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  • Title: Excluding blood donors at high risk of HIV infection in a west African city.
    Author: Schutz R, Savarit D, Kadjo JC, Batter V, Kone N, La Ruche G, Bondurand A, De Cock KM.
    Journal: BMJ; 1993 Dec 11; 307(6918):1517-9. PubMed ID: 8274919.
    Abstract:
    OBJECTIVE: To examine the potential impact of deferral of blood donors at high risk of HIV infection in a west African city where blood is screened for HIV antibodies but no other special measures are taken to protect the blood supply. DESIGN: Cross sectional study. SETTING: National Blood Transfusion Centre and Project RETRO-CI, an international collaborative AIDS research project, Abidjan, Côte d'Ivoire. SUBJECTS: 1257 male first time blood donors. INTERVENTIONS: Blood donors were interviewed about demographic and behavioural characteristics and tested for HIV antibodies by enzyme immunoassay and, if positive, synthetic peptide based tests. MAIN OUTCOME MEASURES: HIV antibody status in relation to presence of behavioural risk factors; calculation of sensitivity, specificity, and predictive values of specific criteria for excluding HIV infected donors. RESULTS: The overall prevalence of HIV infection was 11.4%. The most important risk factors for HIV positivity were prostitute contact and being aged 30-39 years. For identifying seropositive donors individual criteria had sensitivity, specificity, and positive predictive values ranging from 15% to 98%, 38% to 91%, and 17% to 30% respectively. Prostitute contact in the past five years would have excluded 31% of all donors and 73% of HIV infected donors. 27% of those excluded would have been HIV positive. CONCLUSIONS: The widespread assumption that donor deferral is not feasible in sub-Saharan Africa needs reassessment. In Abidjan this approach was well accepted and potentially effective. Donor deferral requires evaluation as a strategy for improving blood safety in resource poor areas with high rates of HIV infection. During February-November 1991 in Abidjan, the Ivory Coast, interviews with 1257 male first-time blood donors and screening of their blood for antibodies to HIV-1 and HIV-2 were conducted at the National Blood Transfusion Center to determine whether it is feasible to exclude or defer donors at high risk of HIV infection. 143 (11.4%) men had antibodies to HIV. The multivariate analysis showed that the strongest risk factor for HIV infection was sex with prostitutes in the last 5 years without regular condom use (odds ratio [OR] = 10, confidence interval [CI] = 6.6-15) followed by prostitute contact in the last 5 years regardless of condom use (OR = 8.4, CI = 5.6-12.6), and an age of 30-39 years (OR = 6.9, CI = 18). 27% of all donors with prostitute contact in the last 5 years were infected (positive predictive value). If the center had used prostitute contact in the last 5 years as a criterion, it would have discarded 31% of all units of blood. Thus, more than 75% of all potentially excluded units would have been from donors infected with HIV. The sensitivity, specificity, and positive predictive values ranged from 15% to 98%, 38% to 91%, and 17% to 30%, respectively. These findings suggest that it is feasible in Abidjan to exclude donors based on behavioral characteristics of those most at risk of HIV infection. Donor deferral should be evaluated as a strategy to improve blood safety in resource-poor areas with high rates of HIV infection.
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