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Quee FA, Slot E, van Leeuwen I, Brands R, Franssen EJF, Hogema BM, Zaaijer HL, van de Laar TJW. Blood safety markers in Dutch donors after relaxation of deferral for men who have sex with men: re-emergence of syphilis and HIV pre-exposure prophylaxis use. Transfusion 2024. [PMID: 38963400 DOI: 10.1111/trf.17941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Revised: 05/31/2024] [Accepted: 06/18/2024] [Indexed: 07/05/2024]
Abstract
BACKGROUND Less discriminatory donor selection policies for men who have sex with men (MSM) may impact transfusion safety in terms of higher residual risks for known transfusion-transmitted infections (TTIs), increased vulnerability toward new TTIs that are also transmitted via sex, and HIV infections masked by pre-exposure prophylaxis (PrEP). STUDY DESIGN AND METHODS TTI trends in Dutch donors were studied over a 13-year period (2011-2023), characterized by successive relaxations of MSM deferral criteria. Structured posttest counseling was performed to determine risk factors in TTI-positive donors. PrEP drug levels were measured in 9977 donations from male donors living in urban areas and in 67 donors with active or resolved syphilis. RESULTS HIV incidence (from 5.8 to 1.5 per 1,000,000 donor years (DY)) and HBV incidence (from 12.4 to 4.5 per 1,000,000 DY) in Dutch donors decreased with less stringent MSM deferral criteria, while syphilis prevalence (from 26.4 to 44.1 per 100,000 new donors) and syphilis incidence (from 18.3 to 46.3 per 1,000,000 DY) increased over time. The proportion of MSM-related syphilis rose from 2% to 32% in new donors and from 12% to 27% in repeat donors. PrEP was detected in 2 of 9977 (0.02%) donations from male donors living in urban areas, and in 1 of 39 (2.6%) male donors with syphilis. DISCUSSION To date, phasing out donor deferral for MSM had no significant impact on transfusion safety in the Netherlands. However, rising syphilis rates and (recent) PrEP use in the blood donor population, albeit rare, suggest an influx of donors with higher sexual risk profiles and requires intensified TTI surveillance in donors.
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Affiliation(s)
- Franke A Quee
- Department of Donor Medicine Research, Sanquin Research, Amsterdam, The Netherlands
- Department of Public and Occupational Health, Amsterdam UMC, Amsterdam, The Netherlands
- Amsterdam Public Health (APH) Research Institute, Amsterdam UMC, Amsterdam, The Netherlands
| | - Ed Slot
- Department of Medical Affairs, Sanquin Corporate Staff, Amsterdam, The Netherlands
| | - Ingeborg van Leeuwen
- Department of Clinical Pharmacy, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands
| | - Ralph Brands
- Department of Clinical Pharmacy, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands
| | - Eric J F Franssen
- Department of Clinical Pharmacy, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands
| | - Boris M Hogema
- Department of Donor Medicine Research, Sanquin Research, Amsterdam, The Netherlands
- Department of Virology, Sanquin Diagnostic Services, Amsterdam, The Netherlands
| | - Hans L Zaaijer
- Department of Donor Medicine Research, Sanquin Research, Amsterdam, The Netherlands
- Department of Virology, Sanquin Diagnostic Services, Amsterdam, The Netherlands
| | - Thijs J W van de Laar
- Department of Donor Medicine Research, Sanquin Research, Amsterdam, The Netherlands
- Department of Virology, Sanquin Diagnostic Services, Amsterdam, The Netherlands
- Department of Medical Microbiology, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands
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Custer B, Whitaker B, Pollack L, Buccheri R, Bruhn R, Crowder L, Stramer SL, Reik R, Pandey S, Stone M, Di Germanio C, Buchacz K, Eder A, Lu Y, Forshee R, Anderson S, Marks P. HIV risk behavior profiles among men who have sex with men interested in donating blood: Findings from the Assessing Donor Variability and New Concepts in Eligibility study. Transfusion 2023; 63:1872-1884. [PMID: 37642154 PMCID: PMC11284767 DOI: 10.1111/trf.17515] [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: 06/23/2023] [Revised: 07/27/2023] [Accepted: 07/27/2023] [Indexed: 08/31/2023]
Abstract
BACKGROUND Individual risk assessment allows donors to be evaluated based on their own behaviors. Study objectives were to assess human immunodeficiency virus (HIV) risk behaviors in men who have sex with men (MSM) and estimate the proportion of the study population who would not be deferred for higher risk HIV sexual behaviors. STUDY DESIGN AND METHODS Cross-sectional survey and biomarker assessment were conducted in eight U.S. cities. Participants were sexually active MSM interested in blood donation aged 18-39 years, assigned male sex at birth. Participants completed surveys during two study visits to define eligibility, and self-reported sexual and HIV prevention behaviors. Blood was drawn at study visit 1 and tested for HIV and the presence of tenofovir, one of the drugs in oral HIV pre-exposure prophylaxis (PrEP). Associations were assessed between HIV infection status or HIV PrEP use and behaviors, including sex partners, new partners, and anal sex. RESULTS A total of 1566 MSM completed the visit 1 questionnaire and blood draw and 1197 completed the visit 2 questionnaire. Among 1562 persons without HIV, 789 (50.4%) were not taking PrEP. Of those not taking PrEP, 66.2% reported one sexual partner or no anal sex and 69% reported no new sexual partners or no anal sex with a new partner in the past 3 months. CONCLUSION The study found that questions were able to identify sexually active, HIV-negative MSM who report lower risk sexual behaviors. About a quarter of enrolled study participants would be potentially eligible blood donors using individual risk assessment questions.
