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- Title
Assessment of HIV transfusion transmission risk in South Africa: a 10-year analysis following implementation of individual donation nucleic acid amplification technology testing and donor demographics eligibility changes.
- Authors
Vermeulen, Marion; Lelie, Nico; Coleman, Charl; Sykes, Wendy; Jacobs, Genevieve; Swanevelder, Ronel; Busch, Michael; Zyl, Gert; Grebe, Eduard; Welte, Alex; Reddy, Ravi; van Zyl, Gert
- Abstract
<bold>Background: </bold>In 1998 we estimated that 34/million infectious window period donations were entering the blood supply at the South African National Blood Service. Selective use of donations based on donor race-ethnicity reduced this risk to 26/million donations but was deemed unethical. Consequently, in 2005 South African National Blood Service eliminated race-ethnicity-based collection policies and implemented individual-donation nucleic acid testing (ID-NAT). We describe the change in donor base demographics, human immunodeficiency virus (HIV) detection rates, and transfusion-transmissible HIV risk.<bold>Study Design and Methods: </bold>In ten years 7.7 million donations were tested for anti-HIV and HIV RNA. Number of donations, HIV prevalence, ID-NAT yield rate, serology yield rate and residual transfusion-transmissible HIV risk were analyzed by donor type, race-ethnicity, age, and sex. Multiple regression analysis was performed to investigate the determinants of HIV-positive and nucleic acid testing yield donations.<bold>Results: </bold>The combined strategy of increasing donations from black donors and implementing ID-NAT increased the proportion of donations from black donors from 6% in 2005 to 30% in 2015 (p < 0.00001), and reduced the transfusion-transmissible risk from 24 to 13 per million transfusions. ID-NAT interdicted 481 (1:16,100) seronegative window period donations, while one transfusion-transmissible case (0.13 per million) was documented. Race-ethnicity and donor type were highly significant predictors of HIV positivity, with adjusted odds ratio for first-time donors of 12.5 (95% confidence interval, 11.9-13.1) and for black race-ethnicity of 31.1 (95% confidence interval, 28.9-33.4). The proportion of serology yields among HIV-infected donors increased from 0.27% to 2.4%.<bold>Conclusion: </bold>ID-NAT enabled the South African National Blood Service to increase the number of donations from black donors fivefold while enhancing the safety of the blood supply.
- Subjects
SOUTH Africa; BLOOD transfusion; HIV infection transmission; DONOR blood supply; DIAGNOSIS of HIV infections; DIRECTED blood donations; BLOOD donors; DRUG resistance in microorganisms; HIV infections; REGRESSION analysis; LOGISTIC regression analysis; NUCLEIC acid amplification techniques; GENOTYPES
- Publication
Transfusion, 2019, Vol 59, p267
- ISSN
0041-1132
- Publication type
journal article
- DOI
10.1111/trf.14959