HIV residual risk in Canada under a three‐month deferral for men who have sex with men

Sheila F. O’Brien · Yves Grégoire · Josiane Pillonel · Whitney Randolph Steele · Brian Custer · Katy L. Davison +3 more

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

Abstract

BACKGROUND AND OBJECTIVES: In Canada, the deferral for men who have sex with men (MSM) was decreased from a permanent deferral to a 5-year then a 12-month deferral. Current HIV testing can detect an HIV infection in donated blood within 2 weeks of exposure; thus, a 12-month deferral may be unnecessarily restrictive. We aimed to estimate the residual risk of HIV if the deferral were further decreased to 3 months. MATERIALS AND METHODS: Using a deterministic model with stochastic Monte Carlo simulation, residual risk of HIV was the sum of testing error, assay sensitivity and window-period risks. Data inputs were estimated from donor surveillance, donor surveys and published data. Residual risk was modelled at baseline and using three scenarios: (1) most likely - non-compliance, HIV prevalence and incidence rates of MSM are unchanged; (2) optimistic - non-compliance improves by 50%; and (3) pessimistic - non-compliance, HIV prevalence and incidence rates of MSM all double. RESULTS: HIV residual risk at baseline was 1 in 36·0 million donations (95% CI 1 in 1 504 907 million, 10·5 million); in the most likely scenario 1 in 34·2 million (1 in 225 534 million, 8·7 million); in the optimistic scenario 1 in 36·0 million (1 in 282 618 million, 9·5 million); in the pessimistic scenario 1 in 16·7 million (1 in 39 469 million, 6·0 million). All confidence intervals overlapped. CONCLUSION: With very low modelled risk under a 12-month deferral, the additional risk with a 3-month deferral is very low. This is true even with a pessimistic scenario.

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References

2010Transfusion‐associated infections: 50 years of relentless challenges and remarkable progress 2017Donor deferral policies for men who have sex with men: past, present and future 2003The risks and benefits of accepting men who have had sex with men as blood donors 2010No evidence of a significantly increased risk of transfusion‐transmitted human immunodeficiency virus infection in Australia subsequent to implementing a 12‐month deferral for men who have had sex with men (CME)2015Blood donor deferral for men who have sex with men: the Blood Donation Rules Opinion Study (Blood DROPS)2007The Canadian Blood Donor Health Assessment Questionnaire: Lessons From History, Application of Cognitive Science Principles, and Recommendations for Change 2013Compliance with the current 12‐month deferral for male‐to‐male sex in A ustralia

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2020Blood Donation and COVID-19: Reconsidering the 3-Month Deferral Policy for Gay, Bisexual, Transgender, and Other Men Who Have Sex With Men 2021HIV incidence and compliance with deferral criteria over three progressively shorter time deferrals for men who have sex with men in Canada 2020Gender‐neutral donor deferral policies: experience in Argentina implementing individual risk‐assessment policies 2022Removing the men who have sex with men blood donation deferral: Informing risk models using Canadian public health surveillance data

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