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Affiliation(s)
- Brian Custer
- Vitalant Research Institute, San Francisco, CA
- University of California San Francisco, San Francisco, CA
| | - Barbee Whitaker
- U.S. Food and Drug Administration, Center for Biologics Evaluation and Research, Silver Spring, MD
| | - Lance Pollack
- University of California San Francisco, San Francisco, CA
| | - Renata Buccheri
- Vitalant Research Institute, San Francisco, CA
- University of California San Francisco, San Francisco, CA
| | - Roberta Bruhn
- Vitalant Research Institute, San Francisco, CA
- University of California San Francisco, San Francisco, CA
| | - Lauren Crowder
- American Red Cross, Scientific Affairs, Rockville & Gaithersburg, MD
| | - Susan L. Stramer
- American Red Cross, Scientific Affairs, Rockville & Gaithersburg, MD
| | | | | | - Mars Stone
- Vitalant Research Institute, San Francisco, CA
- University of California San Francisco, San Francisco, CA
| | - Clara Di Germanio
- Vitalant Research Institute, San Francisco, CA
- University of California San Francisco, San Francisco, CA
| | - Kate Buchacz
- U.S. Centers for Disease Control and Prevention, HIV Research Branch, Division of HIV Prevention, Atlanta, GA
| | - Anne Eder
- U.S. Food and Drug Administration, Center for Biologics Evaluation and Research, Silver Spring, MD
| | - Yun Lu
- U.S. Food and Drug Administration, Center for Biologics Evaluation and Research, Silver Spring, MD
| | - Richard Forshee
- U.S. Food and Drug Administration, Center for Biologics Evaluation and Research, Silver Spring, MD
| | - Steven Anderson
- U.S. Food and Drug Administration, Center for Biologics Evaluation and Research, Silver Spring, MD
| | - Peter Marks
- U.S. Food and Drug Administration, Center for Biologics Evaluation and Research, Silver Spring, MD
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Maddox V, Vallely P, Brailsford SR, Harvala H. Virological safety of the UK blood supply in the era of individual risk assessments and HIV PrEP. Transfus Med 2023; 33:372-378. [PMID: 37668150 DOI: 10.1111/tme.12993] [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: 03/10/2023] [Revised: 08/17/2023] [Accepted: 08/18/2023] [Indexed: 09/06/2023]
Abstract
A more individualised donor selection policy was implemented in the UK in 2021, which replaced the previous 3-month deferral for men who have sex with men (MSM). Other blood services have a variety of policies in place to ensure the virological safety of blood components, ranging from an indefinite ban on MSM, to a defined period of exclusion, or to an individualised risk assessment that is not based on gender or sexual orientation. Justification of these policies should be based on scientific evidence including assessment of lengths of virological window periods, infectious disease epidemiology within donor populations and donation screening assay sensitivities. Developments in molecular technology and assays which can detect both antibodies and antigens in the very early stages of infection have significantly reduced the risk in most developed countries. However, the increasing usage of pre-exposure prophylaxis (PrEP) to prevent acquisition of HIV infection after possible high-risk sexual contact within the UK blood donor population has been recently noted. It has brought with it new diagnostic challenges within blood screening, notably possible non-detection of HIV RNA and serological markers following PrEP use despite potential infectivity. The use of other testing strategies such as detection of HIV DNA and screening for non-declared PrEP usage should be investigated further.
