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Hughes SD, France CL, West-Mitchell KA, Pina T, McElfresh D, Sayers M, Bryant BJ. Advancing Understandings of Blood Donation Motivation and Behavior. Transfus Med Rev 2023; 37:150780. [PMID: 37996288 DOI: 10.1016/j.tmrv.2023.150780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 10/23/2023] [Accepted: 10/23/2023] [Indexed: 11/25/2023]
Abstract
In this review, we provide critical analysis of social science research into blood donation motivation and behavior. We first share an understanding of the existing literature and recommendations for future research collectively developed by members of the Working Group on Blood Donors and the Supply: Diversifying while Maintaining the Donor Pool, Donor Selection, and Optimizing Blood Availability and Safety, as part of the National Heart, Lung, and Blood Institute's 2022 State of the Science in Transfusion Medicine symposium. Then, rather than aim for a comprehensive treatment, we review 4 newer manuscripts that exemplify aspects of the group's recommendations and report results from countries where the blood supply is based on voluntary, nonremunerated donations. From the substantial existing literature, we selected: (1) a study that employed motivational interviewing techniques, thematic analysis, and surveys to link donation motivations and barriers reported by diverse young donors in the United States to actual donation behavior over a year of subsequent eligibility; (2) a survey regarding donation motivations and barriers and monetary amounts associated with willingness to participate in whole blood, plasma, or platelet collection; (3) a survey-based assessment of various emotional states reported by donors at 2 time points during donation and the relationship between emotional experience and subsequent vasovagal reactions; and (4) an interpretive discourse analysis of blood collection agency messaging to donors and the public in the beginning of the COVID-19 pandemic. We close by noting several challenges posed by the structure of the United States blood system and the current funding environment to conducting rigorous research and translating findings into practice.
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Affiliation(s)
- Shana D Hughes
- Vitalant Research Institute, University of California San Francisco, San Francisco, CA, USA; Department of Laboratory Medicine, University of California San Francisco, San Francisco, CA, USA.
| | | | - Kamille A West-Mitchell
- Department of Transfusion Medicine, NIH Clinical Center, National Institutes of Health, Bethesda, MD, USA
| | - Theresa Pina
- Gulf Coast Regional Blood Center, Houston, TX, USA
| | - Duncan McElfresh
- Department of Medicine, Stanford University, Stanford, CA, USA; US Department of Veterans Affairs, Program Evaluation Resource Center, Office of Mental Health and Suicide Prevention, Menlo Park, CA, USA
| | - Merlyn Sayers
- University of Texas Southwestern Medical Center, Dallas, TX, USA; Carter BloodCare, Bedford, TX, USA
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2
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van den Berg K, Murphy EL, Louw VJ, Maartens G, Hughes SD. Motivations for blood donation by HIV-positive individuals on antiretrovirals in South Africa: A qualitative study. Transfus Med 2023; 33:277-286. [PMID: 36799902 PMCID: PMC10403373 DOI: 10.1111/tme.12957] [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: 09/11/2022] [Revised: 01/13/2023] [Accepted: 02/02/2023] [Indexed: 02/18/2023]
Abstract
OBJECTIVES We performed a mixed-methods study to explore the motivations associated with blood donation by donors with known, but undisclosed HIV-positive status and ARV use (HIV+/ARV+), seeking potential strategies to reduce such donations and mitigate risk for blood recipients. Here, we report predominantly the qualitative component. BACKGROUND A safe and sustainable blood supply is dependent in part, on effective pre-donation donor assessment. We previously described failure by HIV+/ARV+ blood donors to disclose their status. Such donations may lead to transfusion-transmitted HIV. METHODS The social ecological model provided the conceptual framework for this study. Previously identified HIV+/ARV+ donors were invited to complete a survey (including a validated stigma scale) and qualitative interview, which underwent inductive and deductive thematic analysis. RESULTS We uncovered two primary motivational paths to HIV+/ARV+ blood donations: privacy and altruism. The latter included a motivation not previously reported in the literature: donating specifically for other people living with HIV (PLWH). The other primary factor was a lack of privacy. These accounts often included donors encountering donation opportunities when accompanied by people to whom they had not and did not plan to disclose their HIV status. Most were highly confident their donations would be identified as HIV-positive and discarded. CONCLUSION We demonstrated a complex interaction between individual, social, cultural, and structural/policy factors in blood donations by PLWH who take ARV. Recommendations to limit HIV + ARV+ donations include: (1) Targeted communication strategies to increase knowledge among PLWH of their deferral from blood donation-without increasing stigma, and (2) development of procedures to assist those who feel unable to opt-out of donation due to privacy concerns.
