sex partner with hepatitis/HIV (moderate-certainty evidence) and paid for sex or anal sex (low-certainty evidence). CONCLUSION Sexual risk behaviour (including having sex with an intravenous drug user, receiving money or goods for sex or having a sex partner with hepatitis/HIV) is probably associated with an increased risk of HBV/HCV infection in blood donors from Western and Pacific countries.
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Affiliation(s)
- Hans Van Remoortel
- Centre for Evidence-Based Practice, Belgian Red Cross, Mechelen, Belgium
| | - Wout Matthysen
- Centre for Evidence-Based Practice, Belgian Red Cross, Mechelen, Belgium
| | - Bert Avau
- Centre for Evidence-Based Practice, Belgian Red Cross, Mechelen, Belgium.,Cochrane Belgium, Belgian Centre for Evidence-Based Medicine (Cebam), Leuven, Belgium
| | - Veerle Compernolle
- Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium.,Blood Services, Belgian Red Cross, Mechelen, Belgium
| | - Philippe Vandekerckhove
- Department of Public Health and Primary Care, Faculty of Medicine, KU Leuven, Leuven, Belgium.,Belgian Red Cross, Mechelen, Belgium
| | - Emmy De Buck
- Centre for Evidence-Based Practice, Belgian Red Cross, Mechelen, Belgium.,Department of Public Health and Primary Care, Faculty of Medicine, KU Leuven, Leuven, Belgium
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12
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O'Brien SF, Grégoire Y, Pillonel J, Steele WR, Custer B, Davison KL, Germain M, Lewin A, Seed CR. HIV residual risk in Canada under a three-month deferral for men who have sex with men. Vox Sang 2019; 115:133-139. [PMID: 31777098 DOI: 10.1111/vox.12867] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Revised: 09/09/2019] [Accepted: 10/21/2019] [Indexed: 01/22/2023]
Abstract
BACKGROUND AND OBJECTIVES In Canada, the deferral for men who have sex with men (MSM) was decreased from a permanent deferral to a 5-year then a 12-month deferral. Current HIV testing can detect an HIV infection in donated blood within 2 weeks of exposure; thus, a 12-month deferral may be unnecessarily restrictive. We aimed to estimate the residual risk of HIV if the deferral were further decreased to 3 months. MATERIALS AND METHODS Using a deterministic model with stochastic Monte Carlo simulation, residual risk of HIV was the sum of testing error, assay sensitivity and window-period risks. Data inputs were estimated from donor surveillance, donor surveys and published data. Residual risk was modelled at baseline and using three scenarios: (1) most likely - non-compliance, HIV prevalence and incidence rates of MSM are unchanged; (2) optimistic - non-compliance improves by 50%; and (3) pessimistic - non-compliance, HIV prevalence and incidence rates of MSM all double. RESULTS HIV residual risk at baseline was 1 in 36·0 million donations (95% CI 1 in 1 504 907 million, 10·5 million); in the most likely scenario 1 in 34·2 million (1 in 225 534 million, 8·7 million); in the optimistic scenario 1 in 36·0 million (1 in 282 618 million, 9·5 million); in the pessimistic scenario 1 in 16·7 million (1 in 39 469 million, 6·0 million). All confidence intervals overlapped. CONCLUSION With very low modelled risk under a 12-month deferral, the additional risk with a 3-month deferral is very low. This is true even with a pessimistic scenario.
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Affiliation(s)
- Sheila F O'Brien
- Epidemiology & Surveillance, Canadian Blood Services, Ottawa, ON, Canada
| | - Yves Grégoire
- Medical Affairs and Innovation, Hema-Quebec, Quebec, QC, Canada
| | - Josiane Pillonel
- Direction des Maladies Infectieuses, Sante Publique France, St Maurice, France
| | - Whitney R Steele
- Transmissible Disease Department, American Red Cross, Rockville, MD, USA
| | - Brian Custer
- Epidemiology and Health Science, Vitalant Research Institute, San Francisco, CA, USA
| | - Katy L Davison
- Immunisation, Hepatitis & Blood Safety, Health Protection Agency, London, UK
| | - Marc Germain
- Medical Affairs and Innovation, Hema-Quebec, Quebec, QC, Canada
| | - Antoine Lewin
- Medical Affairs and Innovation, Hema-Quebec, Montreal, QC, Canada
| | - Clive R Seed
- Donor and Product Safety (DAPS) Policy Unit, Australian Red Cross Blood Service, Perth, WA, Australia
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13
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Davison KL, Gregoire Y, Germain M, Custer B, O'Brien SF, Steele WR, Pillonel J, Seed CR. Changing the deferral for men who have sex with men - an improved model to estimate HIV residual risk. Vox Sang 2019; 114:666-674. [PMID: 31373016 DOI: 10.1111/vox.12826] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Revised: 04/23/2019] [Accepted: 06/13/2019] [Indexed: 12/15/2022]
Abstract
BACKGROUND AND OBJECTIVES Eight published studies modelled the impact of changing from a lifetime to time-limited deferral for men who have sex with men (MSM); each predicted greater risk impact than has been observed. This study uses these previous efforts to develop an 'optimized' model to inform future changes to MSM deferrals. MATERIALS AND METHODS HIV residual risk was calculated using observed HIV incidence/prevalence prior to the change in MSM deferral, then with the additional MSM expected under a 12-month deferral for five compliance scenarios, and finally using data observed after implementation of the deferral. Monte Carlo simulation calculated 95% confidence intervals (CI). RESULTS The architecture of reviewed models was sound, and two were selected for combination into the optimized model. HIV risk estimated by this in the UK under MSM lifetime deferral was 0·102 (95% CI: 0·050-0·172) per million. The model predicted from a 27·8% decrease to a 47·6% increase depending upon compliance pre-implementation of the 12-month deferral. A decrease of 0·9% was observed post-implementation. For Canada, HIV risk under a 5-year deferral was 0·050 (95% CI: 0·00003-0·122) per million. Pre-implementation of the 12-month deferral, the model predicted from 30·2% decrease to 10-fold increase. A decrease of 47·0% was observed after implementation. CONCLUSION The optimized model predicted HIV risk under 12-month MSM deferral in UK and Canada would remain low, and this was confirmed post-implementation. While the model is adaptable to other deferral scenarios, improved data quality would improve precision, particularly estimates of incidence in individuals likely to donate.