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Affiliation(s)
| | - Pamela Vallely
- Division of Evolution, Infection and Genomics Science, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | | | - Heli Harvala
- Microbiology Services, NHS Blood and Transplant, London, UK
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Schroyens N, Borra V, Compernolle V, Vandekerckhove P, De Buck E. Men who have sex with men and risk for transfusion-transmissible infections in blood donors in Western countries: A systematic review update. Vox Sang 2023; 118:709-720. [PMID: 37322809 DOI: 10.1111/vox.13482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Revised: 03/21/2023] [Accepted: 05/26/2023] [Indexed: 06/17/2023]
Abstract
BACKGROUND AND OBJECTIVES This systematic review update summarizes evidence concerning transfusion-transmissible infections (TTIs) in male blood donors reporting sex with another man (MSM) or after easing the MSM deferral period. MATERIALS AND METHODS We searched five databases, including studies comparing MSM versus non-MSM donors (Type I), MSM deferral periods (Type II) or infected versus non-infected donors (Type III) in Western countries, and used GRADE to determine evidence certainty. RESULTS Twenty-five observational studies were included. Four Type I studies suggest that there may be an increased risk for overall TTIs, human immunodeficiency virus (HIV), hepatitis B virus (HBV) and syphilis in MSM donors, but the evidence is very uncertain. There was insufficient evidence of MSM with low-risk sexual behaviour. A Type II study indicates that easing the MSM deferral period to 1 year may have little to no effect on TTI risk. TTI prevalence in blood donors under 5-year, 1-year, 3-month or risk-based deferral in eight other Type II studies was too low to provide clear conclusions on the effect of easing the deferral. Three Type III studies reported that MSM may be a risk factor for HIV. Increased risk of HBV, hepatitis C virus and HTLV-I/II could not be shown. The evidence from Type III studies is very uncertain. CONCLUSION There may be an increased risk of HIV in MSM blood donors. Shortening the deferral from permanent to 1 year may have little to no effect on TTI risk. However, there is limited, unclear evidence from observational studies concerning the impact of introducing 3-month or risk-based deferrals.
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Affiliation(s)
- Natalie Schroyens
- Centre for Evidence-Based Practice, Belgian Red Cross, Mechelen, Belgium
- Department of Public Health and Primary Care, Leuven Institute for Healthcare Policy, KU Leuven, Leuven, Belgium
| | - Vere Borra
- Centre for Evidence-Based Practice, Belgian Red Cross, Mechelen, Belgium
- Department of Public Health and Primary Care, Leuven Institute for Healthcare Policy, KU Leuven, Leuven, Belgium
| | - Veerle Compernolle
- Belgian Red Cross, Blood Services, Mechelen, Belgium
- Faculty of Medicine and Health Sciences, University of Ghent, Ghent, Belgium
| | - Philippe Vandekerckhove
- Department of Public Health and Primary Care, Leuven Institute for Healthcare Policy, KU Leuven, Leuven, Belgium
- Belgian Red Cross, Mechelen, Belgium
- Division of Epidemiology and Biostatistics, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa
| | - Emmy De Buck
- Centre for Evidence-Based Practice, Belgian Red Cross, Mechelen, Belgium
- Department of Public Health and Primary Care, Leuven Institute for Healthcare Policy, KU Leuven, Leuven, Belgium
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Gahan L, Seed CR, Hammoud MA, Prestage G, Hoad VC, Kaldor JM. Perceived risk of HIV transmission by blood transfusion among gay, bisexual, and other men who have sex with men (gbMSM) in Australia. Transfusion 2023; 63:1528-1537. [PMID: 37300281 PMCID: PMC10953370 DOI: 10.1111/trf.17456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 05/18/2023] [Accepted: 05/18/2023] [Indexed: 06/12/2023]
Abstract
BACKGROUND In Australia, men who have sex with men (MSM) are deferred from blood donation for 3 months from last sexual contact. Internationally, deferral policies for MSM are evolving in the direction of expanded inclusivity in response to community expectations. To inform future policy options, we assessed perceptions of the risk of HIV transmission from blood transfusion among Australian MSM. STUDY DESIGN AND METHODS Flux is an online prospective cohort of Australian gay and bisexual men (cis or trans, regardless of their sexual history) and other men who have had sex with men (gbMSM). We included questions on blood donation rules, window period (WP) duration, infectivity of blood from people with HIV on treatment and attitudes to more detailed questioning of sexual practices in the regular survey of Flux participants and conducted a descriptive analysis of responses. RESULTS Of 716 Flux participants in 2019, 703 responded to the blood donation questions. The mean age was 43.7 years (SD 13.6 years). Overall, 74% were willing to confidentially respond to specific sexual behavior questions, such as the last time they had sex and the type of sex they had, in order to be considered eligible to donate blood. The majority (92%) of participants correctly assessed the duration of the WP as less than 1 month. When asked whether transfusion of blood from a donor with HIV and an undetectable viral load could transmit HIV, just under half (48%) correctly said yes. CONCLUSION Our study suggests Australian gbMSM are generally comfortable with answering more detailed questions regarding sexual activity during the assessment to donate, indicating they would do so honestly. gbMSM are knowledgeable about the WP duration, important for their ability to correctly self-assess their HIV risk. However, half of participants incorrectly assessed the transmissibility by blood transfusion from an HIV positive person with an undetectable viral load, suggesting the need for a targeted education campaign.
