Undisclosed human immunodeficiency virus risk factors identified through a computer‐based questionnaire program among blood donors in Brazil

Abstract

Background HIV risk factor screening among blood donors remains a cornerstone for the safety of blood supply and is dependent on prospective donor self-disclosure and an attentive predonation interview. Residual risk of HIV transmission through blood transfusion is higher in Brazil than in many other countries. Audio computer-assisted structured-interview (ACASI) has been shown to increase self-reporting of risk behaviors. Study design and methods This cross-sectional study was conducted between January 2009 and March 2011 at four Brazilian blood centers to identify the population of HIV-negative eligible blood donors that answered face-to-face interviews without disclosing risks, but subsequently disclosed deferrable risk factors by ACASI. Compared to the donor interview, the ACASI contained expanded content on demographics, sexual behavior and other HIV risk factors questions. Results 901 HIV-negative blood donors were interviewed. On the ACASI, 13% of donors (N=120) declared a risk factor that would have resulted in deferral that was not disclosed during the face-to-face assessment. The main risk factors identified were recent unprotected sex with an unknown or irregular partner (49 donors), sex with a person with exposure to blood/ fluids (26 donors), multiple sexual partners (19 donors), and male-male sexual behavior (10 donors). Independent factors associated with the disclosure of any risk factor for HIV were age (≥40 years vs. 18–25 years, AOR=0.45; 95% CI 0.23–0.88) and blood center (Hemope vs. Hemominas, AOR=2.51; 95% CI 1.42–4.44). Conclusion ACASI elicited increased disclosure of HIV risk factors among blood donors. ACASI may be a valuable modality of interview to be introduced in Brazilian blood banks.

Reasons for noncompliance in donor risk reporting regarding male‐to‐male sex

“…In earlier published studies results have shown that computer-based screening is an effective method to improve risk reporting among blood donors. [28][29][30] To further stimulate accurate risk reporting, the DHQ could be modified in a way that donors are required to read the definition of (sexual) behavior that is asked before posing a question. Moreover, adding an "unsure" option on the DHQ could provide donors the possibility to discuss their uncertainty with Blood Service employees and not be forced to choose between "yes" or "no."…”

Risk factors for human immunodeficiency virus among blood donors in Cameroon: evidence for the design of an Africa‐specific donor history questionnaire

“…All the 10 regions of Cameroon are well represented as far as origin of participants are concerned despite lower than projected enrollment at Sites II and III. The use of a computer‐based system like audio computer‐assisted self‐interview created a confidential environment for participants and increased disclosure of HIV risk factors among blood donors . Other studies have noted the benefit of a computer‐based interview for increasing the efficiency of the DHQ …”

Contribution of the Retrovirus Epidemiology Donor Study (REDS) to research on blood transfusion safety in Brazil

“…Among females, predominant risk factors included sex with HIV-positive male partners and unprotected sex with multiple partners 20 . Remarkably, 13% of controls declared a risk factor that would have resulted in deferral had it been disclosed during the face-to-face donor eligibility assessment at the blood center 21 . Thus, ACASI elicited increased disclosure of HIV risk factors among blood donors and may be a valuable modality of interview to be introduced in Brazilian blood banks 21 .…”

“…Remarkably, 13% of controls declared a risk factor that would have resulted in deferral had it been disclosed during the face-to-face donor eligibility assessment at the blood center 21 . Thus, ACASI elicited increased disclosure of HIV risk factors among blood donors and may be a valuable modality of interview to be introduced in Brazilian blood banks 21 . The REDS-II study also allowed us to characterize the HIV subtypes and the primary resistance of HIV-positive donors from the three REDS-II Brazilian blood centers and the blood center of Rio de Janeiro, in accordance with their demographic and exposure risk 22 .…”