1
|
Vesnaver E, Gibson E, Goldman M, Butler-Foster T, Hill NE, Lapierre D, MacDonagh R, Rubini KA, Miguel G, Rosser A, MacPherson P, Palumbo A, Randall T, Osbourne-Sorrell W, O'Brien SF, Otis J, Greaves M, Al-Bakri TB, Reid M, Labrecque M, Germain M, Orvis S, Clapperton AT, Devine D, Presseau J. Navigating imperfect policies to donate plasma: Survey on plasma donation and a pilot plasma donation program among men who have sex with men in Canada. Transfusion 2023. [PMID: 37218408 DOI: 10.1111/trf.17398] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 03/10/2023] [Accepted: 03/10/2023] [Indexed: 05/24/2023]
Abstract
BACKGROUND In 2021, Canada implemented a pilot plasma program allowing some sexually active men who have sex with men (including but not limited to gay and bisexual men; gbMSM) to donate plasma. Changes to plasma donation policy could help address inequities in access to plasma donation and increase Canada's domestically collected plasma supply if more gbMSM donate as a result. We aimed to (1) examine views regarding plasma donation and the pilot program prior to implementation and (2) identify modifiable theory-informed predictors of gbMSM's intention to donate plasma. METHODS We developed, piloted, and disseminated a questionnaire informed by the Theoretical Domains Framework (TDF). We recruited gbMSM in London (ON) and Calgary (AB) to an anonymous, online cross-sectional survey. RESULTS A total of 246 gbMSM completed the survey. On scales from 1 (strongly disagree) to 5 (strongly agree), general intention to donate was high (mean = 4.24; SD = 0.94). The pilot program itself was mostly acceptable (mean = 3.71, SD = 1.16), but the intention to donate under the unique requirements of the pilot program was lower than general intention (mean = 3.58; SD = 1.26). Two domains from the theoretical domains framework (TDF) (beliefs about consequences of donating plasma and social influences) were independently associated with general intention to donate. DISCUSSION The pilot plasma program as an incremental step toward more inclusive policies was mostly viewed as acceptable by the impacted communities. Historical and ongoing exclusions create unique barriers to donation. There are clear opportunities for developing theory-informed interventions to support gbMSM to donate plasma as policies continue to become more inclusive and more become eligible to donate.
Collapse
Affiliation(s)
- Elisabeth Vesnaver
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Emily Gibson
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Mindy Goldman
- Medical Affairs and Innovation, Canadian Blood Services, Ottawa, Ontario, Canada
- Department of Pathology and Laboratory Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Terrie Butler-Foster
- Medical Affairs and Innovation, Canadian Blood Services, Ottawa, Ontario, Canada
| | - Nolan E Hill
- Centre for Sexuality, Calgary, Alberta, Canada
- Local Advisory Group, Calgary, Alberta, Canada
| | - Don Lapierre
- Medical Affairs and Innovation, Canadian Blood Services, Ottawa, Ontario, Canada
| | | | | | | | | | - Paul MacPherson
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Department of Medicine, The Ottawa Hospital, Ottawa, Ontario, Canada
- Department of Biochemistry, Microbiology and Immunology, University of Ottawa, Ottawa, Ontario, Canada
| | - Amelia Palumbo
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | | | | | - Sheila F O'Brien
- Medical Affairs and Innovation, Canadian Blood Services, Ottawa, Ontario, Canada
| | - Joanne Otis
- Department of Sexology, Université du Québec À Montréal, Montreal, Quebec, Canada
| | | | | | - Marco Reid
- Local Advisory Group, Calgary, Alberta, Canada
| | | | - Marc Germain
- Héma-Québec, Medical Affairs, Quebec City, Quebec, Canada
| | - Shane Orvis
- Local Advisory Group, Calgary, Alberta, Canada
| | | | - Dana Devine
- Canadian Blood Services, Vancouver, British Columbia, Canada
- Centre for Blood Research, University of British Columbia, Vancouver, British Columbia, Canada
| | - Justin Presseau
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
- School of Psychology, University of Ottawa, Ottawa, Ontario, Canada
| |
Collapse
|
2
|