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Affiliation(s)
- Luke Gahan
- School of Humanities and Social Sciences, La Trobe UniversityMelbourneVictoriaAustralia
| | - Clive R. Seed
- Australian Red Cross LifebloodMelbourneVictoriaAustralia
| | - Mohamed A. Hammoud
- Kirby Institute, Faculty of Medicine, UNSW SydneySydneyNew South WalesAustralia
| | - Garrett Prestage
- Kirby Institute, Faculty of Medicine, UNSW SydneySydneyNew South WalesAustralia
| | | | - John M. Kaldor
- Kirby Institute, Faculty of Medicine, UNSW SydneySydneyNew South WalesAustralia
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Ferguson E, Bowen S, Lawrence C, Starmer C, Barr A, Davison K, Reynolds C, Brailsford SR. Communicating the move to individualized donor selection policy: Framing messages focused on recipients and safety. Transfusion 2023; 63:171-181. [PMID: 36349898 PMCID: PMC10099824 DOI: 10.1111/trf.17175] [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: 08/18/2022] [Revised: 10/18/2022] [Accepted: 10/18/2022] [Indexed: 11/10/2022]
Abstract
BACKGROUND Men-who-have-sex-with-men (MSM) have been deferred from donating blood. However, recent evidence supports the adoption of donor screening based on individuals' sexual behavior over population-based criteria. We explore how best to frame communications about adopting this change to minimize any potential negative consequences (e.g., reduced donor numbers). We examine the effectiveness of risk (emphasizing safety vs. emphasizing low risk), and focus (donor vs. recipient) frames on intentions to donate blood (approach) or feeling deterred from donating (avoid), and mechanisms linked to under-reporting sexual behavior. STUDY DESIGN AND METHODS We conducted a 2 (risk frame: risk vs. safety) by 3 (focus: donor vs. recipient vs. both) between-subjects online experiment (n = 2677). The main outcomes were intentions to donate and feelings of being put-off/deterred from donating (both for self and others). We also assessed the extent that forgetting, embarrassment/shame, and question irrelevance were perceived to be associated with under-reporting sexual behavior. RESULTS Frames that focused on safety or a recipient resulted in people reporting being less deterred from donating. Regardless of frame, people from ethnic minorities were more likely to feel deterred. Embarrassment/shame followed by forgetting and perceived irrelevance were the main reasons for under-reporting sexual behaviors, especially in ethnic minorities, and smartphones were perceived as an acceptable memory aid for sexual behavior. DISCUSSION Blood services moving to an individualized policy should frame donor selection in terms of safety and/or a recipient focus, explore sensitivities in ethnic minority communities, consider ways to normalize reporting sexual behavior, and use smartphones as a memory aid.
