Blood donation amongst people who inject drugs in Australia: research supporting policy change.
blood donation
injecting drug use
mathematical modelling
non-compliance
transfusion-transmissible infections
Journal
Vox sanguinis
ISSN: 1423-0410
Titre abrégé: Vox Sang
Pays: England
ID NLM: 0413606
Informations de publication
Date de publication:
Apr 2020
Apr 2020
Historique:
received:
06
08
2019
revised:
23
12
2019
accepted:
07
01
2020
pubmed:
6
2
2020
medline:
21
10
2020
entrez:
6
2
2020
Statut:
ppublish
Résumé
Until recently, people in Australia with a history of injection drug use (IDU) were deferred indefinitely from donating blood. Knowledge gaps regarding policy non-compliance and the prevalence of blood donation practices amongst people who inject drugs (PWID) precluded changes to this policy. We sought to address these gaps and to estimate the additional risk to Australia's blood supply associated with changing the indefinite deferral policy to 1 or 5 years since last injecting episode. Data on blood donation amongst PWID were collected from 1853 interviews across two Australian studies of PWID conducted during 2015/16. Mathematical modelling was used to estimate the additional risk of hepatitis C (HCV)-infected window period collections as a result of changing the deferral policy. A very few (2-4%) study participants reported ever donating blood after ≥1 IDU episode. Changing the deferral policy from indefinite to 1 or 5 years was estimated to result in an additional 0·00000070 (95%CI: 0·00000033-0·00000165) or 0·00000020 (95%CI: 0·00000008-0·00000041) HCV-positive window period collections per year, respectively. Changing Australia's indefinite deferral period to 1 or 5 years since last injecting episode poses a negligible increase in the risk of HCV-infected window period collections from blood donors with a history of IDU. Our results informed a successful submission to the Australian regulator to change the deferral period from indefinite to 5 years since last injecting episode, a policy which came into effect in September 2018.
Sections du résumé
BACKGROUND AND OBJECTIVES
OBJECTIVE
Until recently, people in Australia with a history of injection drug use (IDU) were deferred indefinitely from donating blood. Knowledge gaps regarding policy non-compliance and the prevalence of blood donation practices amongst people who inject drugs (PWID) precluded changes to this policy. We sought to address these gaps and to estimate the additional risk to Australia's blood supply associated with changing the indefinite deferral policy to 1 or 5 years since last injecting episode.
MATERIALS AND METHODS
METHODS
Data on blood donation amongst PWID were collected from 1853 interviews across two Australian studies of PWID conducted during 2015/16. Mathematical modelling was used to estimate the additional risk of hepatitis C (HCV)-infected window period collections as a result of changing the deferral policy.
RESULTS
RESULTS
A very few (2-4%) study participants reported ever donating blood after ≥1 IDU episode. Changing the deferral policy from indefinite to 1 or 5 years was estimated to result in an additional 0·00000070 (95%CI: 0·00000033-0·00000165) or 0·00000020 (95%CI: 0·00000008-0·00000041) HCV-positive window period collections per year, respectively.
CONCLUSION
CONCLUSIONS
Changing Australia's indefinite deferral period to 1 or 5 years since last injecting episode poses a negligible increase in the risk of HCV-infected window period collections from blood donors with a history of IDU. Our results informed a successful submission to the Australian regulator to change the deferral period from indefinite to 5 years since last injecting episode, a policy which came into effect in September 2018.
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
162-170Subventions
Organisme : Australian Red Cross Blood Service (Australian government)
Informations de copyright
© 2020 International Society of Blood Transfusion.
Références
Pouget ER, Hagan H, Des Jarlais DC: Meta-analysis of hepatitis C seroconversion in relation to shared syringes and drug preparation equipment. Addiction 2012; 107(6):1057-65
Danta M, Brown D, Bhagani S, et al.: Recent epidemic of acute hepatitis C virus in HIV-positive men who have sex with men linked to high-risk sexual behaviours. AIDS 2007; 21(8):983-91
Transfusion-transmissible infections in Australia: 2018 Surveillance Report. 2018, Kirby Institute, UNSW, and Australian Red Cross Blood Service. Available at: https://kirby.unsw.edu.au/report/transfusion-transmissible-infections-australia-surveillance-report-2018
Hyland C, Seed CR, Kiely P, et al.: Follow-up of six blood donors highlights the complementary role and limitations of hepatitis C virus antibody and nucleic acid amplification tests. Vox Sang 2003; 85(1):1-8
Kiely P, Margaritis AR, Seed CR, et al.: Hepatitis B virus nucleic acid amplification testing of Australian blood donors highlights the complexity of confirming occult hepatitis B virus infection. Transfusion 2014; 54(8):2084-91
Australian Red Cross Lifeblood, Residual risk estimates for transfusion-transmissible infections. 2019. Available at: https://transfusion.com.au/adverse_events/risks/estimates#:~:targetText=Australia%20has%20one%20of%20the,making%20and%20informed%20consent%20processes
O'Brien SF, Ram SS, Vamvakas EC, et al.: The Canadian blood donor health assessment questionnaire: lessons from history, application of cognitive science principles, and recommendations for change. Transfus Med Rev 2007; 21(3):205-22
