Burnet Institute, Melbourne, Australia; Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia.
Australian Red Cross Blood Service, Australia.
Int J Drug Policy. 2017 Oct;48:9-17. doi: 10.1016/j.drugpo.2017.05.058. Epub 2017 Jun 27.
Potential Australian blood donors are deferred indefinitely if they report a history of injecting drug use (IDU), or for 12 months if they report having engaged in sexual activity with someone who might have ever injected. Given incremental improvements in blood safety, this study sought to examine whether Australia's IDU-related eligibility criteria reflected current scientific evidence, were consistent with international best practice and, if current IDU-related policies were to be changed, how this should happen.
An expert committee was formed to review relevant literature with a focus on issues including: the epidemiology of IDU in Australia and key transfusion-transmissible infections (TTIs) among Australian people who inject drugs (PWID); and, 'non-compliance' among PWID regarding IDU-related blood donation guidelines. International policies relating to blood donation and IDU were also reviewed. Modelling with available data estimated the risk of TTIs remaining undetected if the Blood Service's IDU-related guidelines were changed.
Very few (<1%) Australians engage in IDU, and IDU risk practices are reported by only a minority of PWID. However, the prevalence of HCV remains high among PWID, and IDU remains a key transmission route for various TTIs. Insufficient data were available to inform appropriate estimates of cessation and relapse among Australian PWID. Modelling findings indicated that the risk of not detecting HIV becomes greater than the reference group at a threshold of non-admission of being an active PWID of around 1.8% (0.5-5.1%). Excluding Japan, all Organisation for the Economic Co-operation and Development member countries permanently exclude individuals with a history of IDU from donating.
Numerous research gaps meant that the study's expert Review Committee was unable to recommend altering Australia's current IDU-related blood donation guidelines. However, having identified critical knowledge gaps and future areas of research, the review made important steps toward changing the criteria.
如果潜在的澳大利亚献血者报告有注射吸毒史（IDU），则无限期延期献血；如果报告与可能曾经注射过毒品的人发生过性行为，则延期 12 个月。鉴于血液安全性的逐步提高，本研究旨在检查澳大利亚与 IDU 相关的资格标准是否反映了当前的科学证据，是否符合国际最佳实践，以及如果要改变当前与 IDU 相关的政策，应该如何进行。
成立了一个专家委员会，审查相关文献，重点关注以下问题：澳大利亚 IDU 的流行病学以及澳大利亚注射吸毒者（PWID）中的关键输血传播感染（TTI）；以及 PWID 对与 IDU 相关的献血指南的“不遵守”情况。还审查了与献血和 IDU 相关的国际政策。利用现有数据进行建模，估计如果改变血液服务机构与 IDU 相关的指南，TTI 仍未被发现的风险。
很少有（<1%）澳大利亚人参与 IDU，只有少数 PWID 报告 IDU 风险行为。然而，HCV 在 PWID 中的患病率仍然很高，IDU 仍然是各种 TTIs 的主要传播途径。可用于告知澳大利亚 PWID 中适当的戒烟和复发估计的信息不足。建模结果表明，在不承认活跃的 PWID 的门槛为 1.8%（0.5-5.1%）左右时，未检测到 HIV 的风险变得大于参考组。除日本外，所有经济合作与发展组织成员国都永久性地将有 IDU 史的个人排除在献血范围之外。
由于存在众多研究空白，研究的专家审查委员会无法建议修改澳大利亚当前与 IDU 相关的献血指南。但是，通过确定关键的知识空白和未来的研究领域，该审查朝着改变标准迈出了重要的一步。