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Affiliation(s)
- Eamonn Ferguson
- School of Psychology, University of Nottingham, Nottingham, UK.,National Institute for Health and Care Research Blood and Transplant Research Unit in Donor Health and Behaviour, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Sarah Bowen
- School of Economics, University of Nottingham, Nottingham, UK.,Behavioural Practice, KPUK, Westminster, London, UK
| | | | - Chris Starmer
- School of Economics, University of Nottingham, Nottingham, UK
| | - Abigail Barr
- School of Economics, University of Nottingham, Nottingham, UK
| | - Katy Davison
- NHS Blood and Transplant/UK Health Security Agency Epidemiology Unit, UK Health Security Agency London, London, UK
| | - Claire Reynolds
- NHS Blood and Transplant/UK Health Security Agency Epidemiology Unit, NHS Blood and Transplant, London, UK
| | - Susan R Brailsford
- NHS Blood and Transplant/UK Health Security Agency Epidemiology Unit, NHS Blood and Transplant, London, UK
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7
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Perceptions and practices of the Brazilian LGBT+ population toward blood donation. Transfus Apher Sci 2022; 62:103578. [PMID: 36114122 DOI: 10.1016/j.transci.2022.103578] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 08/23/2022] [Accepted: 09/09/2022] [Indexed: 11/22/2022]
Abstract
In May 2020, after years of demands by activists and in light of COVID-19-related blood shortages, the Brazilian Federal Supreme Court abolished the rules that demanded a 12-month celibacy period for men who have sex with men (MSM) to donate blood. The objective of this open web survey was to assess the perceptions and practices regarding blood donation and blood donation rules among members of the Brazilian LGBT+ community. The data collection was conducted between October 2019 and March 2020, before the changes in the rules for blood donation and before the onset of the COVID-19 pandemic in Brazil. A total of 1639 adult individuals, self-declared as LGBT+ , participated (54.3 % MSM, 2.2 non-MSM, 43.5 % women). As expected, most of the study participants did not agree with the 12-month deferral period for MSM donate blood. Blood donation was already practiced by MSM, even before the abolition of the restrictions on donation. Among MSM and women, 38.7 % and 41.0 % have already donated blood, respectively. A significant number of participants reported lying in screening interviews at blood banks in order to be able to donate, and many said they knew people who were MSM and disobeyed the rules for donation, even though they knew them. Therefore, the practice of blood donation was already present among these people, even before the restriction policy change, confirming the need for revised rules for blood donation.
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8
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Preuβel K, Albrecht S, Offergeld R. Undisclosed Sexual Risk Exposures: Results of a Nationwide Compliance Study among Whole Blood Donors in Germany. Transfus Med Hemother 2022; 49:368-378. [PMID: 36654976 PMCID: PMC9764329 DOI: 10.1159/000525007] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Accepted: 05/06/2022] [Indexed: 01/21/2023] Open
Abstract
Background Undisclosed sexual infection risks are the main reasons for transfusion transmissible infections in German blood donors that have qualified for donation by donor health interviews and questionnaires. Until now, data about compliance with deferral criteria were only available from post-donation interviews with infected donors, and information about the proportion of donors which did not disclose (sexual) risks at the donor health questionnaire was not available. Methods A prospective nationwide anonymous online survey was conducted to investigate compliance of whole blood donors with deferral criteria for sexual infection risks. Twenty-one blood establishments which represent 80% of the regular whole blood-donor population invited all donors which donated blood during an 8-week period between January and March 2020. Results 14,882 participants completed the questionnaire. A relevant proportion of non-compliance was shown (3.0%, 95% CI: 2.7-3.3%) - with male donors being non-compliant significantly more frequently than females (3.5% vs. 2.2%, p < 0.001). A quarter of the non-compliant men were MSM (0.9%, 95% CI: 0.7-1.1%). Non-compliance was strongly associated with the perception that questions about sexual risk exposures are too private. This is in line with the finding that a large proportion of donors (21%) refused to answer at least one question about sexual infection risks. Conclusion The presented data, collected for the first time, is suitable for assessing the impact of changes in the donor selection process. Donor's limited willingness to provide detailed information about sexual risk behaviour has to be kept in mind when further strategies for fair appraisal of individual sexual infection risks will be discussed.
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Affiliation(s)
- Karina Preuβel
- Department of Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany,*Karina Preuβel,
| | - Stefan Albrecht
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
| | - Ruth Offergeld
- Department of Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany
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9
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Lewin A, Grégoire Y, Delage G, Thibeault C, Viau C, Milot C, Parent É, Renaud C. Reported non-compliance with pre-donation screening among blood donors in Québec, Canada: A focus on the 3-month deferral for men who have sex with men. Vox Sang 2022; 117:966-970. [PMID: 35377497 DOI: 10.1111/vox.13277] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 03/08/2022] [Accepted: 03/12/2022] [Indexed: 01/31/2023]
Abstract
BACKGROUND AND OBJECTIVES In Québec (Canada), the donation deferral for men who have sex with men (MSM) has recently been shortened to 3 months. Whether this change impacted compliance with pre-donation screening is unknown. We assessed compliance with the disclosure of male-to-male sex and other behavioural risk factors for HIV amid this change. MATERIALS AND METHODS Québec residents who donated from 14 July 2020 to 30 November 2020 were invited to participate in an online survey. Donors were informed that the survey was optional and anonymous. Survey questions were those used for routine pre-donation screening. Rates of reported non-compliance were weighted based on several characteristics. RESULTS Of 21,918 contacted donors, 7113 (32.45%) participated. Among male participants (N = 3347), six (0.27% [95% confidence interval (CI) = 0.09%-0.44%]) were not compliant with a 3-month MSM deferral. Among female participants (N = 3766), two (0.06% [95% CI = 0.00%-0.13%]) were not compliant with a 3-month deferral for sex with a man who had male-to-male sex ≤12 months. Other risk factors exhibited similar or lower rates of reported non-compliance. CONCLUSION Reported non-compliance with a 3-month MSM deferral and the disclosure of other HIV behavioural risk factors was low. These results warrant the investigation of behavioural donor risk assessment approaches to further improve the inclusiveness of blood donation.
