Blood donation amongst people who inject drugs in Australia: research supporting policy change

Risk of variant Creutzfeldt-Jakob disease transmission by blood transfusion in Australia

Background and Objectives

Most of the 233 worldwide cases of variant Creutzfeldt–Jakob disease (vCJD) have been reported in the United Kingdom and 3 have been associated with transfusion‐transmission. To mitigate the potential vCJD risk to blood safety, Australian Red Cross Lifeblood imposes restrictions on blood donation from people with prior residency in, or extended travel to, the United Kingdom during the risk period 1980–1996. We have modified a previously published methodology to estimate the transfusion‐transmission risk of vCJD associated with fresh component transfusion in Australia if the UK residence deferral was removed.

Materials and Methods

The prevalence of current pre‐symptomatic vCJD infection in the United Kingdom by age at infection and genotype was estimated based on risk of exposure to the bovine spongiform encephalopathy agent for the period 1980–1996. These results were used to estimate the age‐specific prevalence of undiagnosed, pre‐symptomatic vCJD in the Australian population in the current year due to prior UK residency or travel. The primary model outputs were the 2020 vCJD risks/unit of vCJD contamination, transfusion‐transmission (infections) and clinical cases.

Results

The overall (prior UK residency in and travel to United Kingdom, 1980–1996) mean risk of contamination per unit was 1 in 29,900,000. The risks of resulting vCJD transmission (infection) and clinical case were 1 in 389,000,000 and 1 in 1,450,000,000, respectively.

Conclusion

Our modelling suggests that removing the Lifeblood donation deferral for travel to, or UK residence, would result in virtually no increased risk of vCJD transfusion‐transmission and would be a safe and effective strategy for increasing the donor base.

What are blood donors telling us about injecting drug use?

BACKGROUND AND OBJECTIVES

Injecting drug use (IDU), a permanent deferral for blood donors, was included in a review of donor selection criteria completed in 2017. Here, we describe what is known about IDU in blood donors in the United Kingdom (UK).

MATERIALS AND METHODS

Data were obtained from routine surveillance of donation testing and confirmed positive donors and a 2013/2014 UK survey of behaviour and compliance in screen-negative donors.

RESULTS

Between 2009 and 2018, of 22 UK million donations screened, IDU was self-reported at the post-test discussion in 5% (86/1777) of donors with confirmed positive donations. Recent injecting within 12 months was reported in 8 HCV-positive donors, but only in 1/14 donors where it was clear HCV infection had been acquired in the previous 12 months. Of 65 439 survey responders, 25 reported IDU, which when weighted to the donor population gave 99·95% compliance. Most of the 111 donors reporting IDU felt it was not important to their donation, mainly because their injecting was in the past, while three HCV-positive recent injectors reported not sharing needles so presumably felt safe to donate.

CONCLUSION

Compliance with the permanent deferral appeared extremely high with low levels of injecting reported by donors, mainly in the past. This agreed with the low-incident HCV infection observed in UK donors. These data contributed to a recommendation to reduce the deferral to 1 year. Ways of improving compliance in those few donors at current increased risk of infection need to be investigated.

A Systematic Review of Interventions Used to Increase Blood Donor Compliance with Deferral Criteria

Background and Objectives

Pre-donation screening of potential blood donors is critical for ensuring the safety of the donor blood supply, and donor deferral as a result of risk factors is practised worldwide. This systematic review was conducted in the context of an expert review convened by the Australian Red Cross Lifeblood in 2013 to consider Lifeblood's injecting drug use (IDU)-related policies and aimed to identify studies assessing interventions to improve compliance with deferral criteria in blood donation settings.

Materials and Methods

MEDLINE/PubMed, OVID Medline, OVID Embase, LILACS, and the Cochrane Library (CENTRAL and DARE) databases were searched for studies conducted within blood donation settings that examined interventions to increase blood donor compliance with deferral criteria. Observational and experimental studies from all geographical areas were considered.

Results

Ten studies were identified that tested at least one intervention to improve blood donor compliance with deferral criteria, including computerized interviews or questionnaires, direct and indirect oral questioning, educational materials, and a combination of a tickbox questionnaire and a personal donor interview. High-quality evidence from a single study was provided for the effectiveness of a computerized interview in improving detection of HIV risk behaviour. Low-quality evidence for the effectiveness of computerized interviews was provided by 3 additional studies. Two studies reported a moderate effect of direct questioning in increasing donor deferral, but the quality of the evidence was low.

Conclusion

This review identified several interventions to improve donor compliance that have been tested in blood donation settings and provided evidence for the effectiveness of computerized interviews in improving detection of risk factors.