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Affiliation(s)
| | - Yves Gregoire
- Medical Affairs and Innovation, Hema-Quebec, Quebec, QC, Canada
| | - Marc Germain
- Medical Affairs and Innovation, Hema-Quebec, Quebec, QC, Canada
| | - Brian Custer
- Blood Centers of the Pacific, San Francisco, CA, USA
| | - Sheila F O'Brien
- Epidemiology and Surveillance, Canadian Blood Services, Ottawa, ON, Canada
| | - Whitney R Steele
- Transmissible Disease Department, American Red Cross, Rockville, MD, USA
| | - Josiane Pillonel
- Direction des Maladies Infectieuses, Sante Publique, Saint-Maurice, France
| | - Clive R Seed
- Donor and Product Safety (DAPS) Policy Unit, Australian Red Cross Blood Service, Perth, WA, Australia
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14
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O'Brien SF, Osmond L, Fan W, Yi QL, Goldman M. Compliance with time-based deferrals for men who have sex with men. Transfusion 2019; 59:916-920. [PMID: 30630215 DOI: 10.1111/trf.15098] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Revised: 11/15/2018] [Accepted: 11/15/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND The deferral for men who have sex with men (MSM) was reduced from a permanent deferral for MSM if even one time since 1977 to progressively shorter time deferrals of 5 years and 1 year in Canada. We assessed compliance with these deferrals and the impact on safety at Canadian Blood Services. STUDY DESIGN AND METHODS Three anonymous online compliance surveys of male whole blood donors were carried out before and after implementation of successive changes. HIV rates and incidence were monitored from January 1, 2011, to August 14, 2018. RESULTS Participation rates in the consecutive surveys were 49.7% before implementation, 36.3% after 5 years and 36.3% after 1 year. There was no difference before versus after implementation in male donors with MSM history in the past year (0.21%, 0.19%, 0.24%; p = 0.70). The percentage of eligible MSM donors increased (0.13%, 0.66%, 1.21%; p < 0.0001), with approximately 2500 eligible MSM donors with the 1-year deferral in place. HIV rates were less than 0.6 per 100,000 donations and unchanged after each policy change (p = 0.14 for trend). Incidence remained unchanged at 0.22 per 100,000 person-years before implementation, 0.54 per 100,000 after 5-year deferral, and no incident cases after 1-year deferral (p = 0.55). CONCLUSION Progressively shorter time deferrals had no impact on noncompliance of MSM with a male partner in the past year. Contrary to modeling predictions, shorter time deferrals had no impact on HIV rates or incidence. There was a modest increase in eligible MSM in the donor pool after each shorter time deferral. These results support the safety of reducing deferral periods for MSM.
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Affiliation(s)
- Sheila F O'Brien
- Canadian Blood Services, Ottawa, Ontario, Canada.,School of Epidemiology Public Health and Preventive Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Lori Osmond
- Canadian Blood Services, Ottawa, Ontario, Canada
| | - Wenli Fan
- Canadian Blood Services, Ottawa, Ontario, Canada
| | - Qi-Long Yi
- Canadian Blood Services, Ottawa, Ontario, Canada.,School of Epidemiology Public Health and Preventive Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Mindy Goldman
- Canadian Blood Services, Ottawa, Ontario, Canada.,Department of Pathology and Laboratory Medicine, University of Ottawa, Ottawa, Ontario, Canada
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15
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Hughes SD, Custer B, Laborde N, Sheon N. Transition to a 1-year deferral for male blood donors who report sexual contact with men: staff perspectives at one blood collection organization. Transfusion 2018; 58:1909-1915. [PMID: 29664123 DOI: 10.1111/trf.14632] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Revised: 02/27/2018] [Accepted: 02/27/2018] [Indexed: 11/27/2022]
Abstract
BACKGROUND Front-line staff at blood collection organizations (BCOs) play important roles in keeping the blood supply safe, yet research on their professional practice and perspectives on training needs is sparse. This qualitative study explored these topics with regard to the then-impending change in donor eligibility for men reporting sex with another man (MSM). STUDY DESIGN AND METHODS Semistructured, individual interviews with BCO staff (n = 13) in Northern California covered experiences of and opinions on indefinite deferral, the revised 1-year deferral, and anticipated potential challenges arising from the new policy. Transcripts were thematically coded, using deductive and inductive approaches. Analysis identified recurrent and divergent themes. RESULTS Interviewees reported strong values of professionalism and respect for donors and supported the change to a 1-year deferral for MSM donors. Nonetheless, nearly all voiced the need for more in-depth training to maximize the likelihood of successful implementation. Specific recommendations included the use of role-play, provision of science-based talking points or FAQs, and empathy for donors and staff. CONCLUSION More than the usual training may be required to help BCO staff feel prepared to educate the public about changes to MSM-related deferrals and communicate effectively with donors about potentially deferrable behavior. Overall, these findings suggest that before future policy changes, BCO staff's opinions about and role in implementing new donor eligibility screening procedures merit consideration.
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Affiliation(s)
- Shana D Hughes
- Division of Prevention Science, University of California, San Francisco, California
| | - Brian Custer
- Blood Systems Research Institute, San Francisco, California.,Department of Laboratory Medicine, University of California, San Francisco, California
| | | | - Nicolas Sheon
- Division of Prevention Science, University of California, San Francisco, California
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16
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17
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Haire B, Whitford K, Kaldor JM. Blood donor deferral for men who have sex with men: still room to move. Transfusion 2017; 58:816-822. [PMID: 29250781 DOI: 10.1111/trf.14445] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Revised: 11/04/2017] [Accepted: 11/11/2017] [Indexed: 12/01/2022]
Abstract
BACKGROUND Like a number of other countries, Australia mandates that a man who has had sex with men is deferred from donation until 12 months has elapsed since the sexual activity. This review examined whether this deferral period is justified by current evidence. STUDY DESIGN AND METHODS Databases (Medline, EMBASE, Scopus) were searched using terms "blood donation" and "gay" or "MSM" and "HIV risk" from the mid-1980s to the present to investigate the history of donor deferral policy and its rationale in Australia. RESULTS Gay and bisexual men in Australia face a higher risk of human immunodeficiency virus and other blood-borne viruses (BBVs) than other populations. All blood donations, however, are tested for BBVs, and with current testing technologies the window period during which infection may be present but not detected is now less than 1 week. While there is a moral imperative to maintain blood safety, there is also a moral imperative to ensure that differential treatment of population groups with regard to donation eligibility is scientifically justified. Potential social harms that may flow from a dissonance between deferral policy and its evidence base include loss of trust and increased nonadherence to policy. CONCLUSIONS A 12-month deferral for gay and bisexual men exceeds what is required to maintain blood safety. This disparity potentially causes social harm without any additional benefit to public health. Reducing the deferral period to 3 months will not increase health risk to recipients and may have the social benefit of increasing inclusiveness.
