McFarland W, Kahn J G, Katzenstein D A, Mvere D, Shamu R
Center for AIDS Prevention Studies, University of California, San Francisco 94105, USA.
J Acquir Immune Defic Syndr Hum Retrovirol. 1995 Jun 1;9(2):183-92.
We compared the cost-effectiveness of three strategies to avert transfusion-associated HIV infection in Zimbabwe: HIV antibody testing, deferral of donors with HIV risk factors, and deferral of donors with risk factors followed by antibody testing ("Defer/Test"). The Defer/Test strategy averted the most HIV infections. Compared with antibody testing alone, the Defer/Test strategy, using history of genital ulcer or any sexually transmitted disease as a criterion for deferral, resulted in net savings. The cost per HIV-infected unit averted using history of paying for sex or having had multiple sex partners was $ 127 and $ 773, respectively. We discern four benefits of risk factor-based deferral before antibody testing. First, deferring donors at risk lessens collection of blood in the window period. Second, deferring donors likely to be HIV positive minimizes the number of units discarded. Third, ascertainment of donor risk provides an opportunity for AIDS education and prevention. Fourth, the number of false negatives is lower with a lower HIV prevalence among accepted donors. The Defer/Test strategy is cost-effective in Zimbabwe because additional recruitment costs are offset by discarding fewer HIV-positive units. We predict the Defer/Test strategy will be cost-effective in other sub-Saharan African donor populations.
艾滋病毒抗体检测、推迟有艾滋病毒风险因素的献血者献血，以及推迟有风险因素的献血者献血后再进行抗体检测（“推迟/检测”）。“推迟/检测”策略预防的艾滋病毒感染最多。与仅进行抗体检测相比，以生殖器溃疡病史或任何性传播疾病作为推迟献血标准的“推迟/检测”策略节省了费用。以有偿性行为史或有多个性伴侣作为标准，每预防一个艾滋病毒感染单位的成本分别为127美元和773美元。我们发现抗体检测前基于风险因素的推迟献血有四个好处。第一，推迟有风险的献血者献血可减少窗口期血液的采集。第二，推迟可能感染艾滋病毒的献血者献血可减少被丢弃的血液单位数量。第三，确定献血者风险为艾滋病教育和预防提供了机会。第四，由于接受的献血者中艾滋病毒感染率较低，假阴性结果的数量也会减少。“推迟/检测”策略在津巴布韦具有成本效益，因为额外的招募成本被丢弃的艾滋病毒阳性单位数量减少所抵消。我们预计“推迟/检测”策略在撒哈拉以南非洲的其他献血人群中也将具有成本效益。