O'Brien SF, Xi G, Yi QL, et al.: Understanding non-disclosure of deferrable risk: a study of blood donors with a history of intravenous drug use. Transfus Med 2010; 20(1):15-21
Williams AE, Thomson RA, Schreiber GB, et al.: Estimates of infectious disease risk factors in US blood donors. Retrovirus epidemiology donor study. JAMA 1997; 277(12):967-72
Lucky TT, Seed CR, Waller D, et al.: Understanding noncompliance with selective donor deferral criteria for high-risk behaviors in Australian blood donors. Transfusion 2014; 54(7):1739-49
Quinn B, Seed C, Keller A, et al.: Re-examining blood donor deferral criteria relating to injecting drug use. IJDP 2017; 48:9-17
Heard S, Iversen J, Geddes L, et al.: Australian NSW Survey National Data Report 2013-2017: Prevalence of HIV, HCV and injecting and sexual behaviour among attendees. Sydney, Kirby Institute, UNSW, 2018: Available at: https://kirby.unsw.edu.au/report/australian-nsp-survey-national-data-report-2013-2017
Stafford J, Breen C, Australian Drug Trends 2016: Findings from the Illicit Drug Reporting System (IDRS), in Australian Drug Trends Series No. 163. 2017, NDARC, UNSW: Sydney. Available at: https://ndarc.med.unsw.edu.au/resource-type/drug-trends-national-reports
Stafford J, Breen C, Australian Drug Trends 2015: Findings from the Illicit Drug Reporting System (IDRS), in Australian Drug Trends Series No. 145. 2016, NDARC, UNSW: Sydney. Available at: https://ndarc.med.unsw.edu.au/resource-type/drug-trends-national-reports
Horyniak D, Higgs P, Jenkinson R, et al.: Establishing the Melbourne Injecting Drug User Cohort Study (MIX): rationale, methods, and baseline and twelve-month follow-up results. Harm Reduct J 2013; 10:11
Harris PA, Taylor R, Thielke R, et al.: Research electronic data capture (REDCap) - A metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform 2009; 42(2):377-81
Seed CR, Kiely P, Keller AJ: Residual risk of transfusion transmitted human immunodeficiency virus, hepatitis B virus, hepatitis C virus and human T lymphotrophic virus. Intern Med J 2005; 35(10):592-8
Lucky TT, Keller AJ, Seed CR, et al.: A refined method for estimating the size of the potential blood donor pool in Australia. Transfusion 2014; 54(10):2445-55
Karki S, Davison TE, Thijsen A, et al.: Completeness and accuracy of self-reported history of blood donation: results from a cohort of older adults in Australia. Transfusion 2019; 59(1):26-31
Iversen J, Dore GJ, Catlett B, et al.: Association between rapid utilisation of direct hepatitis C antivirals and decline in the prevalence of viremia among people who inject drugs in Australia. J Hepatol 2019; 70(1):33-9
Scott N, Sacks-Davis R, Pedrana A, et al.: Eliminating hepatitis C: The importance of frequent testing of people who inject drugs in high-prevalence settings. J Viral Hepat 2018; 25(12):1472-80
Australian Institute of Health and Welfare, National Drug Strategy Household Survey 2016: Detailed findings, in Drug Statistics series no. 31. Cat. no. PHE 214. 2017, AIHW: Canberra. Available at: https://www.aihw.gov.au/reports/illicit-use-of-drugs/ndshs-2016-detailed/contents/table-of-contents
Australian Bureau of Statistics: Australian Demographic Statistics: June Quarter 2018 (3101.0). ABS, Commonwealth of Australia. Available at: https://www.abs.gov.au/AUSSTATS/abs@.nsf/DetailsPage/3101.0Jun%202018?OpenDocument
UK Advisory Committee on SaBTO: Donor Selection Criteria Report. 2017, SaBTO. Available at: https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/809909/sabto-donor-selection-criteria-report-2017-v2.pdf
Kirby Institute: Hepatitis B and C in Australia Annual Surveillance Report Supplement 2016. 2016, Kirby Institute, UNSW: Sydney. Available at: https://kirby.unsw.edu.au/sites/default/files/kirby/report/SERP_HepBandC-Annual-Surveillance-Report-Supp-2016.pdf
Busch MP, Glynn SA, Stramer SL, et al.: A new strategy for estimating risks of transfusion-transmitted viral infections based on rates of detection of recently infected donors. Transfusion 2005; 45(2):254-64
Australian Red Cross Blood Service: Residual risk estimates for transfusion-transmissible infections. 2017
Larney S:Epidemiological definitions and estimates of populations of people who inject drugs with hepatitis C virus infection (Presentation at APSAD Conference). UNSW. Sydney, NDARC,2016
Nambiar D, Agius PA, Stoove M, et al.: Cessation of injecting drug use: The effects of health service utilisation, drug use and demographic factors. Drug Alcohol Depend 2015; 154:208-13
Darke S, Marel C, Slade T, et al.: Patterns and correlates of sustained heroin abstinence: findings from the 11-year follow-up of the Australian treatment outcome study. J Stud Alcohol Drugs 2015; 76(6):909-15
Xia Y, Seaman S, Hickman M, et al.: Factors affecting repeated cessations of injecting drug use and relapses during the entire injecting career among the Edinburgh Addiction Cohort. Drug Alcohol Depend 2015; 151:76-83
Transfusion-transmissible infections in Australia: 2016 Surveillance Report. Kirby Institute, UNSW Sydney, and Australian Red Cross Blood Service. Available at: https://kirby.unsw.edu.au/report/australian-blood-donors-surveillance-report-2016
Australian Bureau of Statistics: 3101.0 - Australian Demographic Statistics, Jun 2015. Available at: https://www.abs.gov.au/AUSSTATS/abs@.nsf/Previousproducts/3101.0Main%20Features1Jun%202015