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Affiliation(s)
- Bridget Haire
- Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | - Kate Whitford
- Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | - John M Kaldor
- Kirby Institute, University of New South Wales, Sydney, NSW, Australia
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18
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Goldman M, W-Y Shih A, O'Brien SF, Devine D. Donor deferral policies for men who have sex with men: past, present and future. Vox Sang 2017; 113:95-103. [DOI: 10.1111/vox.12623] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2017] [Revised: 11/14/2017] [Accepted: 11/14/2017] [Indexed: 11/29/2022]
Affiliation(s)
- M. Goldman
- Canadian Blood Services; Ottawa ON Canada
| | - A. W-Y Shih
- Vancouver General Hospital; Vancouver BC Canada
| | | | - D. Devine
- Canadian Blood Services; Vancouver BC Canada
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19
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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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20
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Duquesnoy A, Danic B, Santos A, Martinaud C, Woimant G, Laperche S, Tiberghien P, Jauffret-Roustide M, Pillonel J. Context and social perceptions of blood donation in donors found positive for human immunodeficiency virus in France. Transfusion 2017; 57:2240-2247. [PMID: 28671313 DOI: 10.1111/trf.14187] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Revised: 04/28/2017] [Accepted: 04/30/2017] [Indexed: 01/19/2023]
Abstract
BACKGROUND In France, information collected during postdonation interviews showed that a majority of human immunodeficiency virus (HIV)-infected donors were not eligible to donate as per donor selection criteria. In the interest of blood safety, this study aimed to explore the mechanisms of noncompliance with blood donor selection criteria, notably the permanent deferral of men who have sex with men (MSM). STUDY DESIGN AND METHODS Semistructured individual interviews were conducted with 32 blood donors found positive for HIV between mid-2011 and 2014. Topics such as the experience and motivations for donating blood, understanding of selection criteria, sexual risk management, and opinions on donor selection were discussed. Transcripts were analyzed inductively. RESULTS More than 50% of study participants were noncompliant with donor selection criteria. Reasons for nondisclosure of risk factors in the predonation questionnaire or the predonation interview included stigma, test-seeking motivations, symbolic attachment to blood donation, and context of donation. Compliance to donor criteria was seen as secondary by donors who reaped personal benefits from the symbolism of their donation. Donors lacked self-reflexivity in their assessment of risky sexual behavior. The "window period" and the underlying epidemiologic arguments for donor selection criteria were poorly understood. Nearly all participants disapproved of the permanent ban on blood donations from MSM. CONCLUSION This study demonstrated the need for more communication on the epidemiologic basis for donor selection criteria and on the window period to facilitate donor compliance. These findings have already advanced improvements to predonation documents, in a larger context of 2016 donor selection criteria revision.
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Affiliation(s)
| | - Bruno Danic
- Etablissement Français du Sang, Saint Denis, France
| | - Aurélie Santos
- Institut National de la Transfusion Sanguine, Paris, France
| | | | | | - Syria Laperche
- Institut National de la Transfusion Sanguine, Paris, France
| | | | - Marie Jauffret-Roustide
- Santé publique France, Saint-Maurice, France.,Cermes3 (Inserm U988/CNRS UMR8211/EHESS/Université Paris Descartes), Paris, France
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21
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Quinn B, Seed C, Keller A, Maher L, Wilson D, Farrell M, Caris S, Williams J, Madden A, Thompson A, Pink J, Hellard ME. Re-examining blood donor deferral criteria relating to injecting drug use. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2017; 48:9-17. [PMID: 28666205 DOI: 10.1016/j.drugpo.2017.05.058] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2016] [Revised: 04/21/2017] [Accepted: 05/30/2017] [Indexed: 11/15/2022]
Abstract
BACKGROUND AND AIMS Potential Australian blood donors are deferred indefinitely if they report a history of injecting drug use (IDU), or for 12 months if they report having engaged in sexual activity with someone who might have ever injected. Given incremental improvements in blood safety, this study sought to examine whether Australia's IDU-related eligibility criteria reflected current scientific evidence, were consistent with international best practice and, if current IDU-related policies were to be changed, how this should happen. METHODS An expert committee was formed to review relevant literature with a focus on issues including: the epidemiology of IDU in Australia and key transfusion-transmissible infections (TTIs) among Australian people who inject drugs (PWID); and, 'non-compliance' among PWID regarding IDU-related blood donation guidelines. International policies relating to blood donation and IDU were also reviewed. Modelling with available data estimated the risk of TTIs remaining undetected if the Blood Service's IDU-related guidelines were changed. RESULTS Very few (<1%) Australians engage in IDU, and IDU risk practices are reported by only a minority of PWID. However, the prevalence of HCV remains high among PWID, and IDU remains a key transmission route for various TTIs. Insufficient data were available to inform appropriate estimates of cessation and relapse among Australian PWID. Modelling findings indicated that the risk of not detecting HIV becomes greater than the reference group at a threshold of non-admission of being an active PWID of around 1.8% (0.5-5.1%). Excluding Japan, all Organisation for the Economic Co-operation and Development member countries permanently exclude individuals with a history of IDU from donating. CONCLUSION Numerous research gaps meant that the study's expert Review Committee was unable to recommend altering Australia's current IDU-related blood donation guidelines. However, having identified critical knowledge gaps and future areas of research, the review made important steps toward changing the criteria.
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Affiliation(s)
- Brendan Quinn
- Burnet Institute, Melbourne, Australia; Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia.
| | - Clive Seed
- Australian Red Cross Blood Service, Australia
| | | | - Lisa Maher
- Kirby Institute, University of New South Wales, Australia
| | - David Wilson
- Burnet Institute, Melbourne, Australia; Kirby Institute, University of New South Wales, Australia
| | - Michael Farrell
- National Drug & Alcohol Research Centre, University of New South Wales, Australia
| | | | | | - Annie Madden
- Australian Injecting & Illicit Drug Users League, Australia
| | | | - Joanne Pink
- Australian Red Cross Blood Service, Australia
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22
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Vahidnia F, Stramer SL, Kessler D, Gonçalez TT, Shaz BH, Leparc G, Krysztof DE, Dodd RY, Glynn SA, Custer B. Motivations for donating and attitudes toward screening policies in US blood donors with viral infection. Transfusion 2016; 56:2013-20. [PMID: 27351292 DOI: 10.1111/trf.13678] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2016] [Revised: 04/11/2016] [Accepted: 04/21/2016] [Indexed: 11/26/2022]
Abstract
BACKGROUND Differences in motivating factors that contribute to the decision to donate blood between infected and uninfected donors may help to identify areas for improving donor education. STUDY DESIGN AND METHODS As part of a risk factor study, confirmed-positive donors (cases) based on serology-only (human T-lymphotropic virus [HTLV]) or serology and nucleic acid testing (NAT) or NAT-only (human immunodeficiency virus [HIV], hepatitis B virus [HBV], hepatitis C virus [HCV]), and serology-unconfirmed, NAT-negative false-positive donors (controls) were asked about motivations and opinions toward blood donation. "Test seeking" was inferred if a donor answered "yes" to "I wanted to get my test results" and one of the following: "blood center testing is confidential," "free," "more accurate than other test centers," or "tests will identify problems with my blood." Cases were compared to controls using descriptive and multivariable analyses. RESULTS Whether a case or control, the most common donation reason was "to help someone in need" (>90% in each group). After adjusting for demographic characteristics, test seeking was not significantly associated with infection status. Test seeking was more common in first-time, younger males and nonwhite, non-Hispanic donors. Of donors with HIV, 13% considered selection policies to be unfair, compared with 1, 2, 0.5, and 6% of donors with HBV, HCV, and HTLV and controls, respectively (adjusted odds ratio for HIV cases vs. controls, 3.9; 95% confidence interval, 2.3-6.7). CONCLUSIONS Most donors give to help those in need, including HIV-positive donors. Our results establish a baseline from which additional studies can be compared focused on alternate ways to reduce noncompliance and improved messaging to ensure that high-risk potential donors understand the reasons for blood donor screening policies.
