Reactive Screening Tests Research Articles

HIV, HCV and HIV-HCV Coinfections in the General Population versus Inmates from Romania.

The objective of this study was to analyze the epidemiological links of the human immunodeficiency virus (HIV), hepatitis C virus (HCV) and HIV-HCV coinfections to less studied types of transmission in certain populations. We performed an observational, prospective study on 903 patients aged between 15-87 years who took part in the Open Test Project. They were divided in two subgroups: general population vs. individuals from prisons who were questioned about multiple risk factors. A chi-square independence test was used to establish correlations between risk factors and results of screening tests. Logistic regression was used to calculate the probability of a reactive screening test based on each independent risk factor and age. HIV was very strongly associated with unprotected sexual intercourse with HIV-positive partners (the strongest association), unprotected sexual intercourse with sex workers, newly diagnosed sexually transmitted diseases (STDs), intravenous drug users (IDUs) and sharing injecting materials. In the case of HCV reactive tests, very strong associations have been established with IDUs (the strongest association), unprotected sex with IDUs and sharing injecting materials. Our study indicates the need for implementing targeted public health programs, tailored to the local epidemiology that can ultimately lead to micro-elimination of hepatitis and HIV infections in this area.

Response rate of blood donors with reactive screening test to the blood bank section notifications of Batangas Medical Center from 2018 to 2019

Response rate of blood donors with reactive screening test to the blood bank section notifications of Batangas Medical Center from 2018 to 2019

Evaluation of a Treponema IgG ELISA alone and in combination with an IgM ELISA as substitutes for Treponema pallidum particle agglutination (TPPA) as confirmatory tests in a two-tier diagnostic algorithm for diagnosis of syphilis infection

Abstract Objectives The Treponema pallidum particle agglutination (TPPA) has been used for decades for serological diagnostics of syphilis but is no longer available. Therefore, we evaluated the Treponema IgG ELISA (TpG) alone and in combination with the Treponema IgM ELISA (TpG+M, both from Euroimmun) as possible substitutes for TPPA as a confirmatory test in a two-tier syphilis screening algorithm. Furthermore, we investigated whether a TPPA titer of 5,120 which is used as cut-off for therapeutic decision in pregnant women in Germany can be transferred to an appropriate cut-off value of the TpG. Methods All serum samples with reactive syphilis screening test (CLIA, Diasorin) within a 13-months period were included (n=739). In addition to TPPA and rapid plasma reagin test both ELISA tests were done in all samples. Results Sensitivity, specificity, positive and negative predictive values were 92.2, 100, 100, and 74.5 % for TpG, and 93.2, 85.4, 96.6, and 74.1 % for TpG+M. By ROC analysis the cut-off of TpG corresponding to a TPPA titer ≥5,120 was calculated to be 54 RU/mL with a sensitivity of 99.6 % and a resulting specificity of 58.6 %. Conclusions TpG appears suitable to substitute TPPA as a confirmatory test for syphilis diagnostics but TpG-negative samples have to be evaluated by further tests like FTA-Abs or immunoblot. Treponema IgM determined in addition to TpG did not improve the test performance compared to the TPPA as a reference standard. Valid prediction of a TPPA titer ≥5,120 from TpG result appears not reasonable.

The Challenge of Preoperative Panel Reactive Antibody Positivity in Parathyroid Transplantation.