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Affiliation(s)
- Karin van den Berg
- Medical Division, South African National Blood Service, Roodepoort, South Africa
- Division of Clinical Haematology, Department of Medicine, University of Cape Town, Cape Town, South Africa
- Division of Clinical Haematology, University of the Free State, Bloemfontein, South Africa
| | - Edward L Murphy
- Departments of Laboratory Medicine and Epidemiology/Biostatistics, University of California, San Francisco, California, USA
- Vitalant Research Institute, San Francisco, California, USA
| | - Vernon J Louw
- Division of Clinical Haematology, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Gary Maartens
- Division of Clinical Pharmacology, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Shana D Hughes
- Vitalant Research Institute, San Francisco, California, USA
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Sriamporn KT, Saxton P, Consedine N, Hammoud M, Prestage G. Blood donation behaviour and attitudes towards the 12-month deferral policy among gay and bisexual men in New Zealand. Vox Sang 2022; 117:1145-1152. [PMID: 35919939 PMCID: PMC9804482 DOI: 10.1111/vox.13336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 07/06/2022] [Accepted: 07/08/2022] [Indexed: 01/05/2023]
Abstract
BACKGROUND AND OBJECTIVES Gay and bisexual men (GBM) are deferred from donating blood in many countries. Perceptions by GBM that blood donor deferral policies are unjustifiably discriminatory, especially due to advances in HIV prevention, could contribute to non-compliance and need to be understood. We explore blood donation interest and history among GBM and attitudes towards donor deferral policies for the first time in New Zealand (NZ). MATERIALS AND METHODS Data from a cross-sectional online survey of GBM in NZ were examined. We constructed three groups: (1) never donated blood and not interested; (2) never donated but expressed interest; and (3) previously donated blood. We tested these for association with demographic and behavioural variables, as well as attitudes towards blood donation policy. RESULTS A total of 607 GBM were eligible for the study, of whom 32.9% reported having donated blood previously, 44.3% had never donated blood but expressed interest and 22.7% expressed no interest in donating. Among previous donors, a third (8.6% of the total sample) reported non-compliance with the deferral policy. Most participants found the 12-month deferral policy to be too strict (81.8%), unfair (75.4%) and homophobic (68.8%). CONCLUSION We estimate that, for the first time in NZ, almost 10% of the sample did not report compliance with the 12-month deferral policy for men who have sex with men (MSM). Negative attitudes towards the deferral policy were common and could potentially increase the risk to the blood supply if compliance reduces. Further work is needed to inform a deferral policy that is accepted by GBM while maintaining the safety of NZ's blood supply.
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Affiliation(s)
| | - Peter Saxton
- School of Population HealthUniversity of AucklandAucklandNew Zealand
| | | | - Mohamed Hammoud
- Kirby InstituteUniversity of New South WalesSydneyNew South WalesAustralia
| | - Garrett Prestage
- Kirby InstituteUniversity of New South WalesSydneyNew South WalesAustralia
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4
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Cappy P, Chaillon A, Pillonel J, Essat A, Chaix ML, Meyer L, Barin F, Tiberghien P, Laperche S. HIV transmission network analysis allows identifying unreported risk factors in HIV-positive blood donors in France. Transfusion 2021; 61:1191-1201. [PMID: 33592129 DOI: 10.1111/trf.16290] [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: 07/02/2020] [Revised: 12/04/2020] [Accepted: 12/05/2020] [Indexed: 11/27/2022]
Abstract
OBJECTIVES As sex between men is a major route of human immunodeficiency virus (HIV) infection in most western countries, restrictive deferral rules for blood donation have largely been implemented regarding men having sex with men (MSM). Here, we sought here to assign unreported HIV risk factors in blood donors (BDs) and reevaluated the MSM-associated fraction of HIV transfusion residual risk (%RRMSM ). METHODS We applied a genetic distance-based approach to infer an HIV transmission network for 384 HIV sequences from French BDs and 1337 HIV sequences from individuals with known risk factors (ANRS PRIMO primary HIV infection cohort). We validated the possibility of assigning a risk factor according to clustering using assortative mixing. Finally, we recalculated the %RRMSM . RESULTS A total of 81 of 284 (28.5%) male and 5 of 100 (5%) female BDs belonged to a cluster; 72 (88.9%) of the 81 male BDs belonged to MSM clusters. After cluster correction, 8 of 67 (11.9%), 4 of 21 (19.0%), and 19 of 88 (21.6%) HIV-positive (HIV+) male BDs with heterosexual, other, or unknown risk factors could be reclassified as MSM, accounting for 10.9% of the total HIV+ male BDs. Overall, 139 of 284 HIV+ male donors (48.9%) could be considered MSM between 2000 and 2016 in France. Between 2005 and 2016, the %RRMSM increase varied from 0 to 19%, without differing significantly from the %RRMSM before reclassification. CONCLUSION Network inference can be used to complement declaration data on risk factors for HIV infection in BDs. This approach, complementary to behavioral studies, is a valuable tool to evaluate the effect of changes in deferral criteria on BD compliance.
