1
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Goldman M, Caffrey N, O'Brien SF. Screening for high-risk sexual behavior in Canada. Transfusion 2022; 62:2419-2422. [PMID: 36285751 DOI: 10.1111/trf.17164] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 10/12/2022] [Accepted: 10/12/2022] [Indexed: 12/13/2022]
Affiliation(s)
- Mindy Goldman
- Medical Affairs and Innovation, Canadian Blood Services, Ottawa, Ontario, Canada.,Department of Pathology and Laboratory Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Niamh Caffrey
- Medical Affairs and Innovation, Canadian Blood Services, Ottawa, Ontario, Canada
| | - Sheila F O'Brien
- Medical Affairs and Innovation, Canadian Blood Services, Ottawa, Ontario, Canada.,School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
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Pillonel J, Pelat C, Tiberghien P, Sauvage C, Danic B, Martinaud C, Barin F, Sainte-Marie I, Coignard B, Gross S, Laperche S, Lot F. The evolving blood donor deferral policy for men who have sex with men: impact on the risk of HIV transmission by transfusion in France. Transfusion 2020; 60:525-534. [PMID: 32027031 DOI: 10.1111/trf.15677] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Revised: 12/10/2019] [Accepted: 12/19/2019] [Indexed: 12/01/2022]
Abstract
BACKGROUND Blood donation deferral for men who have sex with men (MSM) in France was reduced from permanent to 12 months in July 2016. To inform a further reduction of the deferral period, an HIV risk assessment was conducted with two scenarios: S1, 4-month deferral; S2, 4-month deferral only in the case of more than one sexual partner (i.e., similar to other blood donors). METHODS Baseline HIV residual risk (RR) was calculated from July 2016 to December 2017, using the Incidence Rate-Window Period method. The impact of both scenarios on RR was assessed using data from surveys on MSM and blood donors, to estimate 1) the number of additional MSM expected to donate in each scenario and 2) HIV incidence among these donors. RESULTS Baseline HIV RR was estimated at 1 in 6,380,000 donations. For S1, an additional 733 MSM donors, and an additional 0.09 HIV-positive donations were estimated, yielding an unchanged RR of 1 in 6,300,000. For S2, these numbers were estimated at 3102 and 3.92, respectively, yielding an RR of 1 in 4,300,000. Sensitivity analyses showed that, under worst-case assumptions, the RR would equal 1 in 6,225,000 donations for S1 and 1 in 3,000,000 for S2. CONCLUSION For both scenarios, the HIV RR remains very low. For S1, the risk is identical to the baseline RR. For S2, it is 1.5 times higher, and sensitivity analysis shows that this estimate is less robust than for S1. The French Minister of Health announced that S1 will be implemented in April 2020.
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Affiliation(s)
- Josiane Pillonel
- Santé publique France, Direction des Maladies Infectieuses, Saint-Maurice, France
| | - Camille Pelat
- Santé publique France, Direction Appui, Traitements et Analyses de données, Saint-Maurice, France
| | | | - Claire Sauvage
- Santé publique France, Direction des Maladies Infectieuses, Saint-Maurice, France
| | - Bruno Danic
- Etablissement Français du Sang de Bretagne, Rennes, France
| | | | - Francis Barin
- CHU Bretonneau & Université François Rabelais, Centre National de Référence du VIH-Laboratoire associé, Inserm U1259, Tours, France
| | - Isabelle Sainte-Marie
- Agence Nationale de Sécurité du Médicament et des produits de santé, Saint-Denis, France
| | - Bruno Coignard
- Santé publique France, Direction des Maladies Infectieuses, Saint-Maurice, France
| | - Sylvie Gross
- Etablissement Français du Sang, La Plaine Saint-Denis, France
| | - Syria Laperche
- Centre National de Référence Risques Infectieux Transfusionnels, Institut National de Transfusion Sanguine (INTS), Paris, France
| | - Florence Lot
- Santé publique France, Direction des Maladies Infectieuses, Saint-Maurice, France
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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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4
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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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5