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Affiliation(s)
| | | | | | | | | | | | | | - Roger Y Dodd
- American Red Cross, Holland Laboratory, Rockville, Maryland
| | - Simone A Glynn
- National Heart, Lung, and Blood Institute, Bethesda, Maryland
| | - Brian Custer
- Blood Systems Research Institute, San Francisco, California.,University of California at San Francisco, San Francisco, California
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23
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Germain M. The risk of allowing blood donation from men having sex with men after a temporary deferral: predictions versus reality. Transfusion 2016; 56:1603-7. [PMID: 26948287 DOI: 10.1111/trf.13541] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2015] [Revised: 01/10/2016] [Accepted: 01/17/2016] [Indexed: 12/15/2022]
Abstract
BACKGROUND In most industrialized countries, men who had sex with men (MSM) are permanently deferred from blood donation. Some countries have adopted a temporary deferral after the MSM behavior, thus avoiding donations made during the window period of human immunodeficiency virus (HIV) infection. However, one concern with this approach is the possible increase in the number of HIV-positive donations obtained from unknowingly infected, abstinent MSM; such donations might inadvertently be made available for transfusion, a risk that was previously estimated through mathematical modeling. STUDY DESIGN AND METHODS Model predictions were compared to the actual donor rate of HIV in three countries that went from a permanent to a temporary deferral: Australia, the United Kingdom, and Canada. RESULTS Depending on the model, a temporary deferral should have increased the rate of HIV in the male donor pool by 73% to more than 3400%. In reality, the very low baseline rate of HIV before the change in these three countries (22 cases/year) remained unchanged 2 years after the revised policy (16 cases/year). CONCLUSION These observations strongly suggest that a temporary deferral for MSM incurs zero risk to recipients, at least in jurisdictions where HIV epidemiology is comparable to that of countries where the change happened.
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24
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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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25
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O'Brien SF, Osmond L, Fan W, Yi QL, Goldman M. Impact of a 5-year deferral from blood donation for men who have sex with men. Transfusion 2015; 56:1598-602. [PMID: 26717893 DOI: 10.1111/trf.13445] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2015] [Revised: 11/04/2015] [Accepted: 11/11/2015] [Indexed: 11/30/2022]
Abstract
BACKGROUND The deferral for men who have sex with men (MSM) changed from a permanent deferral since 1977 to a 5-year deferral on July 22, 2013, in Canada. We assessed the impact on safety and adequacy of the blood supply at Canadian Blood Services. STUDY DESIGN AND METHODS Human immunodeficiency virus (HIV) rates were monitored from January 1, 2010, to July 21, 2015. Risk factors were assessed in notification interviews. Anonymous online surveys of male whole blood donors assessed compliance before and after implementation. RESULTS HIV rates were 0.2, 0.5, and 0.51 per 100,000 donations in 2010 to 2012; they were 0.54 and 0.22 in the first and second years after implementation (p = 0.8). Of four male HIV-positive donors after implementation, three denied risk factors and one knew he had HIV. Before implementation 9669 of 19,437 (49.7%) donors participated in the survey, and after implementation, 6881 of 18,934 (36.3%). Before implementation 0.67% of male donors were noncompliant, and after implementation, 0.44%. There was no difference before versus after implementation in male donors with MSM history in the past 5 years (0.37% vs. 0.43%, p = 0.54). After implementation, eligible MSM donors increased (0.42% vs. 0.66%, p = 0.04), with approximately 500 more donors in 2014. CONCLUSION Implementation of a 5-year deferral for MSM had no impact on HIV rates in 2 years of postimplementation monitoring. Donor compliance improved after implementation due to MSM donors who were previously ineligible becoming eligible. There was no change in the percentage of male donors with recent male partners but there was a modest increase in eligible MSM in the donor pool.
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Affiliation(s)
- Sheila F O'Brien
- Canadian Blood Services, Ottawa, Ontario.,School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | | | - Wenli Fan
- Canadian Blood Services, Ottawa, Ontario
| | - Qi-Long Yi
- Canadian Blood Services, Ottawa, Ontario.,School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Mindy Goldman
- Canadian Blood Services, Ottawa, Ontario.,Department of Pathology & Laboratory Medicine, University of Ottawa, Ottawa, Ontario, Canada
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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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Davison KL, Reynolds CA, Andrews N, Brailsford SR. Getting personal with blood donors - the rationale for, methodology of and an overview of participants in the UK blood donor survey. Transfus Med 2015; 25:265-75. [PMID: 26337860 DOI: 10.1111/tme.12236] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2015] [Revised: 06/15/2015] [Accepted: 07/29/2015] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To design and pilot a survey of UK blood donors to assess, on a large scale, their understanding of and compliance with the donor selection guidelines (DSG). BACKGROUND Compliance with the DSG is important for maintaining blood safety, however, little is currently known about the extent of this among UK donors. MATERIALS AND METHODS The online, unlinked survey was based on the donor health check form with a focus on behaviours associated with blood borne infections, sexual contact, drug use and travel. The survey materials were reviewed by a donor focus group and the survey was piloted among 2982 UK donors. Percentage responses were calculated, complaints monitored and answers to questions reviewed. The survey went live in 2013; 225 091 donors were invited via email to participate followed by two reminders. RESULTS The survey was well received by the focus group, with little concern about the sensitive and personal questions. Their feedback led to important refinement in the survey materials. In the pilots, 21·0% (627/2982) responded, a reminder was necessary to achieve this. Among responders, there was evidence of non-compliance and test seeking behaviour, and no evidence that intention to donate again was affected. In the live survey, 29% (65 439) responded; responders were generally representative of donors overall. CONCLUSION A large scale survey of donor compliances is feasible, acceptable and effective in ascertaining appropriate information; involving donors and the blood services in the development stages through a focus group and pilots was important to achieve this.
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Affiliation(s)
- K L Davison
- NHS Blood and Transplant/Public Health England Epidemiology Unit, Public Health England, London, UK
| | - C A Reynolds
- NHS Blood and Transplant/Public Health England Epidemiology Unit, NHS Blood and Transplant, London, UK
| | - N Andrews
- Statistics Unit, Public Health England, London, UK
| | - S R Brailsford
- NHS Blood and Transplant/Public Health England Epidemiology Unit, NHS Blood and Transplant, London, UK
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Daniel H, Butkus R. Lesbian, Gay, Bisexual, and Transgender Health Disparities: Executive Summary of a Policy Position Paper From the American College of Physicians. Ann Intern Med 2015; 163:135-7. [PMID: 25961598 DOI: 10.7326/m14-2482] [Citation(s) in RCA: 158] [Impact Index Per Article: 17.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
In this position paper, the American College of Physicians examines the health disparities experienced by the lesbian, gay, bisexual, and transgender (LGBT) community and makes a series of recommendations to achieve equity for LGBT individuals in the health care system. These recommendations include enhancing physician understanding of how to provide culturally and clinically competent care for LGBT individuals, addressing environmental and social factors that can affect their mental and physical well-being, and supporting further research into understanding their unique health needs.
