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

On behalf of the Surveillance, Risk Assessment and Policy Sub-group of the ISBT Transfusion Transmitted Diseases Working Party

doi:10.1111/vox.12867

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

On behalf of the Surveillance, Risk Assessment and Policy Sub-group of the ISBT Transfusion Transmitted Diseases Working Party

Research output: Contribution to journal › Article › peer-review

11 Citations (Scopus)

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.

Original language	English
Pages (from-to)	133-139
Number of pages	7
Journal	Vox Sanguinis
Volume	115
Issue number	2
Early online date	27 Nov 2019
DOIs	https://doi.org/10.1111/vox.12867
Publication status	Published - 1 Feb 2020

Bibliographical note

Funding Information: Canadian Blood Services MSM Research Grant.

Open Access: No Open Access licence

Publisher Copyright: © 2019 International Society of Blood Transfusion.

Citation: O'Brien, S.F., Grégoire, Y., Pillonel, J., Steele, W.R., Custer, B., Davison, K.L., Germain, M., Lewin, A., Seed, C.R. and (2020), HIV residual risk in Canada under a three-month deferral for men who have sex with men. Vox Sang, 115: 133-139.

DOI: https://doi.org/10.1111/vox.12867

Keywords

Canada
HIV
MSM
deferral
residual risk

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1111/vox.12867

Cite this

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title = "HIV residual risk in Canada under a three-month deferral for men who have sex with men",

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.",

keywords = "Canada, HIV, MSM, deferral, residual risk",

author = "{On behalf of the Surveillance, Risk Assessment and Policy Sub-group of the ISBT Transfusion Transmitted Diseases Working Party} and O'Brien, {Sheila F.} and Yves Gr{\'e}goire and Josiane Pillonel and Steele, {Whitney R.} and Brian Custer and Davison, {Katy L.} and Marc Germain and Antoine Lewin and Seed, {Clive R.}",

note = "Funding Information: Canadian Blood Services MSM Research Grant. Open Access: No Open Access licence Publisher Copyright: {\textcopyright} 2019 International Society of Blood Transfusion. Citation: O'Brien, S.F., Gr{\'e}goire, Y., Pillonel, J., Steele, W.R., Custer, B., Davison, K.L., Germain, M., Lewin, A., Seed, C.R. and (2020), HIV residual risk in Canada under a three-month deferral for men who have sex with men. Vox Sang, 115: 133-139. DOI: https://doi.org/10.1111/vox.12867",

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doi = "10.1111/vox.12867",

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T1 - HIV residual risk in Canada under a three-month deferral for men who have sex with men

AU - On behalf of the Surveillance, Risk Assessment and Policy Sub-group of the ISBT Transfusion Transmitted Diseases Working Party

AU - O'Brien, Sheila F.

AU - Grégoire, Yves

AU - Pillonel, Josiane

AU - Steele, Whitney R.

AU - Custer, Brian

AU - Davison, Katy L.

AU - Germain, Marc

AU - Lewin, Antoine

AU - Seed, Clive R.

N1 - Funding Information: Canadian Blood Services MSM Research Grant. Open Access: No Open Access licence Publisher Copyright: © 2019 International Society of Blood Transfusion. Citation: O'Brien, S.F., Grégoire, Y., Pillonel, J., Steele, W.R., Custer, B., Davison, K.L., Germain, M., Lewin, A., Seed, C.R. and (2020), HIV residual risk in Canada under a three-month deferral for men who have sex with men. Vox Sang, 115: 133-139. DOI: https://doi.org/10.1111/vox.12867

PY - 2020/2/1

Y1 - 2020/2/1

N2 - 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.

AB - 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.

KW - Canada

KW - HIV

KW - MSM

KW - deferral

KW - residual risk

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JO - Vox Sanguinis

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SN - 0042-9007

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ER -

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

Abstract

Bibliographical note

Keywords

UN SDGs

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