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Affiliation(s)
- Pierre Cappy
- Département des Agents Transmissibles par le Sang, CNR Risques Infectieux Transfusionnels, Institut National de la Transfusion Sanguine (INTS), Paris, France
| | - Antoine Chaillon
- Division of Infectious Diseases, University of California San Diego, La Jolla, California, USA
| | - Josiane Pillonel
- Département des maladies infectieuses, Santé publique France, Saint-Maurice, France
| | - Asma Essat
- INSERM CESP U1018, Université Paris Sud, Université Paris Saclay, Le Kremlin-Bicêtre, France
| | - Marie-Laure Chaix
- Service de Virologie, CNR VIH, Hôpital Saint-Louis, APHP - INSERM U944, Université de Paris, Paris, France
| | - Laurence Meyer
- INSERM CESP U1018, Université Paris Sud, Université Paris Saclay, Le Kremlin-Bicêtre, France.,Service de Santé Publique, Hôpital Bicêtre, APHP, Le Kremlin Bicêtre, France
| | - Francis Barin
- Laboratoire de Virologie, Laboratoire associé au CNR VIH, CHRU de Tours - INSERM U1259, Université de Tours, Tours, France
| | - Pierre Tiberghien
- Etablissement Français du Sang, La Plaine St Denis, France.,UMR 1098 INSERM, Université de Franche-Comté, Etablissement Français du Sang, Besançon, France
| | - Syria Laperche
- Département des Agents Transmissibles par le Sang, CNR Risques Infectieux Transfusionnels, Institut National de la Transfusion Sanguine (INTS), Paris, France
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Park C, Gellman C, O'Brien M, Eidelberg A, Subudhi I, Gorodetsky EF, Asriel B, Furlow A, Mullen M, Nadkarni G, Somani S, Sigel K, Reich DL. Blood Donation and COVID-19: Reconsidering the 3-Month Deferral Policy for Gay, Bisexual, Transgender, and Other Men Who Have Sex With Men. Am J Public Health 2020; 111:247-252. [PMID: 33211588 DOI: 10.2105/ajph.2020.305974] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
In April 2020, in light of COVID-19-related blood shortages, the US Food and Drug Administration (FDA) reduced the deferral period for men who have sex with men (MSM) from its previous duration of 1 year to 3 months.Although originally born out of necessity, the decades-old restrictions on MSM donors have been mitigated by significant advancements in HIV screening, treatment, and public education. The severity of the ongoing COVID-19 pandemic-and the urgent need for safe blood products to respond to such crises-demands an immediate reconsideration of the 3-month deferral policy for MSM.We review historical HIV testing and transmission evidence, discuss the ethical ramifications of the current deferral period, and examine the issue of noncompliance with donor deferral rules. We also propose an eligibility screening format that involves an individual risk-based screening protocol and, unlike current FDA guidelines, does not effectively exclude donors on the basis of gender identity or sexual orientation. Our policy proposal would allow historically marginalized community members to participate with dignity in the blood donation process without compromising blood donation and transfusion safety outcomes.