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Affiliation(s)
- Hilary Daniel
- From the American College of Physicians, Washington, DC
| | - Renee Butkus
- From the American College of Physicians, Washington, DC
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De Buck E, Dieltjens T, Compernolle V, Vandekerckhove P. Is having sex with other men a risk factor for transfusion-transmissible infections in male blood donors in Western countries? A systematic review. PLoS One 2015; 10:e0122523. [PMID: 25875812 PMCID: PMC4398316 DOI: 10.1371/journal.pone.0122523] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2014] [Accepted: 02/12/2015] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Although increased prevalence of transfusion transmissible infections (TTI) among "men who have sex with men" (MSM) has been well documented, the exclusion of MSM as blood donors is contested. The aim of this systematic review is to find studies that describe the risk of TTI in MSM blood donors. METHODS We searched MEDLINE, Embase, The Cochrane Central Register of Controlled Trials, Cinahl, and Web of Science, and used GRADE for determining evidence quality. We included studies comparing MSM and non-MSM blood donors (or people eligible to give blood), living in areas most relevant for our Blood Service. RESULTS Out of 18 987 articles, 14 observational studies were included. Two studies directly compared MSM with non-MSM donors showing that MSM donors have a statistically significant higher risk of HIV-1 infections. In one of these studies it was shown that this was related to recent (< 12 months) MSM contact. In two additional studies no evidence was shown in favour of a certain deferral period for MSM. Ten studies, applying permanent deferral for MSM, compared infected versus non-infected donors. One study found that MSM is a statistically significant risk factor for HIV-1 infection in blood donors. For other TTI such as HBV or HCV, an increased risk of infection could not be demonstrated, because the precision of the results was affected by the low numbers of donors with MSM as risk factor, or because of risk of bias in the included studies. All studies included low level evidence, because of risk of bias and imprecision of the results. CONCLUSIONS High-quality studies investigating the risk of TTI in MSM who donate blood are scarce. The available evidence suggests a link between MSM blood donors and HIV-1 infection, but is too limited to be able to unambiguously/clearly recommend a certain deferral policy.
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Affiliation(s)
- Emmy De Buck
- Centre for Evidence-Based Practice, Belgian Red Cross-Flanders, Mechelen, Belgium
| | - Tessa Dieltjens
- Centre for Evidence-Based Practice, Belgian Red Cross-Flanders, Mechelen, Belgium
| | - Veerle Compernolle
- Blood Service, Belgian Red Cross-Flanders, Mechelen, Belgium
- Faculty of Medicine and Health Sciences, University of Ghent, Ghent, Belgium
| | - Philippe Vandekerckhove
- Belgian Red Cross-Flanders, Mechelen, Belgium
- Department of Public Health and Primary Care, Faculty of Medicine, Catholic University of Leuven, Leuven, Belgium
- Faculty of Medicine, University of Ghent, Ghent, Belgium
- * E-mail:
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Germain M, Delage G. Models used to predict the impact of having less stringent deferral policies for men who had sex with men: can we validate these predictions? ACTA ACUST UNITED AC 2015. [DOI: 10.1111/voxs.12111] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Wong HTH, Lee SS, Lee CK, Chan DPC. Failure of self-disclosure of deferrable risk behaviors associated with transfusion-transmissible infections in blood donors. Transfusion 2015; 55:2175-83. [PMID: 25846739 PMCID: PMC4672705 DOI: 10.1111/trf.13106] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2015] [Revised: 02/27/2015] [Accepted: 03/01/2015] [Indexed: 12/29/2022]
Abstract
BACKGROUND To date, most studies on deferral of blood donors have focused on men who have sex with men (MSM) and/or injecting drug users. Few have examined deferrable risk behaviors relating to transfusion-transmissible infections (TTIs) in general. This study aimed to examine the prevalence of, and factors associated with, nondisclosure of TTI-related risk behaviors in donors. STUDY DESIGN AND METHODS Chinese-speaking donors who had just given blood in Hong Kong were invited to self-complete an anonymous questionnaire. Practices of one or more of seven deferrable risk behaviors associated with TTI were inquired. Factors associated with noncompliance with self-disclosure were evaluated by logistic regression. RESULTS Over a 4-week study period in 2012, a total of 1143 donors were recruited. Overall, 0.2% gave a history of drug injection, 1.7% had had sex with sex worker(s), and 0.3% had had sex with a human immunodeficiency virus–infected partner, while none had been paid for sex. Some 1.5% of male donors reported having same-sex behaviors. Factors associated with noncompliance were male gender (odds ratio [OR] 31.1; 95% confidence interval [CI], 3.7-263.6), having multiple sex partners (OR, 89.7; 95% CI, 28.7-279.9), and previous history of temporary deferral (OR, 11.4; 95% CI, 2.5-53.3). If suspected noncompliance was included, the overall prevalence of nondisclosure of deferrable behaviors could be high at 6.5%. CONCLUSION Albeit uncommon, some donors fail to provide accurate answers to predonation screening questions and are not deferred appropriately. There is room for improvement to make deferral policy acceptable and understandable, so as to minimize the risk of TTI. Efforts are also needed to tackle the paucity of data on noncompliance of non-MSM donors.
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Affiliation(s)
- Horas Tze Hoo Wong
- Stanley Ho Centre for Emerging Infectious Diseases, the Chinese University of Hong Kong, Shatin, Hong Kong
| | - Shui Shan Lee
- Stanley Ho Centre for Emerging Infectious Diseases, the Chinese University of Hong Kong, Shatin, Hong Kong
| | - Cheuk-Kwong Lee
- Hong Kong Red Cross Blood Transfusion Service, Kowloon, Hong Kong
| | - Denise Pui Chung Chan
- Stanley Ho Centre for Emerging Infectious Diseases, the Chinese University of Hong Kong, Shatin, Hong Kong
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Offergeld R, Kamp C, Heiden M, Norda R, Behr-Gross ME. Sexual risk behaviour and donor deferral in Europe. Vox Sang 2014; 107:420-7. [PMID: 25040600 DOI: 10.1111/vox.12179] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2013] [Revised: 06/06/2014] [Accepted: 06/13/2014] [Indexed: 11/26/2022]
Abstract
One of the most controversial policies in blood transfusion worldwide is the permanent deferral from donating blood of men with sexual contacts to other men (MSM). This policy was implemented for safety reasons as sex between men is known to be a high risk factor for acquiring severe infectious diseases transmissible by blood transfusion. Sexual contacts among heterosexual persons may hold similar risks but a clear-cut discrimination between different individual risks is impossible. Nevertheless, the current blood donor deferral periods defined by European Union (EU) legislation depend on a distinction of different grades of risk with respect to sexual behaviour. Under the aegis of the Steering Committee on Blood Transfusion (CD-P-TS) of the Council of Europe (CoE), an international working group evaluated epidemiological and behavioural data, modelling studies on residual risk and spread of infections, and studies on adherence to donor selection criteria. The aim was to distinguish sexual behaviour of different risk categories. It was concluded, that existing data confirm that MSM and commercial sex workers (CSW) are groups at high risk. Any further grading lacks a scientific data base. Modelling studies indicate that adherence to deferral policies is of major relevance suggesting that good donor adherence may outweigh the small negative effects on blood safety postulated for changing from permanent to temporary deferral periods for high risk sexual behaviours. The fact that a considerable percentage of donors are MSM - despite the permanent deferral policy - demonstrates the need to increase donor understanding and adherence.