Vesnaver E, Butler-Foster T, Goldman M, Gibson E, Palumbo A, Lapierre D, Hill NE, MacDonagh R, Rubini KA, Bridel W, Miguel G, Rosser A, MacPherson P, Randall T, Osbourne-Sorrell W, O'Brien SF, Otis J, Greaves M, Al-Bakri TB, Germain M, Orvis S, Clapperton AT, Reid M, Labrecque M, Devine D, Presseau J. Improved access yet inequitable experience: gay, bisexual and other men who have sex with men's views of more inclusive criteria for source plasma donation. BMC Public Health 2023; 23:768. [PMID: 37098497 PMCID: PMC10131411 DOI: 10.1186/s12889-023-15424-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 03/11/2023] [Indexed: 04/27/2023] Open
Abstract
BACKGROUND Canada has incrementally reduced restrictions to blood and plasma donation that impact men who have sex with men, gay, bisexual, and queer men, and some Two Spirit, transgender and non-binary individuals (MSM/2SGBTQ+). Prior to the launch of a pilot program in 2021 enabling some MSM/2SGBTQ + to donate source plasma, we explored the acceptability of the program among individuals who could become eligible to donate in the program. METHODS We invited men identifying as MSM/2SGBTQ + to participate in two consecutive semi-structured interviews to explore their views on blood and plasma donation policy, plasma donation, and the proposed Canadian plasma donation program. Interview transcripts were analyzed thematically and acceptability-related themes were mapped onto the Theoretical Framework of Acceptability. RESULTS Twenty-seven men identifying as having sex with men participated in 53 interviews. Eighteen themes were mapped onto the seven construct domains of the Theoretical Framework of Acceptability. Underlying all aspects of acceptability was a tension between four primary values influencing participants' views: altruism, equity, supply sufficiency, and evidence-based policy. The program was viewed as welcome progress on a discriminatory policy, with many excited to participate, yet tension with inequitable aspects of the program undermined support for the program and interest to contribute to it. The high demands of the program are unique for MSM/2SGBTQ + and are only tolerable as part of a program that is an incremental and instrumental step to more equitable donation policies. CONCLUSION Findings highlight past experiences of exclusion in Canada as a unique and critical part of the context of the donation experience among MSM/2SGBTQ+. Despite the program's goals of greater inclusivity of MSM/2SGBTQ + individuals, the anticipated experience of the program included continued stigmatization and inequities. Future research should seek to understand the experienced views of MSM/2SGBTQ + donors to ensure that as policies change, policies are implemented equitably.
Collapse
Affiliation(s)
- Elisabeth Vesnaver
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, 501 Smyth Road, K1H 8M2, Ottawa, Canada.
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada.
| | | | - Mindy Goldman
- Medical Affairs and Innovation, Canadian Blood Services, Ottawa, Canada
- Department of Pathology and Laboratory Medicine, University of Ottawa, Ottawa, Canada
| | - Emily Gibson
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, 501 Smyth Road, K1H 8M2, Ottawa, Canada
| | - Amelia Palumbo
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, 501 Smyth Road, K1H 8M2, Ottawa, Canada
| | - Don Lapierre
- Medical Affairs and Innovation, Canadian Blood Services, Ottawa, Canada
| | - Nolan E Hill
- Centre for Sexuality, Calgary, Canada
- Local Advisory Group, Calgary, Canada
| | | | | | - William Bridel
- Local Advisory Group, Calgary, Canada
- Faculty of Kinesiology, University of Calgary, Calgary, Canada
| | | | | | - Paul MacPherson
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, 501 Smyth Road, K1H 8M2, Ottawa, Canada
- Department of Medicine, The Ottawa Hospital, Ottawa, Canada
- Department of Biochemistry, Microbiology and Immunology, University of Ottawa, Ottawa, Canada
| | | | | | - Sheila F O'Brien
- Medical Affairs and Innovation, Canadian Blood Services, Ottawa, Canada
| | - Joanne Otis
- Department of Sexology, Université du Québec À Montréal, Montreal, Canada
| | | | | | - Marc Germain
- Medical Affairs, Héma-Québec, Quebec City, Canada
| | | | | | | | | | - Dana Devine
- Canadian Blood Services, Vancouver, Canada
- Centre for Blood Research, University of British Columbia, Vancouver, Canada
| | - Justin Presseau
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, 501 Smyth Road, K1H 8M2, Ottawa, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada
- School of Psychology, University of Ottawa, Ottawa, Canada
| |
Collapse
|
3
|