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Affiliation(s)
- Christopher Park
- Christopher Park, Caroline Gellman, Madeline O'Brien, Benjamin Asriel, Andrew Furlow, Michael Mullen, Girish Nadkarni, Sulaiman Somani, Keith Sigel, and David L. Reich are with the Icahn School of Medicine at Mount Sinai, New York, NY. Andrew Eidelberg is with the Weill Cornell School of Medicine, New York, NY. Ipsita Subudhi and Elizabeth F. Gorodetsky are with the New York University Grossman School of Medicine, New York, NY
| | - Caroline Gellman
- Christopher Park, Caroline Gellman, Madeline O'Brien, Benjamin Asriel, Andrew Furlow, Michael Mullen, Girish Nadkarni, Sulaiman Somani, Keith Sigel, and David L. Reich are with the Icahn School of Medicine at Mount Sinai, New York, NY. Andrew Eidelberg is with the Weill Cornell School of Medicine, New York, NY. Ipsita Subudhi and Elizabeth F. Gorodetsky are with the New York University Grossman School of Medicine, New York, NY
| | - Madeline O'Brien
- Christopher Park, Caroline Gellman, Madeline O'Brien, Benjamin Asriel, Andrew Furlow, Michael Mullen, Girish Nadkarni, Sulaiman Somani, Keith Sigel, and David L. Reich are with the Icahn School of Medicine at Mount Sinai, New York, NY. Andrew Eidelberg is with the Weill Cornell School of Medicine, New York, NY. Ipsita Subudhi and Elizabeth F. Gorodetsky are with the New York University Grossman School of Medicine, New York, NY
| | - Andrew Eidelberg
- Christopher Park, Caroline Gellman, Madeline O'Brien, Benjamin Asriel, Andrew Furlow, Michael Mullen, Girish Nadkarni, Sulaiman Somani, Keith Sigel, and David L. Reich are with the Icahn School of Medicine at Mount Sinai, New York, NY. Andrew Eidelberg is with the Weill Cornell School of Medicine, New York, NY. Ipsita Subudhi and Elizabeth F. Gorodetsky are with the New York University Grossman School of Medicine, New York, NY
| | - Ipsita Subudhi
- Christopher Park, Caroline Gellman, Madeline O'Brien, Benjamin Asriel, Andrew Furlow, Michael Mullen, Girish Nadkarni, Sulaiman Somani, Keith Sigel, and David L. Reich are with the Icahn School of Medicine at Mount Sinai, New York, NY. Andrew Eidelberg is with the Weill Cornell School of Medicine, New York, NY. Ipsita Subudhi and Elizabeth F. Gorodetsky are with the New York University Grossman School of Medicine, New York, NY
| | - Elizabeth F Gorodetsky
- Christopher Park, Caroline Gellman, Madeline O'Brien, Benjamin Asriel, Andrew Furlow, Michael Mullen, Girish Nadkarni, Sulaiman Somani, Keith Sigel, and David L. Reich are with the Icahn School of Medicine at Mount Sinai, New York, NY. Andrew Eidelberg is with the Weill Cornell School of Medicine, New York, NY. Ipsita Subudhi and Elizabeth F. Gorodetsky are with the New York University Grossman School of Medicine, New York, NY
| | - Benjamin Asriel
- Christopher Park, Caroline Gellman, Madeline O'Brien, Benjamin Asriel, Andrew Furlow, Michael Mullen, Girish Nadkarni, Sulaiman Somani, Keith Sigel, and David L. Reich are with the Icahn School of Medicine at Mount Sinai, New York, NY. Andrew Eidelberg is with the Weill Cornell School of Medicine, New York, NY. Ipsita Subudhi and Elizabeth F. Gorodetsky are with the New York University Grossman School of Medicine, New York, NY
| | - Andrew Furlow
- Christopher Park, Caroline Gellman, Madeline O'Brien, Benjamin Asriel, Andrew Furlow, Michael Mullen, Girish Nadkarni, Sulaiman Somani, Keith Sigel, and David L. Reich are with the Icahn School of Medicine at Mount Sinai, New York, NY. Andrew Eidelberg is with the Weill Cornell School of Medicine, New York, NY. Ipsita Subudhi and Elizabeth F. Gorodetsky are with the New York University Grossman School of Medicine, New York, NY
| | - Michael Mullen
- Christopher Park, Caroline Gellman, Madeline O'Brien, Benjamin Asriel, Andrew Furlow, Michael Mullen, Girish Nadkarni, Sulaiman Somani, Keith Sigel, and David L. Reich are with the Icahn School of Medicine at Mount Sinai, New York, NY. Andrew Eidelberg is with the Weill Cornell School of Medicine, New York, NY. Ipsita Subudhi and Elizabeth F. Gorodetsky are with the New York University Grossman School of Medicine, New York, NY
| | - Girish Nadkarni
- Christopher Park, Caroline Gellman, Madeline O'Brien, Benjamin Asriel, Andrew Furlow, Michael Mullen, Girish Nadkarni, Sulaiman Somani, Keith Sigel, and David L. Reich are with the Icahn School of Medicine at Mount Sinai, New York, NY. Andrew Eidelberg is with the Weill Cornell School of Medicine, New York, NY. Ipsita Subudhi and Elizabeth F. Gorodetsky are with the New York University Grossman School of Medicine, New York, NY
| | - Sulaiman Somani