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Epstein J, Ganz PR, Seitz R, Jutzi M, Schaerer C, Michaud G, Agbanyo F, Smith G, Prosser I, Heiden M, Saint‐Marie I, Oualikene‐Gonin W, Hamaguchi I, Yasuda N. A shared regulatory perspective on deferral from blood donation of men who have sex with men (
MSM
). Vox Sang 2014; 107:416-9. [DOI: 10.1111/vox.12166] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2013] [Revised: 05/08/2014] [Accepted: 05/11/2014] [Indexed: 11/28/2022]
Affiliation(s)
- J. Epstein
- Office of Blood Research and Review Center for Biologics Evaluation and Research U.S. Food and Drug Administration Silver Spring MD USA
| | - P. R. Ganz
- Centre for Blood and Tissues Evaluation Biologics and Genetic Therapies Directorate, Health Canada Ottawa ON Canada
| | - R. Seitz
- Division of Haematology/Transfusion Medicine Paul‐Ehrlich‐Institut Langen Germany
| | - M. Jutzi
- Swissmedic, Swiss Agency for Therapeutic Products Bern Switzerland
| | - C. Schaerer
- Swissmedic, Swiss Agency for Therapeutic Products Bern Switzerland
| | - G. Michaud
- Office of Blood Research and Review Center for Biologics Evaluation and Research U.S. Food and Drug Administration Silver Spring MD USA
| | - F. Agbanyo
- Centre for Blood and Tissues Evaluation Biologics and Genetic Therapies Directorate, Health Canada Ottawa ON Canada
| | - G. Smith
- Office of Scientific Evaluation Therapeutic Goods Administration Woden ACT Australia
| | - I. Prosser
- Office of Scientific Evaluation Therapeutic Goods Administration Woden ACT Australia
| | - M. Heiden
- Division of Haematology/Transfusion Medicine Paul‐Ehrlich‐Institut Langen Germany
| | - I. Saint‐Marie
- Division for Advanced Therapies Products from Human Origin and Vaccines French National Agency for Medicines and Health Products Safety Saint‐Denis Cedex France
| | - W. Oualikene‐Gonin
- Division for Advanced Therapies Products from Human Origin and Vaccines French National Agency for Medicines and Health Products Safety Saint‐Denis Cedex France
| | - I. Hamaguchi
- Department of Safety Research on Blood and Biological Products National Institute of Infectious Diseases Musashimurayama Tokyo Japan
| | - N. Yasuda
- Minister's Secretariat Ministry of Health Labour and Welfare Chiyoda, Tokyo Japan
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Lucky TTA, Seed CR, Waller D, Lee JF, McDonald A, Wand H, Wroth S, Shuttleworth G, Keller AJ, Pink J, Wilson DP. Understanding noncompliance with selective donor deferral criteria for high-risk behaviors in Australian blood donors. Transfusion 2014; 54:1739-49. [PMID: 24720444 DOI: 10.1111/trf.12554] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2013] [Revised: 11/27/2013] [Accepted: 11/27/2013] [Indexed: 11/27/2022]
Abstract
BACKGROUND Using a predonation screening questionnaire, potential blood donors are screened for medical or behavioral factors associated with an increased risk for transfusion-transmissible infection. After disclosure of these risks, potential donors are deferred from donating. Understanding the degree of failure to disclose full and truthful information (termed noncompliance) is important to determine and minimize residual risk. This study estimates the prevalence of, and likely reasons for, noncompliance among Australian donors with the deferrals for injecting drug use, sex with an injecting drug user, male-to-male sex, sex worker activity or contact, and sex with a partner from a high-HIV-prevalence country. STUDY DESIGN AND METHODS An anonymous, online survey of a nationally representative sample of Australian blood donors was conducted. Prevalence of noncompliance with deferrable risk categories was estimated. Factors associated with noncompliance were determined using unadjusted and adjusted odds ratios. RESULTS Of 98,044 invited donors, 30,790 donors completed the survey. The estimated prevalence of overall noncompliance (i.e., to at least one screening question) was 1.65% (95% confidence interval CI, 1.51%-1.8%). Noncompliance with individual deferrals ranged from 0.05% (sex work) to 0.54% (sex with an injecting drug user). The prevalences of the disclosed exclusionary risk behaviors were three to 14 times lower than their estimated prevalence in the general population. CONCLUSION The prevalence of noncompliance is relatively low but our estimate is likely to be a lower bound. The selected high-risk behaviors were substantially less common in blood donors compared to the general population suggesting that self-deferral is effective. Nevertheless, a focus on further minimization should improve the blood safety.
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Affiliation(s)
- Tarana T A Lucky
- The Kirby Institute, The University of New South Wales, Sydney, New South Wales, Australia
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Liszewski W, Becerril J, Terndrup C, West N, Lavin BC, Schieffler D, Van Sickels N. The rates, perceptions, and willingness of men who have sex with men to donate blood. Transfusion 2014; 54:1733-8. [PMID: 24410718 DOI: 10.1111/trf.12535] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2013] [Revised: 10/22/2013] [Accepted: 11/07/2013] [Indexed: 11/30/2022]
Abstract
BACKGROUND Since 1983 in the United States, any man who has had sex with another man (MSM) at any time since 1977 has been deferred from donating blood for life. Although there has been a push to change the deferral, there is a paucity of information on both the rates of MSM blood donation and the willingness of MSMs to donate if the deferral were changed. STUDY DESIGN AND METHODS A 15-question survey was given at two lesbian, gay, bisexual, and transgender festivals in Chicago and New Orleans. Participants were asked about a previous history of blood donation and whether they would be willing to donate were the lifetime deferral changed. Participants were also asked to determine whether it was safe for hypothetical MSMs with varying sexual practices to donate blood and whether they believed that it was safe for them to donate their own blood. RESULTS Our study found that 42.0% of all participants had not complied with the deferral policy and have donated blood at least once, with a mean number of donations of 4.84. Additionally, 85.9% of participants would be willing to donate blood if the deferral were changed. CONCLUSION Despite the lifetime deferral, many MSMs have previously donated blood, and many more are willing to donate. Given this, along with the safe implementation of temporary deferral policies in other nations, the United States should consider adopting a temporary deferral policy for MSMs.
