The contribution of unsafe blood transfusion to human immunodeficiency virus incidence in sub‐Saharan Africa: reexamination of the 5% to 10% convention

Malika M. Morar · John P. Pitman · Willi McFarland · Evan M. Bloch

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Blood donation and transfusion practices HIV/AIDS Research and Interventions HIV, Drug Use, Sexual Risk

Abstract

BACKGROUND: Historical estimates have attributed 5% to 10% of new human immunodeficiency virus (HIV) infections in sub-Saharan Africa (SSA) to unsafe blood transfusions. Although frequently cited, the validity of this statistic is uncertain or outdated. Recent estimates suggest blood transfusion's contribution to new HIV infections in the region may be much lower. STUDY DESIGN AND METHODS: We searched the peer-reviewed and gray literature for quantitative estimates of the specific contribution of unsafe blood transfusion to the proportion of new HIV infections occurring in SSA. The sources and methods used to generate attribution estimates were evaluated against published country-specific HIV prevalence data. RESULTS: Despite multiple secondary citations, a primary published source attributing 5% to 10% of new HIV infections to blood transfusions in SSA could not be established for the current era. The United Nations Programme on HIV and AIDS (UNAIDS) modes of transmission (MOT) reports representing 15 countries suggest that between 0 and 1.1% of new HIV infections per year (median, 0.2% or approx. two out of 1000 new infections each year) may be attributable to blood transfusions. CONCLUSION: Recent modeled estimates suggest that blood transfusions account for a very low proportion of new HIV infections in SSA, likely an order of magnitude lower than 5% to 10%. Direct quantification of risk is challenging given the paucity of data on the variables that impact transfusion-associated HIV. Specifically, data on HIV incidence in blood donors, blood bank laboratory test performance, and posttransfusion surveillance are lacking. Findings suggest an urgent need for improved surveillance and modeling of transfusion-associated HIV transmission in the region.

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References

2005A new strategy for estimating risks of transfusion‐transmitted viral infections based on rates of detection of recently infected donors 2010Transfusion‐associated infections: 50 years of relentless challenges and remarkable progress 2011Blood Transfusion Safety in Africa: A Literature Review of Infectious Disease and Organizational Challenges 2009The risk of transfusion‐transmitted infections in sub‐Saharan Africa 2009The blood donor in sub-Saharan Africa: a review 2008Blood safety in Sub‐Saharan Africa: a multi‐factorial problem 2005Predonation screening of blood donors with rapid tests: implementation and efficacy of a novel approach to blood safety in resource‐poor settings 2009Impact of individual‐donation nucleic acid testing on risk of human immunodeficiency virus, hepatitis B virus, and hepatitis C virus transmission by blood transfusion in South Africa

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2018Towards a safe and sufficient blood supply in Sub‐Saharan Africa 2021Challenges in transfusion-transmitted infection screening in Sub-Saharan Africa 2022Evaluation of Transfusion Transmissible Infections Prevalence and Trend Among Blood Donors Attended at Bule Hora Blood Bank, West Guji, South Ethiopia 2017

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