Blood Donation in the Era of Biomedical HIV Prevention and Gender-neutral Donor Screening
Date
2024-01-29
Authors
Higgins, Robert
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Abstract
Objective.
Canada’s implementation of gender-neutral sexual behaviour screening allows sexually active men who have sex with men to donate blood for the first time. Public health campaigns promoting effectiveness of pre-exposure prophylaxis (PrEP) and undetectable = untransmittable (U=U) for HIV prevention heavily target sexual and gender minorities. Donor deferral policies remain in place for both methods. This thesis explores the tension between the effectiveness of these HIV prevention methods and donor policies considering them indicators of HIV risk.
Methods.
I wrote an algorithm approximating donor eligibility producing two analytic samples; one including PrEP use, one including HIV-negative men using U=U. I then estimate the proportion of donors who would be deferred for each prevention method. Chapter Two uses logistic regression to investigate PrEP use as a motivator for blood donation. Chapter Three describes HIV risk and protective factors for HIV and compares these observations to population health estimates of HIV incidence risk.
Results.
The algorithm identified n = 2,301 potential donors when PrEP users were included. Of these n = 85 (3.7%) would have been deferred for PrEP use. When repeated with HIV-negative donors using U=U, n= 2,354 donors were identified and n = 53 (2.3%) would have been deferred. PrEP use was not associated with willingness to donate. Estimates of HIV acquisition risk observed in the U=U analytic sample showed high risk of HIV acquisition. Contradictorily, a high number of combination HIV prevention strategies were also observed in the sample.
Conclusion.
It is likely donors are deferred solely for their choice of HIV prevention method. Having made a past donation was the best predictor of willingness to donate blood. Observed combination HIV prevention strategies employed by the U=U analytic sample did not support high public health estimates of HIV acquisition risk. Future research should explore PrEP adherence in samples of donors deferred for PrEP use and adjusting estimates of HIV acquisition risk to consider PrEP and U=U in risk estimates.
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Keywords
HIV, blood donation, MSM, GBMSM, PrEP, Pre-exposure prophylaxis, undetectable equals untransmittable, biomedical hiv prevention, transfusion medicine, blood donor screening, TasP, treatment as prevention, gender-neutral donor screening