- Christopher Park, Caroline Gellman, Madeline O'Brien, Benjamin Asriel, Andrew Furlow, Michael Mullen, Girish Nadkarni, Sulaiman Somani, Keith Sigel, and David L. Reich are with the Icahn School of Medicine at Mount Sinai, New York, NY. Andrew Eidelberg is with the Weill Cornell School of Medicine, New York, NY. Ipsita Subudhi and Elizabeth F. Gorodetsky are with the New York University Grossman School of Medicine, New York, NY
| | - Keith Sigel
- Christopher Park, Caroline Gellman, Madeline O'Brien, Benjamin Asriel, Andrew Furlow, Michael Mullen, Girish Nadkarni, Sulaiman Somani, Keith Sigel, and David L. Reich are with the Icahn School of Medicine at Mount Sinai, New York, NY. Andrew Eidelberg is with the Weill Cornell School of Medicine, New York, NY. Ipsita Subudhi and Elizabeth F. Gorodetsky are with the New York University Grossman School of Medicine, New York, NY
| | - David L Reich
- Christopher Park, Caroline Gellman, Madeline O'Brien, Benjamin Asriel, Andrew Furlow, Michael Mullen, Girish Nadkarni, Sulaiman Somani, Keith Sigel, and David L. Reich are with the Icahn School of Medicine at Mount Sinai, New York, NY. Andrew Eidelberg is with the Weill Cornell School of Medicine, New York, NY. Ipsita Subudhi and Elizabeth F. Gorodetsky are with the New York University Grossman School of Medicine, New York, NY
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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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7
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Vesnaver E, Goldman M, O'Brien S, MacPherson P, Butler-Foster T, Lapierre D, Otis J, Devine DV, Germain M, Rosser A, MacDonagh R, Randall T, Osbourne-Sorrell W, Clement-Thorne B, Al-Bakri TB, Rubini KA, Hill NE, Presseau J. Barriers and enablers to source plasma donation by gay, bisexual and other men who have sex with men under revised eligibility criteria: protocol for a multiple stakeholder feasibility study. Health Res Policy Syst 2020; 18:131. [PMID: 33138828 PMCID: PMC7605323 DOI: 10.1186/s12961-020-00643-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 10/06/2020] [Indexed: 01/19/2023] Open
Abstract
Background Blood donation policy in Canada for gay, bisexual and other men who have had sex with men (gbMSM) has changed progressively in the last decade from indefinite deferral to 3-month deferral from last male-to-male sex. Driven by safety data and overseen by the national regulator, more inclusive policies continue to redress the disparity in donation for gbMSM. At the same time, the need for source plasma to prepare fractionated blood products is growing worldwide. The collection and processing of source plasma ensures greater safety compared to whole blood donation with respect to transfusion-transmitted infection. This greater safety offers an opportunity to evolve policies for gbMSM from time-based to behaviour-based deferral using revised eligibility criteria. However, changing policies does not in itself necessarily guarantee that gbMSM will donate or that staff in donor clinics are ready to support them to do so. In anticipation of a move to behaviour-based donation screening for gbMSM in Canada, we aim to assess the acceptability of and perceived barriers and enablers to source plasma donation using revised screening criteria for gbMSM among key stakeholders to inform policy implementation strategies. Methods This mixed-methods feasibility study will involve gbMSM and donor centre staff to understand modifiable barriers to implementing more inclusive eligibility criteria. Key informant interviews and surveys will be rooted in the Theoretical Domains Framework to identify modifiable factors associated with source plasma donation motives in gbMSM and training needs in donation centre staff. We will use an integrated knowledge translation approach involving a partnership between researchers, the national blood operator and gbMSM, situating knowledge users as key research team members to ensure their perspectives inform all aspects of the research. Discussion Our integrated knowledge translation approach will provide a more comprehensive and collaborative understanding of blood operator and gbMSM needs while accelerating the implementation of study findings. Given the historical backdrop of the decades of exclusion of sexually active gbMSM from blood donation, this study has the potential not only to inform a process and policy for gbMSM to donate source plasma, a blood product, but also offers opportunities for new relationships between these knowledge users.
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Affiliation(s)
- Elisabeth Vesnaver
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada. .,Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada.