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Wilson K, Atkinson K, Keelan J. Three decades of MSM donor deferral policies. What have we learned? Int J Infect Dis 2013; 18:1-3. [PMID: 24211477 DOI: 10.1016/j.ijid.2013.09.016] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2013] [Revised: 09/17/2013] [Accepted: 09/20/2013] [Indexed: 11/16/2022] Open
Abstract
In the early 1980s, donor deferrals targeting men who have sex with men (MSM) and other high-risk groups were implemented in response to the outbreak of HIV/AIDS. It has now been three decades since the implementation of these deferrals. We review the international experience with developing these policies, which involves combining scientific evidence with ethical and moral concerns and the challenge of moving from precautionary to risk management policies as scientific knowledge and technology evolves. We provide key lessons that can guide blood policymakers as they confront potential new threats to the safety of the blood system and also provide lessons to the wider public health community on how best to incorporate precaution into the policymaking process.
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Affiliation(s)
- Kumanan Wilson
- Departments of Medicine and of Epidemiology and Community Medicine, University of Ottawa, The Ottawa Hospital, Civic Campus, 1053 Carling Avenue, Administrative Services Building, Room 1009, Box 684, Ottawa, ON, K1Y 4E9, Canada; Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada.
| | - 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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Germain M, Robillard P, Delage G, Goldman M. Allowing blood donation from men who had sex with men more than 5 years ago: a model to evaluate the impact on transfusion safety in Canada. Vox Sang 2013; 106:372-5. [DOI: 10.1111/vox.12109] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
| | | | - G. Delage
- Héma-Québec; Saint-Laurent QC Canada
| | - M. Goldman
- Canadian Blood Services; Ottawa ON Canada
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Seed CR, Lucky TT, Waller D, Wand H, Lee JF, Wroth S, McDonald A, Pink J, Wilson DP, Keller AJ. Compliance with the current 12-month deferral for male-to-male sex in Australia. Vox Sang 2013; 106:14-22. [DOI: 10.1111/vox.12093] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2013] [Revised: 09/01/2013] [Accepted: 09/03/2013] [Indexed: 11/27/2022]
Affiliation(s)
- C. R. Seed
- Australian Red Cross Blood Service; Perth WA Australia
| | - T. T. Lucky
- The Kirby Institute; University of New South Wales; Sydney NSW Australia
| | - D. Waller
- Australian Red Cross Blood Service; Sydney NSW Australia
| | - H. Wand
- The Kirby Institute; University of New South Wales; Sydney NSW Australia
| | - J. F. Lee
- Australian Red Cross Blood Service; Perth WA Australia
| | - S. Wroth
- Australian Red Cross Blood Service; Perth WA Australia
| | - A. McDonald
- The Kirby Institute; University of New South Wales; Sydney NSW Australia
| | - J. Pink
- Australian Red Cross Blood Service; Brisbane Qld Australia
| | - D. P. Wilson
- The Kirby Institute; University of New South Wales; Sydney NSW Australia
| | - A. J. Keller
- Australian Red Cross Blood Service; Perth WA Australia
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Changing blood donor screening criteria from permanent deferral for men who have sex with men to individual sexual risk assessment: no evidence of a significant impact on the human immunodeficiency virus epidemic in Italy. BLOOD TRANSFUSION = TRASFUSIONE DEL SANGUE 2013; 11:441-8. [PMID: 23867178 DOI: 10.2450/2013.0162-12] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Received: 07/18/2012] [Accepted: 04/30/2013] [Indexed: 11/21/2022]
Abstract
BACKGROUND In 2001, the criteria for blood donor eligibility in Italy were modified by a ministerial decree from a permanent deferral for "men who have sex with men" to an individual risk assessment of sexual behaviours. The aim of this study was to evaluate the impact of this change in donor screening criteria on the human immunodeficiency virus epidemic among blood donors in Italy. MATERIALS AND METHODS We used the data obtained from the Italian blood donor epidemiological surveillance system. We compared data collected in 2009 and 2010, when the individual risk assessment policy was applied, with data collected in 1999 when permanent deferral was applied for men who have sex with men based on a declaration of sexual orientation. We evaluated the change over time in the relative proportion of HIV antibody-positive donors who likely acquired the infection from men who have sex with men vs heterosexual sexual exposure; the relative risk was calculated using 1999 as the reference year. RESULTS In all 3 years, the majority of HIV antibody-positive donors reported sexual exposure as a risk factor for HIV infection; this proportion increased over time, although not statistically significantly. Heterosexuals always accounted for at least 40% of all HIV antibody-positive cases. The rate of HIV antibody-positive donors increased similarly in men who have sex with men and heterosexuals; specifically, the rate of HIV antibody-positive cases per 100,000 donors was more than 2-fold higher among men who have sex with men in 2009-2010 than in 1999 (2009-2010 vs 1999, RR =2.8; P =0.06), and that among heterosexuals was 1.5 fold higher (P =0.18). DISCUSSION When comparing the period before (1999) and after (2009-2010), the implementation of the individual risk assessment policy in 2001, no significant increase in the proportion of men who have sex with men compared to heterosexuals was observed among HIV antibody-positive blood donors, suggesting that the change in donor deferral policy did not lead to a disproportionate increase of HIV-seropositive men who have sex with men.
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Abstract
Although blood suppliers are seeing short-term reductions in blood demand as a result of initiatives in patient blood management, modelling suggests that during the next 5-10 years, blood availability in developed countries will need to increase again to meet the demands of ageing populations. Increasing of the blood supply raises many challenges; new approaches to recruitment and retainment of future generations of blood donors will be needed, and care will be necessary to avoid taking too much blood from these donors. Integrated approaches in blood stock management between transfusion services and hospitals will be important to minimise wastage--eg, by use of supply chain solutions from industry. Cross-disciplinary systems for patient blood management need to be developed to lessen the need for transfusion--eg, by early identification and reversal of anaemia with haematinics or by reversal of the underlying cause. Personalised medicine could be applied to match donors to patients, not only with extended blood typing, but also by using genetically determined storage characteristics of blood components. Growing of red cells or platelets in large quantities from stem cells is a possibility in the future, but challenges of cost, scaling up, and reproducibility remain to be solved.