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Grace D, Gaspar M, Lessard D, Klassen B, Brennan DJ, Adam BD, Jollimore J, Lachowsky NJ, Hart TA. Gay and bisexual men's views on reforming blood donation policy in Canada: a qualitative study. BMC Public Health 2019; 19:772. [PMID: 31208391 PMCID: PMC6580549 DOI: 10.1186/s12889-019-7123-4] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Accepted: 06/07/2019] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Researchers and activists have long called for changes to blood donation policies to end what is frequently framed as unjustified bans or deferral periods for men who have sex with men (MSM). Since 2016, in Canada, a man had to be abstinent from all sexual contact (anal or oral sex) with other men for at least 12 months in order to be an eligible blood donor. As of June 3, 2019, this deferral period was reduced to 3 months. METHODS To better understand the acceptance of existing deferral policies and possible future policy, we conducted 47 in-depth interviews with a demographically diverse sample of gay, bisexual, queer, and other men who have sex with men (GBM) in Canada's three largest cities: Vancouver, (n = 17), Toronto (n = 15), and Montreal (n = 15). Interviews were coded in NVivo 11 following an inductive thematic analysis. We focus on men's preferred policy directions and their opinions about a policy change proposed by Canada's blood operators: a 3-month deferral for all sexual activity between men. We interviewed GBM approximately one-year before this new deferral policy was approved by Health Canada. RESULTS Most participants were opposed to any deferral period in relation to MSM-specific sexual activity. A fair and safe policy was one that was the "same for everyone" and included screening for several risk factors during the blood donation process with no categorical exclusion of all sexually active MSM. Participants believed that multiple "gender blind" and HIV testing-related strategies could be integrated into the blood donation process. These preferences for a move away from MSM-specific exclusions aligned with their opinions concerning the possible change to a 3-month MSM deferral, for which participants shared three overarching perspectives: (1) step in the right direction; (2) ambivalence and uncertainty; and (3) not an improvement. CONCLUSION A predominant assertion was that a change from a 12-month to a 3-month deferral period would not resolve the fundamental issues of fairness and equity affecting blood screening practices for GBM in Canada. Many participants believed that blood donation policy should be based on more up-to-date scientific evidence concerning risk factor assessment and HIV testing.
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Affiliation(s)
- Daniel Grace
- Dalla Lana School of Public Health, University of Toronto, 155 College Street, 5th Floor, Room 556, Toronto, ON, M5T 3M7, Canada.
| | - Mark Gaspar
- Dalla Lana School of Public Health, University of Toronto, 155 College Street, 5th Floor, Room 510, Toronto, ON, M5T 3M7, Canada
| | - David Lessard
- Centre for Health Outcomes Research, McGill University Health Centre, 5252 de Maisonneuve West, Montréal, QC, H4A 3S5, Canada
| | - Benjamin Klassen
- Department of History, Simon Fraser University, 8888 University Drive, Burnaby, BC, V5A 1S6, Canada
| | - David J Brennan
- Factor-Inwentash Faculty of Social Work, University of Toronto, 246 Bloor St W, Toronto, ON, M5S 1V4, Canada
| | - Barry D Adam
- Ontario HIV Treatment Network, 1300 Yonge Street #600, Toronto, ON, M4T 1X3, Canada
| | - Jody Jollimore
- Community-Based Research Centre, 1007-808 Nelson Street, Vancouver, BC, V6Z 2H2, Canada
| | - Nathan J Lachowsky
- School of Public Health & Social Policy, Faculty of Human & Social Development, University of Victoria, Michael Smith Foundation for Health Research Scholar, P.O. Box 1700, STN CSC, Victoria, BC, V8W 2Y2, Canada
| | - Trevor A Hart
- HIV Prevention Lab, Department of Psychology, Ryerson University, 350 Victoria St, Toronto, ON, M5B 2K3, Canada
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Liu S, Luo L, Xi G, Wan L, Zhong L, Chen X, Gong T, Li S, He Y, Li N. Seroprevalence and risk factors on Syphilis among blood donors in Chengdu, China,from 2005 to 2017. BMC Infect Dis 2019; 19:509. [PMID: 31182042 PMCID: PMC6558839 DOI: 10.1186/s12879-019-4128-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Accepted: 05/23/2019] [Indexed: 12/02/2022] Open
Abstract
