OBJECTIVES: To compare risk factors for HIV seropositivity with risk factors for HIV seroconversion in a population of volunteer blood donors in Harare, Zimbabwe, and to assess the impact of risk factor exclusion strategies on the safety of the blood supply. DESIGN: A secondary analysis of a longitudinal cohort study was performed. SUBJECTS AND METHODS: The subjects were volunteer blood donors who were also taking part in a prospective cohort study in Harare, Zimbabwe. They were tested for HIV antibodies upon enrollment and at 6-month intervals. Their donation history, age, marital status and the presence or absence of multiple sex partners and paying for sex were assessed as predictors of HIV seropositivity and HIV seroconversion. The impact of exclusion strategies on blood safety was modeled by estimating the number of HIV-infected units that would escape detection by antibody screening if blood donors with these risk factors were excluded. RESULTS: The HIV seroprevalence among persons accepted for blood donation was 8.8%; the HIV seroincidence was 2.1 per 100 person-years. Significant risk factors for HIV seropositivity were being a new donor (odds ratio 7.3, 95% confidence interval 4.4-1 2.1), age over 25 years (odds ratio 1.6, confidence interval 1.1-2.4), being married (odds ratio 1.7, confidence interval 1.2-2.6), paying for sex (odds ratio 2.6, confidence interval 1.7-3.9) and multiple sex partners (odds ratio 2.1, confidence interval 1.4-2.9). Significant risk factors for HIV seroconversion were age under 25 years (hazard ratio 2.5, confidence interval 1.4-5.0) and being unmarried (hazard ratio 2.5, confidence interval 1.4-5.0). Of note, age and marital status reversed their direction of association with respect to HIV seropositivity and HIV seroconversion. Exclusion strategies based on strong predictors of HIV seroconversion were the most effective in improving the safety of the blood supply. CONCLUSIONS: A distinction between risk factors for HIV seropositivity and HIV seroconversion is necessary in order to develop strategies to reduce the residual risk of transfusion-associated HIV transmission. Because window-period donations are the most important source of residual HIV contamination and arise from incident infections, research to develop risk factor exclusion strategies must focus on predictors of HIV seroconversion.
OBJECTIVES: To compare risk factors for HIV seropositivity with risk factors for HIV seroconversion in a population of volunteer blood donors in Harare, Zimbabwe, and to assess the impact of risk factor exclusion strategies on the safety of the blood supply. DESIGN: A secondary analysis of a longitudinal cohort study was performed. SUBJECTS AND METHODS: The subjects were volunteer blood donors who were also taking part in a prospective cohort study in Harare, Zimbabwe. They were tested for HIV antibodies upon enrollment and at 6-month intervals. Their donation history, age, marital status and the presence or absence of multiple sex partners and paying for sex were assessed as predictors of HIV seropositivity and HIV seroconversion. The impact of exclusion strategies on blood safety was modeled by estimating the number of HIV-infected units that would escape detection by antibody screening if blood donors with these risk factors were excluded. RESULTS: The HIV seroprevalence among persons accepted for blood donation was 8.8%; the HIV seroincidence was 2.1 per 100 person-years. Significant risk factors for HIV seropositivity were being a new donor (odds ratio 7.3, 95% confidence interval 4.4-1 2.1), age over 25 years (odds ratio 1.6, confidence interval 1.1-2.4), being married (odds ratio 1.7, confidence interval 1.2-2.6), paying for sex (odds ratio 2.6, confidence interval 1.7-3.9) and multiple sex partners (odds ratio 2.1, confidence interval 1.4-2.9). Significant risk factors for HIV seroconversion were age under 25 years (hazard ratio 2.5, confidence interval 1.4-5.0) and being unmarried (hazard ratio 2.5, confidence interval 1.4-5.0). Of note, age and marital status reversed their direction of association with respect to HIV seropositivity and HIV seroconversion. Exclusion strategies based on strong predictors of HIV seroconversion were the most effective in improving the safety of the blood supply. CONCLUSIONS: A distinction between risk factors for HIV seropositivity and HIV seroconversion is necessary in order to develop strategies to reduce the residual risk of transfusion-associated HIV transmission. Because window-period donations are the most important source of residual HIV contamination and arise from incident infections, research to develop risk factor exclusion strategies must focus on predictors of HIV seroconversion.
Entities:
Keywords:
Acquired Immunodeficiency Syndrome; Africa; Africa South Of The Sahara; Biology; Blood Donors; Blood Supply; Developing Countries; Diseases; Eastern Africa; English Speaking Africa; Equipment And Supplies; Examinations And Diagnoses; Hiv Infections; Hiv Serodiagnosis; Immunity; Incidence; Laboratory Examinations And Diagnoses; Longitudinal Studies; Measurement; Physiology; Prevalence; Research Methodology; Research Report; Risk Factors; Seroconversion; Studies; Viral Diseases; Zimbabwe
Authors: Ben Lopman; Constance Nyamukapa; Phyllis Mushati; Zivai Mupambireyi; Peter Mason; Geoff P Garnett; Simon Gregson Journal: Int J Epidemiol Date: 2008-01-18 Impact factor: 7.196