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Belanger GA, McFarland W, Raymond HF, Custer B. If the permanent deferral were lifted would men who have sex with men want to donate blood, and if so, who would be eligible? Transfusion 2013; 53:2729-33. [DOI: 10.1111/trf.12124] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2012] [Revised: 12/12/2012] [Accepted: 12/13/2012] [Indexed: 11/27/2022]
Affiliation(s)
- Geoffrey A. Belanger
- San Jose State University; San Jose California
- Stanford Blood Center; Palo Alto California
- HIV Epidemiology Section; San Francisco Department of Public Health; San Francisco California
- Epidemiology and Biostatistics and Laboratory Medicine; University of California at San Francisco; San Francisco California
- Blood Systems Research Institute; San Francisco California
| | - Willi McFarland
- San Jose State University; San Jose California
- Stanford Blood Center; Palo Alto California
- HIV Epidemiology Section; San Francisco Department of Public Health; San Francisco California
- Epidemiology and Biostatistics and Laboratory Medicine; University of California at San Francisco; San Francisco California
- Blood Systems Research Institute; San Francisco California
| | - H. Fisher Raymond
- San Jose State University; San Jose California
- Stanford Blood Center; Palo Alto California
- HIV Epidemiology Section; San Francisco Department of Public Health; San Francisco California
- Epidemiology and Biostatistics and Laboratory Medicine; University of California at San Francisco; San Francisco California
- Blood Systems Research Institute; San Francisco California
| | - Brian Custer
- San Jose State University; San Jose California
- Stanford Blood Center; Palo Alto California
- HIV Epidemiology Section; San Francisco Department of Public Health; San Francisco California
- Epidemiology and Biostatistics and Laboratory Medicine; University of California at San Francisco; San Francisco California
- Blood Systems Research Institute; San Francisco California
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Davison KL, Conti S, Brailsford SR. The risk of transfusion-transmitted HIV from blood donations of men who have sex with men, 12 months after last sex with a man: 2005-2007 estimates from England and Wales. Vox Sang 2013; 105:85-8. [DOI: 10.1111/vox.12024] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2012] [Revised: 12/10/2012] [Accepted: 12/12/2012] [Indexed: 11/30/2022]
Affiliation(s)
| | - S. Conti
- Statistics Unit; Health Protection Agency; Colindale; London; UK
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Cascio MA, Yomtovian R. Sex, Risk, and Education in Donor Educational Materials: Review and Critique. Transfus Med Rev 2013; 27:50-5. [DOI: 10.1016/j.tmrv.2012.05.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Flanagan P. How should we assess risk behaviour when determining donor deferral? Reflections on the MSM deferral. Biologicals 2011; 40:173-5. [PMID: 22071002 DOI: 10.1016/j.biologicals.2011.10.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2011] [Accepted: 10/18/2011] [Indexed: 11/25/2022] Open
Abstract
Concerns are increasingly being raised in a number of countries in relation to the behavioural donor criteria and in particular the on-going permanent exclusion of men who have had sex with other men (MSM). The justification for this is broadly linked to the use of risk models. Generally current exclusion criteria are broadly defined and indirectly it might be argued that this leads to exclusion based on sexual orientation. Available data indicates compliance issues with the exclusion and recent reviews in Europe have recommended that further research in this area is needed before any change in the current permanent exclusion should be made. Lobby groups however promote a more targetted approach to behavioural criteria. Firm data to support this is however currently lacking. There are a number of possible approaches to assessing risk including the period since the activity took place, the number of partners in a given period, the type of sex act or a combination of these factors. Definition of an optimal approach will need to consider both the sensitivity and specificity of the intervention along with an assessment of ease and consistency of application.
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Affiliation(s)
- Peter Flanagan
- New Zealand Blood Service, Auckland Mail Centre, New Zealand.
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O'Brien SF, Zou S, Laperche S, Brant LJ, Seed CR, Kleinman SH. Surveillance of transfusion-transmissible infections comparison of systems in five developed countries. Transfus Med Rev 2011; 26:38-57. [PMID: 21944935 PMCID: PMC7134890 DOI: 10.1016/j.tmrv.2011.07.001] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
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.
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Affiliation(s)
- Sheila F O'Brien
- National Epidemiology and Surveillance, Canadian Blood Services, 1800 Alta Vista Drive, Ottawa, Ontario, Canada K1G 4J5. sheila.o'
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Grenfell P, Nutland W, McManus S, Datta J, Soldan K, Wellings K. Views and experiences of men who have sex with men on the ban on blood donation: a cross sectional survey with qualitative interviews. BMJ 2011; 343:d5604. [PMID: 21903692 PMCID: PMC3168936 DOI: 10.1136/bmj.d5604] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To explore compliance with the UK blood services' criterion that excludes men who have had penetrative sex with a man from donating blood, and to assess the possible effects of revising this policy. DESIGN A random location, cross sectional survey followed by qualitative interviews. SETTING Britain. PARTICIPANTS 1028 of 32,373 men in the general population reporting any male sexual contact completed the survey. Additional questions were asked of a general population sample (n=3914). Thirty men who had had penetrative sex with a man participated in the qualitative interviews (19 who had complied with the blood services' exclusion criterion and 11 who had not complied). Main outcome measure Compliance with the blood services' lifetime exclusion criterion for men who have had penetrative sex with a man. RESULTS 10.6% of men with experience of penetrative sex with a man reported having donated blood in Britain while ineligible under the exclusion criterion, and 2.5% had donated in the previous 12 months. Ineligible donation was less common among men who had had penetrative sex with a man recently (in previous 12 months) than among men for whom this last occurred longer ago. Reasons for non-compliance with the exclusion included self categorisation as low risk, discounting the sexual experience that barred donation, belief in the infallibility of blood screening, concerns about confidentiality, and misunderstanding or perceived inequity of the rule. Although blood donation was rarely viewed as a "right," potential donors were seen as entitled to a considered assessment of risk. A one year deferral since last male penetrative sex was considered by study participants to be generally feasible, equitable, and acceptable. CONCLUSIONS A minority of men who have sex with men who are ineligible to donate blood under the current donor exclusion in Britain have nevertheless done so in the past 12 months. Many of the reasons identified for non-compliance seem amenable to intervention. A clearly rationalised and communicated one year donor deferral is likely to be welcomed by most men who have sex with men.
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Affiliation(s)
- P Grenfell
- Department of Social and Environmental Health Research, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London WC1H 9SH, UK
| | - W Nutland
- Department of Social and Environmental Health Research, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London WC1H 9SH, UK
| | - S McManus
- National Centre for Social Research, London EC1V 0AX
| | - J Datta
- Department of Social and Environmental Health Research, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London WC1H 9SH, UK
| | - K Soldan
- Health Protection Agency, London NW9 5EQ
| | - K Wellings
- Department of Social and Environmental Health Research, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London WC1H 9SH, UK
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Pillonel J, Heraud-Bousquet V, Pelletier B, Semaille C, Velter A, Saura C, Desenclos JC, Danic B. Deferral from donating blood of men who have sex with men: impact on the risk of HIV transmission by transfusion in France. Vox Sang 2011; 102:13-21. [DOI: 10.1111/j.1423-0410.2011.01509.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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Davison KL, Brant LJ, Presanis AM, Soldan K. A re-evaluation of the risk of transfusion-transmitted HIV prevented by the exclusion of men who have sex with men from blood donation in England and Wales, 2005-2007. Vox Sang 2011; 101:291-302. [DOI: 10.1111/j.1423-0410.2011.01491.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Accès au don du sang des hommes ayant des relations sexuelles avec des hommes et impact sur le risque de transmission du VIH par transfusion : tour d’horizon international. Transfus Clin Biol 2011; 18:151-7. [DOI: 10.1016/j.tracli.2011.02.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2011] [Accepted: 02/05/2011] [Indexed: 11/22/2022]
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