Unit of PharmacoEpidemiology & PharmacoEconomics (PE2), Department of Pharmacy, University of Groningen, Groningen, Netherlands; Planning, Information & Research Department, Coordination Department, Medical Services Department, National Blood Service Zimbabwe; Department of Community Medicine, College of Health Sciences, University of Zimbabwe, Harare, Zimbabwe; Department of Clinical Pharmacy and Toxicology, Martini Hospital, Groningen, Netherlands.
Transfusion. 2013 Oct;53(10 Pt 2):2413-21. doi: 10.1111/trf.12311. Epub 2013 Jun 23.
National Blood Service Zimbabwe human immunodeficiency virus (HIV) risk management strategy includes screening and discarding of first-time donations, which are collected in blood packs without an anticoagulant (dry pack). To evaluate the impact of discarding first-time donations on blood safety the HIV prevalence, incidence, and residual risk in first-time and repeat donations (wet packs) were compared.
Donor data from 2002 to 2010 were retrieved from a centralized national electronic donor database and retrospectively analyzed. Chi-square test was used to compare HIV prevalence with relative risk (RR), and the RR point estimates and 95% confidence interval (CI) are reported. Trend analysis was done using Cochran-Armitage trend test. HIV residual risk estimates were determined using published residual risk estimation models.
Over the 9 years the overall HIV prevalence estimates are 1.29% (n = 116,058) and 0.42% (n = 434,695) for first-time and repeat donations, respectively. The overall RR was 3.1 (95% CI, 2.9-3.3; p < 0.0001). The overall mean residual transmission risk of HIV window phase donations in first-time was 1:7384 (range, 1:11,308-1:5356) and in repeat donors it was 1:5496 (range, 1:9943-1:3347).
The significantly high HIV prevalence estimates recorded in first-time over repeat donations is indicative of the effectiveness of the HIV risk management strategy. However, comparable residual transmission risk estimates in first-time and repeat donors point to the need to further review the risk management strategies. Given the potential wastage of valuable resources, future studies should focus on the cost-effectiveness and utility of screening and discarding first-time donations.
津巴布韦国家血液服务中心的人类免疫缺陷病毒（HIV）风险管理策略包括筛查和淘汰首次献血，这些血液是在没有抗凝剂（干袋）的情况下采集的血袋中收集的。为了评估淘汰首次献血对血液安全的影响，比较了首次和重复献血（湿袋）的 HIV 流行率、发病率和剩余风险。
从集中的国家电子献血者数据库中检索了 2002 年至 2010 年的献血者数据，并进行了回顾性分析。使用卡方检验比较 HIV 流行率与相对风险（RR），并报告 RR 点估计值和 95%置信区间（CI）。使用 Cochran-Armitage 趋势检验进行趋势分析。使用已发表的剩余风险估计模型确定 HIV 剩余风险估计值。
在 9 年期间，首次和重复献血的 HIV 总流行率估计值分别为 1.29%（n=116058）和 0.42%（n=434695）。总体 RR 为 3.1（95%CI，2.9-3.3；p<0.0001）。首次和重复献血者 HIV 窗口期捐赠的平均剩余传播风险分别为 1:7384（范围，1:11308-1:5356）和 1:5496（范围，1:9943-1:3347）。
首次献血的 HIV 高流行率估计值明显高于重复献血，这表明 HIV 风险管理策略是有效的。然而，首次和重复献血者的剩余传播风险估计值相当，表明需要进一步审查风险管理策略。鉴于宝贵资源的潜在浪费，未来的研究应集中在筛查和淘汰首次献血的成本效益和实用性上。