| | - Mindy Goldman
- Medical Affairs and Innovation, Canadian Blood Services, Ottawa, Canada
| | - Sheila O'Brien
- Medical Affairs and Innovation, Canadian Blood Services, Ottawa, Canada
| | - Paul MacPherson
- Medicine, The Ottawa Hospital, Ottawa, Canada.,Department of Biochemistry, Microbiology and Immunology, University of Ottawa, Ottawa, Canada
| | | | - Don Lapierre
- Medical Affairs and Innovation, Canadian Blood Services, Ottawa, Canada
| | - Joanne Otis
- Department of Sexology, Université du Québec À Montréal, Montreal, Canada
| | - Dana V Devine
- Canadian Blood Services, Vancouver, Canada.,Centre for Blood Research, University of British Columbia, Vancouver, Canada
| | - Marc Germain
- Héma-Québec, Medical Affairs, Quebec City, Canada
| | | | | | | | | | | | | | | | | | - Justin Presseau
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada.,Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
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8
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Quiner C, Bruhn R, Grebe E, Di Germanio C, Kessler D, Reik R, Williamson P, Hampton D, Fayed R, Anderson SA, Williams AE, Glynn SA, Busch MP, Stramer SL, Custer B. Recently acquired infection among HIV-seropositive donors in the US from 2010-2018. Transfusion 2020; 60:2340-2347. [PMID: 32860262 DOI: 10.1111/trf.16032] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 08/03/2020] [Accepted: 08/03/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Monitoring of transfusion-transmissible infections in the blood supply is essential for blood safety, as the donor population is not static, and changes in policy, donor behavior, or other factors could increase the risk of recipient infection. We assessed patterns of recently acquired HIV infection in US blood donors, including before and after the implementation of the 12-month deferral for men who have sex with men (MSM). STUDY DESIGN AND METHODS A large convenience sample of donations from donors testing HIV-1 nucleic acid testing (NAT) and serology-reactive were further tested with the Sedia HIV-1 Limiting Antigen enzyme immunoassay. Samples were analyzed across available demographic and donation data to provide an assessment of recently acquired HIV infection in US blood donors from 2010 to 2018. RESULTS Overall, 317 of 1154 (27.5%; 95% confidence interval, 24.9%-30.1%) donations from HIV NAT and serology-reactive donors had recently acquired HIV infection. There was no evidence of change in the percentages of recent HIV infection by year over the study period, either in all donors or in male donors, including after the MSM policy change. In multivariable logistic regression analysis, donors aged 24 years or younger were over 2.7 times more likely and repeat donors 2.2 times more likely to have recently acquired HIV infection compared to donors aged 55 years or older and first-time donors, respectively. CONCLUSION Patterns of recently acquired HIV infection varied by demographics but not over time. These findings suggest no impact of the MSM policy change on recently acquired HIV infection in US blood donors.
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Affiliation(s)
- Claire Quiner
- Vitalant Research Institute, San Francisco, California, USA
| | - Roberta Bruhn
- Vitalant Research Institute, San Francisco, California, USA.,Department of Laboratory Medicine, University of California San Francisco, San Francisco, California, USA
| | - Eduard Grebe
- Vitalant Research Institute, San Francisco, California, USA
| | | | | | - Rita Reik
- OneBlood, St. Petersburg, Florida, USA
| | | | - Dylan Hampton
- Vitalant Research Institute, San Francisco, California, USA
| | - Rahima Fayed
- American Red Cross Scientific Affairs, Gaithersburg, Maryland, USA
| | | | - Alan E Williams
- U.S. Food and Drug Administration, Silver Spring, Maryland, USA
| | - Simone A Glynn
- National Heart, Lung and Blood Institute, National Institutes of Health, Rockville, Maryland, USA
| | - Michael P Busch
- Vitalant Research Institute, San Francisco, California, USA.,Department of Laboratory Medicine, University of California San Francisco, San Francisco, California, USA
| | - Susan L Stramer
- American Red Cross Scientific Affairs, Gaithersburg, Maryland, USA
| | - Brian Custer
- Vitalant Research Institute, San Francisco, California, USA.,Department of Laboratory Medicine, University of California San Francisco, San Francisco, California, USA
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Sauvage C, Charpentier F, Garrabé É, Pelat C, Spinardi R, Danic B, Lot F, Morel P, Laperche S, Pillonel J. Noncompliance to blood donor selection criteria by men who have sex with men - Complidon 2017, France. Vox Sang 2020; 115:628-636. [PMID: 32687631 DOI: 10.1111/vox.12975] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Revised: 06/11/2020] [Accepted: 06/11/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND OBJECTIVES In France, blood donation deferral for men who have sex with men (MSM) was reduced from permanent to 12 months in July 2016. Assessing noncompliance (rate and reasons) with this criterion is important to maintain a high level of viral safety in blood products. MATERIALS AND METHODS An anonymous online survey (Complidon) of a sample of blood donors was conducted in 2017. Data were post-stratified to be representative of all those who donated blood between July 2016 and December 2017. A multivariable analysis was performed to assess factors associated with noncompliance. RESULTS Among male donors, 0·73% [95% CI: 0·63-0·83] reported having sex with men in the 12 months preceding their donation. Factors associated with noncompliance were as follows: young age, a low educational level, concerns about privacy, and better knowledge of donor selection criteria and the window period than compliant men. More than half of noncompliant MSM donors (57·6% [95% CI: 50·6-64·3]) felt that sexual orientation should not be a criterion for donation, 47·2% [95% CI: 40·4-54·0] did not disclose their male-to-male sexual relations in order to avoid being excluded from donating, 40·5% [95% CI: 34·0-47·4] reported using condoms and 21·8% [95% CI: 16·7-27·9] had the same male partner for at least 12 months. CONCLUSION Complidon showed that compliance with blood donation criteria in MSM was high, but not optimal, especially among younger men. HIV residual risk did not increase after the implementation of 12-month deferral. Data from Complidon helped French policymakers to assess the additional HIV risk posed by increased access to blood donation for MSM.
