Does offering human immunodeficiency virus testing at the time of blood donation reduce transfusion transmission risk and increase disclosure counseling? Results of a randomized controlled trial, São Paulo, Brazil

Abstract

Background In a randomized controlled trial (RCT) in a blood bank in São Paulo, we tested the hypotheses that offering client-centered HIV counseling and testing to blood donors would: 1) reduce the risk of HIV contamination in the blood supply by diverting higher risk, test-seeking donors away from donation, and 2) increase return for results and referrals to care. Study Design and Methods We randomly selected weeks between August, 2012 and May, 2013 when donors were offered HIV counseling and testing (N=6,298), leaving usual procedure weeks as control (N=5,569). Results Few candidate donors chose HIV testing (N=81, 1.3%). There was no significant difference in HSV-2 prevalence (a marker of sexual risk) among donors during intervention weeks compared to control (10.4% vs 11.1%, p=0.245). No donor choosing testing was HIV-infected, and there was no difference in HSV-2 prevalence between testers and donors (9.9% vs. 10.4%, p=0.887). Returning for positive results did not differ between testers and donors (3 of 3 vs. 58 of 80, p=0.386). A higher proportion of donors acknowledged that HIV testing was a strong motivation to donate during intervention weeks compared to control (2.6% vs. 2.0%, p=0.032). Conclusion The evidence of our RCT is that offering HIV counseling and testing at the time of donation would not change the risk of contamination in the blood supply, nor improve results disclosure and referral to care.

Motivations for donating and attitudes toward screening policies in US blood donors with viral infection

“…Donation reasons stated by cases and controls in this study are within the same content categories of cross‐validated motivations reported by previous studies of the general donor population . In addition, our findings confirm that although for some donors the desire to get test results was evident, they also have the altruistic motivation to donate blood to help someone …”

“…14 In addition, our findings confirm that although for some donors the desire to get test results was evident, they also have the altruistic motivation to donate blood to help someone. 15,23 The wide gap between HIV cases and cases with other viral infections in their opinions about donor screening policies merits further investigation. While a majority of cases did not think that current policies are unfair, a significant proportion of HIV cases responded affirmatively to the "unfairness" question.…”

Self‐reported historic human immunodeficiency virus (HIV) testing in a Brazilian blood donor HIV case‐control study

“…Likewise, continuous educational marketing campaigns focused on HIV prevention in the young population are recommended. Of note, offering voluntary counseling and HIV testing at the time of donation at one large public blood center in Sao Paulo, Brazil, did not increase voluntary HIV testing and referral to care nor did it decrease the risk of HIV‐infected donations in the blood supply . Ultimately, these findings suggest a larger need for collaborative program development that includes VCTs and blood centers.…”

A novel approach to detect test‐seeking behaviour in the blood donor population: making the invisible visible

“…In case such behaviour is detected, extra measures may be implemented to identify and/or exclude test‐seeking donors. These might include more careful donor screening (questionnaires and interviews) , donor education or perhaps offering free (anonymous) testing to non‐donors . Measures may be tailored to TS or LTS behaviour observed among infected donors (e.g.…”