1286. Evaluating Strategies to Reduce Risk of HIV Infection in the U.S. Blood Supply
Session: Poster Abstract Session: HIV: Prevention
Friday, October 5, 2018
Room: S Poster Hall
Posters
  • Evaluating Strategies to Reduce Risk of HIV Infection in the US Blood Supply_Final.pdf (635.9 kB)
  • Background:

    Due to risk of HIV transmission, the FDA recommends a ban on blood donation from men who have sex with men (MSM). Revised in 2015, the current restriction applies to men who have had sex with a man in the year before donation. Given advances in HIV testing and the option of risk-based screening, the current approach may not represent the optimal strategy for ensuring a safe blood supply.

    Methods:

    Using a decision tree, we compared 3 strategies: 1) the current standard: a deferral for MSM followed by 4th generation HIV antibody/antigen (Ab/Ag) and viral load (VL) testing of all donated units; 2) test-only: no deferral, with Ab/Ag and VL testing; 3) risk-based: deferral for all male donors who report condomless anal intercourse in the past 6 weeks, followed by Ab/Ag and VL testing. The primary outcome was the expected number of accepted HIV+ donations per million units of donated blood. Key input parameters include MSM prevalence (3.6%), HIV testing sensitivity for chronic (99.96%) and acute (75%) infection, and false negative rate of the current MSM deferral question and the risk-based screening question (2.6% for each). In sensitivity analyses, we assessed the impact of variation in these parameters.

    Results:

    In the base case, the current strategy resulted in 5.39 HIV+ accepted blood donations per million; the testing only strategy resulted in 7.10 HIV+ accepted blood donations per million; and the risk-based strategy resulted in 2.54 HIV+ accepted blood donations per million. In sensitivity analyses, the risk-based strategy was superior across plausible ranges of HIV test sensitivity and MSM prevalence. The risk-based strategy was superior when the false negative rate generated by the risk-based screening question was <10.4%; at higher rates, the current strategy was superior. The current strategy was superior when the MSM deferral question yielded <0.8% false negative rate; at higher rates, the risk-based strategy is superior. Compared with the current standard, a risk-based strategy could add 5 million low-risk MSM to the potential donor supply.

    Conclusion:

    A risk-based screening question, combined with Ab/Ag and VL testing, may be more effective than the current strategy. The quality and ability of screening questions to accurately assess risk is key to any pre-donation screening strategy.

    Robert Goldstein, MD, PhD, Department of Medicine, Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, Chana Sacks, MD, Department of Medicine, Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA and Rochelle Walensky, MD, MPH, FIDSA, Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA

    Disclosures:

    R. Goldstein, None

    C. Sacks, None

    R. Walensky, None

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