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Affiliation(s)
| | | | - Éliane Garrabé
- Centre de Transfusion Sanguine des Armées, Clamart, France
| | | | - Roxane Spinardi
- Etablissement Français du Sang, La Plaine Saint-Denis, France
| | - Bruno Danic
- Etablissement Français du Sang, La Plaine Saint-Denis, France
| | | | - Pascal Morel
- Etablissement Français du Sang, La Plaine Saint-Denis, France
| | - Syria Laperche
- Centre national de référence Risque infectieux transfusionnel, Institut National de la Transfusion Sanguine, Paris, France
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10
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Sauvage C, Spinardi R, Pelat C, Pouget T, Danic B, Woimant G, Lot F, Gross S, Laperche S, Pillonel J. Noncompliance with blood donor selection criteria ‐ Complidon 2017, France. Transfusion 2019; 60:73-83. [DOI: 10.1111/trf.15623] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Revised: 10/22/2019] [Accepted: 10/22/2019] [Indexed: 11/29/2022]
Affiliation(s)
| | | | | | - Thomas Pouget
- Centre de Transfusion Sanguine des Armées Clamart France
| | - Bruno Danic
- Etablissement français du sang La Plaine Saint‐Denis France
| | | | | | - Sylvie Gross
- Etablissement français du sang La Plaine Saint‐Denis France
| | - Syria Laperche
- Centre National de Référence Risque Infectieux Transfusionnel, Institut National de la Transfusion Sanguine Paris France
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11
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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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12
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Pandey S, Shan H. Do high-risk behavior deferrals work? How to make it better? Transfusion 2019; 59:2180-2183. [PMID: 31268590 DOI: 10.1111/trf.15409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Accepted: 06/04/2019] [Indexed: 11/29/2022]
Affiliation(s)
- Suchitra Pandey
- Department of Pathology, Stanford University, Palo Alto, California.,Stanford Blood Center and Transfusion Service, Stanford Health Care, Palo Alto, California
| | - Hua Shan
- Department of Pathology, Stanford University, Palo Alto, California.,Stanford Blood Center and Transfusion Service, Stanford Health Care, Palo Alto, California
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13
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Gosbell IB, Hoad VC, Styles CE, Lee J, Seed CR. Undetectable does not equal untransmittable for
HIV
and blood transfusion. Vox Sang 2019; 114:628-630. [DOI: 10.1111/vox.12790] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Iain B. Gosbell
- Clinical Services and Research Australian Red Cross Blood Service Sydney NSW Australia
- School of Medicine Western Sydney University Penrith NSW Australia
| | - Veronica C. Hoad
- Clinical Services and Research Australian Red Cross Blood Service Perth WA Australia
| | - Claire E. Styles
- Clinical Services and Research Australian Red Cross Blood Service Perth WA Australia
| | - June Lee
- Clinical Services and Research Australian Red Cross Blood Service Perth WA Australia
| | - Clive R. Seed
- Clinical Services and Research Australian Red Cross Blood Service Perth WA Australia
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Jean Baptiste AE, Chevalier MS, Polo E, Noel E, Hulland EN, Archer WR. Trends in hepatitis B and hepatitis C seroprevalence among blood donors - Haiti, 2005-2014. ACTA ACUST UNITED AC 2018; 13:150-157. [PMID: 30613210 DOI: 10.1111/voxs.12427] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Background and Objectives Data on the seroprevalence of viral hepatitis are limited in Haiti; consequently, the epidemiology is poorly described. This study aims to provide a descriptive analysis of hepatitis B virus (HBV) and hepatitis C virus (HCV) seroprevalence of blood donations in Haiti. Materials and Methods Using Haiti's National Blood Safety Program and Haitian Red Cross reports from 2005 to 2014, we analysed the results of screening tests of donor serum samples to assess HBV and HCV seroprevalence among adults aged 17 to 65 years. Results A total of 198 758 donor samples were screened from 2005 to 2014, of which 0·56% were positive for antibody to hepatitis C virus (anti-HCV) and 3·80% were positive for hepatitis B surface antigen. Over the 10-year study period, anti-HCV seroprevalence among blood donors increased by 31% from 0.66% to 0.86% (95% CI: 1·01-1·70); however, this trend was not uniform over time, with a significant decrease from 0·66% in 2005 to 0·39% in 2009 (95% CI: 0·43- 0·82) and 0·43% in 2012 (95% CI: 0·50-0·90). Conversely, HBV decreased significantly by 13% from 3·95% in 2005 to 3·42% in 2014 (95% CI: 0·77-0·97), a trend that was also observed in 2012 and 2013. Conclusion The significant, uniform decrease in HBV seroprevalence in more recent years may represent the positive impact of public health interventions in preventing the transmission of blood-borne infections. More research is needed to understand why the trends in HCV transmission are non-uniform and to investigate the significant increase in more recent years.