Background High-risk population of blood donation increases the prevalence of transmit blood-borne diseases and harm the blood safety. Syphilis accounts for approximately 10% of commonly sexually transmitted diseases. The risk factors for blood donors infected with syphilis are also risk factors for other blood borne diseases. The objective of the study is to investigate the seroprevalence and risk factors on syphilis among blood donors, and analyze the donation status of high-risk population. Methods A retrospective study was conducted in Chengdu Blood Center during 2005 and 2017. Serological test results of volunteer blood donors were collected. Conditional logistic regression models were performed to investigate syphilis-related risk factors and population attributable risk (PAR) was performed to predict the tendencies of high-risk populations’ on risky behaviors. Results The serological epidemic for syphilis among blood donors in Chengdu showed an upward trend from 2005 to 2017.TP positive blood donors were more likely to have multiple sexual partners and commercial sex (50.6% vs.22.6, 11.1% vs.4.6%). Multiple condition logistic regression model denoted the following risk factors for increasing rates of syphilis infections: multiple sexual partners (OR = 7.1, 95% CI:1.72–6.58), razor reuse (OR = 1.7;, 95% CI:1.01–2.01); ear piercing (OR = 2.7, 95% CI:1.48–3.37); tattoo (OR = 3.3, 95% CI:1.17–6.78); condom occasionally (OR = 2.8, 95% CI:0.68–1.66). The PAR for each of the risk factors were 0.225, 0.144, 0.147, 0.018, 0.129, 0.018, respectively. Conclusion Health consultation and screening of high-risk groups before blood donation need to be further improved. Blood donor recruitment should emphasize on excluding the high-risk donors and recruiting more low-risk blood donors. In addition, this study also shows that sharing cosmetic surgical instrument has been proven to transmit blood-borne diseases. Therefore, the syphilis in blood circulation should not be ignored. Electronic supplementary material The online version of this article (10.1186/s12879-019-4128-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Shuangli Liu
- Department of Blood Collection, Chengdu Blood Center, Chengdu, China
| | | | - Guangxiang Xi
- Department of Blood Supply, Chengdu Blood Center, Chengdu, China
| | - Like Wan
- Department of Blood Preparation, Chengdu Blood Center, Chengdu, China
| | - Li Zhong
- Department of Donor Service, Chengdu Blood Center, Chengdu, China
| | - Xue Chen
- Blood Screening Laboratory, Chengdu Blood Center, Chengdu, China
| | - Tianxiang Gong
- Blood research laboratory, Chengdu Blood Center, Chengdu, China
| | - Shuping Li
- Blood research laboratory, Chengdu Blood Center, Chengdu, China
| | - Yi He
- Department of Quality Control, Chengdu Blood Center, Chengdu, China
| | - Na Li
- Blood research laboratory, Chengdu Blood Center, Chengdu, China.
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7
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Romeijn B, Merz EM, Kok G, de Kort W, van Dongen A. Eligibility and willingness to donate blood in men who have (had) sex with men. Transfusion 2017; 58:710-717. [DOI: 10.1111/trf.14469] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Revised: 11/13/2017] [Accepted: 11/17/2017] [Indexed: 01/11/2023]
Affiliation(s)
- Bas Romeijn
- Department of Donor Studies; Sanquin Research; Amsterdam the Netherlands
| | - Eva-Maria Merz
- Department of Donor Studies; Sanquin Research; Amsterdam the Netherlands
- Department of Sociology; Vrije Universiteit; Amsterdam the Netherlands
| | - Gerjo Kok
- Department of Applied Social Psychology; Maastricht University; Maastricht the Netherlands
| | - Wim de Kort
- Department of Donor Studies; Sanquin Research; Amsterdam the Netherlands
- Department of Social Medicine; Academic Medical Centre; Amsterdam the Netherlands
| | - Anne van Dongen
- School of Psychology; University of New South Wales; Sydney Australia
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8
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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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Abstract
PURPOSE OF REVIEW The review summarizes recent publications on the contentious issue of donor deferral criterion for men who have sex with men (MSM). RECENT FINDINGS Recent studies from the United States and China demonstrated that MSM is still a frequent risk factor for HIV-positive donors. Noncompliance is an important factor in the overall risk of HIV transmission but does not appear to be affected by the length of the deferral period. A major US study found a 2.6% noncompliance rate with the current indefinite deferral for MSM; similar or lower rates were found in other jurisdictions with shorter deferral periods. Several countries have had a defined deferral period of 1 year or 5 years in place long enough to determine that increases in HIV-positive cases predicted by modeling studies did not actually occur, suggesting that the assumptions made in these models are overly conservative. SUMMARY In summary, MSM eligibility policies are slowly changing around the world, with the US FDA now permitting a 1-year deferral. Transparency, involvement of stakeholders, and careful evaluation of risk and societal benefit should be part of future policy discussions on this issue.