Castillo G, Vesnaver E, Gibson E, Butler-Foster T, Goldman M, Hill NE, Rosser A, Lapierre D, Rubini KA, MacDonagh R, Miguel G, Palumbo A, MacPherson P, Randall T, Osbourne-Sorrell W, O'Brien SF, Bridel W, Otis J, Greaves M, Al-Bakri TB, Reid M, Labrecque M, Germain M, Orvis S, Clapperton AT, Devine D, Presseau J. Staff perspectives on barriers and enablers to implementing alternative source plasma eligibility criteria for gay, bisexual, and other men who have sex with men. Transfusion 2022; 62:1571-1582. [PMID: 35834537 PMCID: PMC9544875 DOI: 10.1111/trf.17000] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 05/12/2022] [Accepted: 05/12/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Canadian Blood Services introduced new eligibility criteria that allows some sexually active gay, bisexual, and other men who have sex with men (gbMSM) to donate source plasma, marking a significant change from time-based deferral criteria. We aimed to identify potential barriers and enablers to implementing the new criteria from the perspective of donor center staff. STUDY DESIGN AND METHODS We conducted Theoretical Domains Framework-informed interviews with staff from two source plasma donation centers in Canada. RESULTS We completed 28 interviews between June 2020 and April 2021. Three themes representing eight domains captured key tensions. Valuing inclusive eligibility criteria: staff support inclusive criteria; many were concerned the new criteria remained discriminatory. Investing in positive donor experiences: staff wished to foster positive donor experiences; however, they worried gbMSM donors would express anger and disappointment regarding the new criteria, staff would experience unease over using stigmatizing criteria and convey nonverbal cues of discomfort, and recurring plasma donors may behave inappropriately. Supporting education, training, and transparency of eligibility criteria: participants believed providing in-person training (i.e., to explain criteria rationale, address discomfort, practice responding to donor questions) and ensuring donors and the public were well-informed of the upcoming changes would improve implementation. DISCUSSION Participant views emphasize the importance of supporting staff through training and transparent communication to optimize the delivery of world-class equitable care for a new cohort of donors who have previously been excluded from plasma donation. Findings inform which staff supports to consider to improve implementation as policies continue to shift internationally.
Collapse
Affiliation(s)
- Gisell Castillo
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
| | - Elisabeth Vesnaver
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada.,School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada
| | - Emily Gibson
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
| | | | - Mindy Goldman
- Medical Affairs and Innovation, Canadian Blood Services, Ottawa, Canada.,Department of Pathology and Laboratory Medicine, University of Ottawa, Ottawa, Canada
| | - Nolan E Hill
- Centre for Sexuality, Calgary, Canada.,Local Advisory Group, Calgary, Canada
| | | | - Don Lapierre
- Medical Affairs and Innovation, Canadian Blood Services, Ottawa, Canada
| | | | | | | | - Amelia Palumbo
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
| | - Paul MacPherson
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada.,Department of Medicine, The Ottawa Hospital, Ottawa, Canada.,Department of Biochemistry, Microbiology and Immunology, University of Ottawa, Ottawa, Canada
| | | | | | - Sheila F O'Brien
- Medical Affairs and Innovation, Canadian Blood Services, Ottawa, Canada
| | | | - Joanne Otis
- Department of Sexology, Université du Québec À Montréal, Montreal, Canada
| | | | | | | | | | - Marc Germain
- Héma-Québec, Medical Affairs, Quebec City, Canada
| | | | | | - Dana Devine
- Canadian Blood Services, Vancouver, Canada.,Centre for Blood Research, University of British Columbia, Vancouver, Canada
| | - Justin Presseau
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada.,School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada.,School of Psychology, University of Ottawa, Ottawa, Canada
| |
Collapse
|
4
|
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] [What about the content of this article? (0)] [Affiliation(s)] [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.
Collapse
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
| |
Collapse
|