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Affiliation(s)
- A E Jean Baptiste
- Division of Global HIV/AIDS and TB (DGHT), Center for Global Health (CGH), Centers for Disease Control and Prevention (CDC), Port-au-Prince, Haϊti
| | | | - E Polo
- National Blood Safety Program, Ministry of Public Health and Population, Port-au-Prince, Haϊti
| | - E Noel
- National Blood Safety Program, Ministry of Public Health and Population, Port-au-Prince, Haϊti
| | - E N Hulland
- Division of Global Health Protection, CGH, CDC, Atlanta, GA, USA
| | - W R Archer
- Global Immunization Division, CGH, CDC, Atlanta, GA, USA
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Importance of information provision in the acceptance of blood donation criteria by the general public in Belgium. BLOOD TRANSFUSION = TRASFUSIONE DEL SANGUE 2018; 16:475-482. [PMID: 29328906 DOI: 10.2450/2017.0151-17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Accepted: 10/05/2017] [Indexed: 11/21/2022]
Abstract
BACKGROUND Blood transfusions save lives, but carry the risk of causing transfusion-transmitted diseases. This risk is limited by strict donor selection criteria, the most controversial being the exclusion of men who had sex with men (MSM). This cross-sectional study investigated knowledge and beliefs of the general public concerning donor exclusion criteria, with emphasis on MSM. MATERIALS AND METHODS A representative sample of the population of Flanders, Belgium was questioned using a web-based questionnaire. The effect of additional information on people's opinions was tested. RESULTS People were less aware of the exclusion of MSM than of other risk populations, e.g. prostitutes. Correspondingly, they were more willing to accept blood from MSM than from other risk populations. MSM were also considered appropriate donors. Interestingly, prior knowledge about the exclusion of MSM appeared to be the strongest predictor for not accepting blood from MSM or a more stringent attitude on MSM exclusion. Receiving information on reasons for exclusion shifted opinions towards more stringency. Nevertheless, most people think that exceptions for MSM should be made under certain circumstances. This study identified several demographic factors associated with opinions concerning the exclusion of MSM for blood donation and the potential to change opinions after receiving information, e.g. age or socio-economic status. DISCUSSION Blood collecting services can gain understanding from the general public about their exclusion policies by providing clear information. Communication efforts targeting specific audiences in function of their knowledge and likeliness to change their opinion, might improve the effectiveness of information campaigns.
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Preußel K, Offergeld R. Which Infectious Blood Donors Could Be Identified by the Donor History Questionnaire? - Comparison of Blood Donors Infected with HIV or HCV with Notified Cases from General Population in Germany. Transfus Med Hemother 2018; 45:108-114. [PMID: 29765294 DOI: 10.1159/000481829] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2017] [Accepted: 09/25/2017] [Indexed: 01/05/2023] Open
Abstract
Background Potential risks for transfusion-transmissible infections are identified by donor history questionnaires (DHQs), and donors with higher risks are deferred from donation. We assessed to which extent the currently used DHQs support the identification of infections among blood donors. Methods Between 2006 and 2013, we analyzed data from notified HIV and HCV cases in the general population and positive blood donors in Germany. Logistic regressions were used to identify relevant infection risks. We estimated the possible effect of improved capture of risk factors for donor selection by calculation of population attributable fractions (PAF). Results Risky sexual contacts - MSM as well as heterosexual contacts - were the most prominent infection risks among HIV-infected donors. Whereas MSM contacts were significantly less reported by donors than by cases from the general population, 58% of donors disclosed heterosexual risks compared to 26% of notified cases. The complete identification of heterosexual risk contacts might prevent acceptance of 53% of HIV-infected donors. HCV-infected donors were more likely to report heterosexual exposure, imprisonment, and piercing/tattoo than notified HCV cases. Improved recording of piercing/tattoo could prevent acceptance of 16% of HCV-infected donors. Conclusion Donor selection should be improved with special attention to the identification of (hetero)sexual risk factors, invasive procedures (piercing/tattoo and imprisonment) applying well-designed DHQs, effective donor education, and confidential environment in all steps of the selection process.
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Affiliation(s)
- Karina Preußel
- Department for Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany
| | - Ruth Offergeld
- Department for Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany
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