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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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11
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Ginsberg GM, Shinar E, Kopel E, Chemtob D. Should Men who have sex with Men be allowed to donate blood in Israel? Isr J Health Policy Res 2016; 5:60. [PMID: 27999657 PMCID: PMC5154142 DOI: 10.1186/s13584-016-0123-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2016] [Accepted: 12/01/2016] [Indexed: 11/28/2022] Open
Abstract
Background The present permanent deferral policy in Israel for MSM was established in 1977 and was based on the previous (now outdated) USA Food and Drug Administration standards. This study analyses epidemiological data regarding blood donations among MSM, in order to estimate the risk for HIV transfusion transmitted infection (TTI) if the policy is changed to allow at-risk MSM to donate blood. Methods An Excel based spreadsheet model integrated demographic, epidemiological data from the HIV National Register, laboratory, blood donation and testing data in order to calculate TTI due to false-negatives in known HIV+ donors, windows period donations, asymptomatic carriers and laboratory misclassification errors. A sensitivity analysis of our estimated TTIs for deferral periods for MSM was performed based on a literature review regarding this overall policy issue worldwide. Results MSM in Israel have a considerably higher relative risk (RR) of both prevalence (115) and incidence (143) of being HIV+ than persons without a risk factor. Allowing MSM to donate blood, without any deferral period, will add an additional five HIV TTI cases over the next decade. Imposition of a 1 or 5 years deferral of abstinence will increase the number of HIV TTI cases only by 0.10 and 0.05 cases, respectively. Conclusion A 1 year deferral period for blood donations from MSM in Israel is recommended.
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Affiliation(s)
- Gary Michael Ginsberg
- Public Health Services, Ministry of Health, Yirmiahu Street 39, Jerusalem, 9446724 Israel
| | - Eilat Shinar
- Magen David Adom Blood Services, Ramat Gan, Israel
| | - Eran Kopel
- Epidemiology Division, Ministry of Health, Jerusalem, Israel
| | - Daniel Chemtob
- Department of Tuberculosis and AIDS, Ministry of Health, Jerusalem, Israel
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12
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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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Bakhschai B, Kiessig ST. Comments on the Judgement of the Court of Justice of the European Union of April 29, 2015: Is the Permanent Exclusion of MSM from Giving Blood Compatible with the Directive 2004/33/EC? What Are the Consequences for Blood Donations in Germany? Transfus Med Hemother 2016; 43:51-3. [DOI: 10.1159/000443676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2015] [Accepted: 12/23/2015] [Indexed: 11/19/2022] Open
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14
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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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15
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Hughes S, Sheon N, Siedle-Khan B, Custer B. Saving lives, maintaining safety, and science-based policy: qualitative interview findings from the Blood Donation Rules Opinion Study (Blood DROPS). Transfusion 2015; 55:2835-2841. [PMID: 26271755 DOI: 10.1111/trf.13268] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2015] [Revised: 07/14/2015] [Accepted: 07/15/2015] [Indexed: 11/29/2022]
Abstract
BACKGROUND Indefinite deferral from donation for any man who discloses having had sex with another man even once since 1977 (MSM77) is the US FDA's standing policy. This qualitative component of the Blood Donation Rules and Opinion Study was designed to provide insight into the perceptions and practices of current or previous donors with MSM history. STUDY DESIGN AND METHODS Forty human immunodeficiency virus (HIV)-negative MSM completed an online survey, indicating that they had donated blood and were willing to be interviewed. Semistructured, individual interviews with these key informants covered donation experience and motivations, perceptions of MSM77, policy change preferences, and possible impact of a change to a time-limited deferral. Transcripts were coded deductively and inductively, following a modified Grounded Theory approach. Analysis identified recurrent and divergent themes. RESULTS Ninety-five percent of participants endorsed modifying MSM77. Preferred deferral length ranged from none to 5 years; a common opinion was that a science-based deferral period would be less than 1 year. Other policy change recommendations included incorporating questions about specific HIV risk behaviors to the donor questionnaire for all potential donors. Interviewees recognized HIV infection rates are higher in MSM than the general US population, but participants considered themselves low-risk for HIV, donated blood "to save lives," and justified their recommendations as being more effective ways to identify donors at risk for HIV. CONCLUSION Results suggest that MSM donors are concerned with blood safety; they can be appealed to as such. Communications about a new deferral policy should include scientific explanations and acknowledge altruistic motivations of potential donors.
