Deferred donor care in a regional hospital blood center in Ghana

Abstract

In sub-Saharan Africa, the viral marker burden in blood donor populations ranges between 10 and 30 percent. Deferred donors constitute a rare population of asymptomatic human immunodeficiency virus (HIV)- and hepatitis B virus (HBV)-infected individuals with high likelihood of long survival if cared for. Deferred donor care provides an opportunity for a public health impact on highly pathogenic infections. Between 2004 and 2007, all candidate donors deferred before donation for reactivity of anti-HIV, hepatitis C virus antibody (anti-HCV), and hepatitis B virus surface antigen (HBsAg) rapid tests were informed and referred to a donor care program consisting of test confirmation, information, counseling, and potential referral for follow-up and therapy. Dedicated trained nurses supervised the program including alanine aminotransferase (ALT) level testing to identify liver disease. In a 4-year period 51,100 donors were screened and 5778, 1578, and 227 candidate donors were deferred for reactivity to HBV, HIV, or HCV serologic markers, respectively. The rates of entry into the donor care program were 48, 14.3, and 22 percent of deferred donors, respectively. A total of 83 of 210 HBsAg-positive donors with elevated ALT levels were referred and 66 received antiviral treatment. A total of 89 of 516 confirmed anti-HIV-positive donors were referred to the hospital acquired immune deficiency syndrome clinic for follow-up. With little additional expense, the deferred donor care program identified asymptomatic infections with high odds of benefiting from monitoring and therapy. In the local circumstances, this public health-limited but definite impact was permitted by the rapid-test pre-donation screening, and this impact could be increased if more resources were available.