Predonation screening of blood donors with rapid tests: implementation and efficacy of a novel approach to blood safety in resource-poor settings.
BACKGROUND
In sub-Saharan Africa, the percentage of screened blood is limited to approximately 75 percent for human immunodeficiency virus antibodies (anti-HIV), 50 percent for hepatitis B surface antigen, and 19 percent for hepatitis C virus antibodies (anti-HCV), mainly because of costs.


METHODS
In 2002 to 2003, candidate blood donors were screened before donation for HIV, HCV, and hepatitis B virus (HBV) serologic markers with rapid tests. The efficacy of this screening was assessed by nucleic acid testing (NAT) applied to pools of 10 plasma samples from donated units with a virus specific triplex assay. NAT-reactive pools were resolved by viral genome identification in individual plasma sample. Deferred candidate donors were referred to a donor-care program.


RESULTS
A total of 9372 people were screened and 1534 (16.4%) were deferred. No HIV or HCV RNA-containing samples remained undetected by rapid tests unless a human testing error was involved. In contrast, 1.3 and 3.0 percent of HBV DNA-containing blood units were negative with rapid tests but were detected in individual donations with enzyme immunoassay and genomic amplification, respectively. Only half of these units were detectable in pools of 10 samples. One-third of deferred candidate donors attended the donor-care program and were informed and counseled.


CONCLUSIONS
Predonation viral screening of blood donors is effective in high endemic areas, and the savings it generates may improve the safety and limit the cost of blood. Communication with deferred donors may contribute to public health. A new screening strategy associating serologic rapid test before donation and NAT on pools of 10 plasma samples after donation is proposed.
Owusu-Ofori
Shirley
S
Department of Medicine, Komfo Anokye Teaching Hospital, Kumasi, Ghana.
Temple
Jillian
J
Sarkodie
Francis
F
Anokwa
Margaret
M
Candotti
Daniel
D
Allain
Jean-Pierre
JP
D001782:Blood Donors; D017848:Blood-Borne Pathogens / Q000302:isolation & purification*; D004279:DNA, Viral / Q000032:analysis; D003906:Developing Countries; D005869:Ghana / Q000453:epidemiology; D015658:HIV Infections / Q000453:epidemiology / Q000517:prevention & control / Q000635:transmission; D006509:Hepatitis B / Q000453:epidemiology / Q000517:prevention & control / Q000635:transmission; D006526:Hepatitis C / Q000453:epidemiology / Q000517:prevention & control / Q000635:transmission; D006801:Humans; D007124:Immunoenzyme Techniques; D008403:Mass Screening / Q000379:methods*; D015995:Prevalence; D012307:Risk Factors; D014777:Virus Diseases / Q000453:epidemiology / Q000517:prevention & control* / Q000635:transmission
D004279:DNA, Viral