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Affiliation(s)
- Shana Hughes
- UCSF Center for AIDS Prevention Studies, San Francisco, CA
| | - Nicolas Sheon
- UCSF Center for AIDS Prevention Studies, San Francisco, CA
| | | | - Brian Custer
- Blood Systems Research Institute, San Francisco, CA.,Department of Laboratory Medicine, UCSF, San Francisco, CA
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16
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Custer B, Sheon N, Siedle-Khan B, Pollack L, Spencer B, Bialkowski W, D'Andrea P, Sullivan M, Glynn S, Williams A. Blood donor deferral for men who have sex with men: the Blood Donation Rules Opinion Study (Blood DROPS). Transfusion 2015. [PMID: 26202349 DOI: 10.1111/trf.13247] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND In the United States, any man who discloses having had sex with another man (MSM) even once since 1977 is currently deferred from donating blood. A study was conducted to assess noncompliance with the policy at four geographically dispersed blood centers. STUDY DESIGN AND METHODS Male donors 18+ years of age with e-mail addresses were randomly selected and invited to complete a confidential online survey between August and October 2013. No additional recruitment e-mails were sent. Survey content included demographics, sexual history, donation history, compliance with the policy, and opinions about current and modified policies. RESULTS Response rate was 11.5% but varied by center (6.3% to 21.7%). Of 3183 completed surveys, 2.6% of respondents (95% confidence interval, 2.1%-3.2%) reported donation after male-male sex. Noncompliance was not statistically different among the centers (p = 0.1), but was related to age with 5.7, 4.6, 2.5, and 1.0% of donors 18 to 24, 25 to 34, 35 to 54, and 50+ years of age, respectively, reporting noncompliance (p < 0.001). Of all respondents, 6.8% reported at least six female and 0.3% reported at least six male sex partners in the past 5 years. Opinions about the current MSM policy were mixed with noncomplying donors more supportive of change than complying donors. Approximatey half of noncompliers indicated they would adhere to a 1-year deferral. CONCLUSION Noncompliance with the MSM policy is evident and may be increasing compared to earlier data. Any change from the current policy will require close monitoring to determine whether it affects residual risk of HIV in the US blood supply.
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Affiliation(s)
- Brian Custer
- Blood Systems Research Institute, San Francisco, California.,Department of Laboratory Medicine, UCSF, San Francisco, California
| | - Nicolas Sheon
- UCSF Center for AIDS Prevention Studies, San Francisco, California
| | - Bob Siedle-Khan
- UCSF Center for AIDS Prevention Studies, San Francisco, California
| | - Lance Pollack
- UCSF Center for AIDS Prevention Studies, San Francisco, California
| | - Bryan Spencer
- American Red Cross, New England Region, Dedham, Massachusetts
| | | | - Pam D'Andrea
- Institute for Transfusion Medicine, Pittsburgh, Pennsylvania
| | | | - Simone Glynn
- National Heart, Lung and Blood Institute (NHLBI), Bethesda, Maryland
| | - Alan Williams
- US Food and Drug Administration, Silver Spring, Maryland
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17
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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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18
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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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19
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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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