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Affiliation(s)
- Antoine Lewin
- Héma-Québec, Medical Affairs and Innovation, Montréal, Québec, Canada.,Faculté de médecine et des sciences de la santé, Université de Sherbrooke, Sherbrooke, Québec, Canada
| | - Yves Grégoire
- Héma-Québec, Medical Affairs and Innovation, Québec, Québec, Canada
| | - Gilles Delage
- Héma-Québec, Medical Affairs and Innovation, Montréal, Québec, Canada
| | | | | | | | - Éric Parent
- Héma-Québec, Regulatory Affairs, Montréal, Québec, Canada
| | - Christian Renaud
- Héma-Québec, Medical Affairs and Innovation, Montréal, Québec, Canada
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10
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Caffrey N, Goldman M, Osmond L, Yi QL, Fan W, O'Brien SF. HIV incidence and compliance with deferral criteria over three progressively shorter time deferrals for men who have sex with men in Canada. Transfusion 2021; 62:125-134. [PMID: 34854092 DOI: 10.1111/trf.16753] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 11/10/2021] [Accepted: 11/12/2021] [Indexed: 12/30/2022]
Abstract
BACKGROUND In Canada, the deferral for men who have sex with men (MSM) has been progressively reduced from a permanent deferral for MSM since 1977, to 5 years, 1 year, and, most recently, 3 months. We estimated human immunodeficiency virus (HIV) residual risk and compliance with the MSM time deferral after each change. METHODS Four anonymous online compliance surveys were carried out before and after each change. HIV incidence and prevalence were monitored from 2010 to 2021. Residual risk was estimated using the incidence-window period model. RESULTS Human immunodeficiency virus prevalence, incidence, and residual risk did not change with incrementally shorter MSM deferrals. The residual risk per million donations post 3-month deferral was 0.05 (0.001-0.371). Men with temporally remote MSM history became eligible and, therefore, compliant as the deferral periods decreased (Cochran-Armitage p value = <.0001). However, the percentage of men with MSM history in the last 3 months with the indefinite deferral in place was similar to the percentage noncompliant, while the 3-month deferral was in place. MSM donors did not report high-risk behaviors for which they would otherwise be deferred in any survey. Following the change, an estimated 4467 MSM per year were eligible to donate, an increase from 2501 estimated eligible MSM donors following the change to the 1-year deferral. CONCLUSION With progressively shorter MSM deferral periods, HIV residual risk was unchanged. The proportion of male donors with deferrable MSM history remained low, while those with temporally remote MSM history became eligible, increasing the number of eligible MSM donors.
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Affiliation(s)
- Niamh Caffrey
- Donation Policy & Studies, Canadian Blood Services, 1800 Alta Vista Drive, Ottawa, Ontario, K1G 4J5, Canada
| | - Mindy Goldman
- Donation Policy & Studies, Canadian Blood Services, 1800 Alta Vista Drive, Ottawa, Ontario, K1G 4J5, Canada.,Department of Pathology and Laboratory Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Lori Osmond
- Donation Policy & Studies, Canadian Blood Services, 1800 Alta Vista Drive, Ottawa, Ontario, K1G 4J5, Canada
| | - Qi-Long Yi
- Donation Policy & Studies, Canadian Blood Services, 1800 Alta Vista Drive, Ottawa, Ontario, K1G 4J5, Canada
| | - Wenli Fan
- Donation Policy & Studies, Canadian Blood Services, 1800 Alta Vista Drive, Ottawa, Ontario, K1G 4J5, Canada
| | - Sheila F O'Brien
- Donation Policy & Studies, Canadian Blood Services, 1800 Alta Vista Drive, Ottawa, Ontario, K1G 4J5, Canada.,School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
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