Identifying suitable recipient criteria and matching recipients with appropriate donors are required to increase survival for parathyroid transplant. This study was undertaken to evaluate transplant survival rates while comparing preoperative panel reactive antibody positivity. The study included 14 hypoparathyroidism patients who presented to our clinic for parathyroid transplant. Preoperative ABO compatibility and negative cross-match tests were prioritized for recipient-donor matching, and panel reactive antibody screening tests were performed. During the 24-month follow-up, we evaluated medication use and serum calcium, phosphorus, and parathormone levels of patients. Preoperative panel reactive antibody positivity was assessed in 3 groups. The HLA class I-positive group (mean fluorescence intensity range, 179-1770) showed decreased medication use and stability in serum calcium levels. The HLA class IIpositive (mean fluorescence intensity range, 85-3959) showed decreased medication use by 25% to 50% and returned to their former prescription doses after 12 months. An opposite pattern was observed in 2 patients with panel reactive antibody positivity for both HLA classes (mean fluorescence intensity range, 462-2289), with 1 patient requiring medication for continuing symptoms and the other patient occasionally taking additional magnesium supplementation, despite decreased medication doses after 12 months. Serum calcium levels remained normal, and parathormone and phosphorus levels were elevated. Improving patient symptoms and having no requirement for intravenous calcium replacement are priorities, and monitoring serum levels is the next important step. Varied panel reactive antibody positivities and survival rates indicate a requirement, and each HLA class could require a proper limitation for the mean fluorescence intensity. Preoperative mean fluorescence intensity cut-off value should be <900. Higher mean fluorescence intensity values in panel reactive antibody screenings could increase risk of short-term graft survival after parathyroid transplant. Further studies should include immunological risk assessments by individualizing the outcome with donor-specific antibodies.

The state of the pediatric HIV epidemic in Lesotho.

Lesotho does not have reliable data on HIV prevalence in children, relying on estimates generated from program data. The 2016 Lesotho Population-based HIV Impact Assessment (LePHIA) aimed to determine HIV prevalence among children 0-14 years to assess the effectiveness of the prevention of mother-to-child transmission (PMTCT) program and guide future policy. A nationally representative sample of children under 15 years underwent household-based, two-stage HIV testing from November 2016-May 2017. Children <18 months with a reactive screening test were tested for HIV infection using total nucleic acid (TNA) PCR. Parents (61.1%) or legal guardians (38.9%) provided information on children's clinical history. Children aged 10-14 years also answered a questionnaire on knowledge and behaviors. HIV prevalence was 2.1% [95% confidence interval (CI): 1.5-2.6]. Prevalence in 10-14 year olds (3.2%; 95% CI: 2.1, 4.2) was significantly greater compared to 0-4 year olds (1.0%; 95% CI: 0.5, 1.6). HIV prevalence in girls and boys was 2.6% (95% CI: 1.8-3.3) and 1.5% (95% CI: 1.0-2.1), respectively. Based on reported status and/or the presence of detectable antiretrovirals, 81.1% (95% CI: 71.7-90.4) of HIV-positive children were aware of their status, 98.2% (95% CI: 90.7-100.0) of those aware were on antiretroviral therapy (ART) and 73.9% (95% CI: 62.1-85.8) of those on ART were virally suppressed. Despite the roll-out of Option B+ in Lesotho in 2013, pediatric HIV prevalence remains high. Further research is required to understand the greater prevalence among girls, barriers to PMTCT, and how to better achieve viral suppression in children with HIV.

Lyme Disease - Laboratory Diagnostics

Lyme Disease - Laboratory Diagnostics Abstract. Lyme borreliosis is caused by Borrelia burgdorferi. Laboratory testing for Borrelia-specific antibodies is crucial for the diagnosis of Lyme borreliosis in addition to clinical definitions. The diagnostic approach consists of a two-tier testing: firstly, a highly sensitive screening test such as an enzyme immunoassay and secondly, a highly specific confirmatory assay such as a line immunoblot. The screening test detects Borrelia-specific IgM and IgG antibodies but also unspecific antibodies or cross-reactive antibodies against Treponema (causative agent of syphilis). Thus, a reactive screening test always needs confirmation by a specific test such as the immunoblot thereby resolving specific antibodies against different Borrelia antigens. Moreover, the characteristic spectrum of bands in the immunoblot provides evidence to divide the immune response into an early or a late stage of the disease. For the diagnosis of Lyme neuroborreliosis, intrathecal antibody production to B. burgdorferi should be determined by analyzing paired serum and cerebrospinal fluid samples obtained on the same timepoint. Diagnostics of Lyme borreliosis requires a comprehensive report of Borrelia-specific antibody responses and clinical manifestations.

Follow-Up of Plasma Donors after Quarantine Storage: Results of a 5-Year Survey in Germany

Background and Objectives: In 1993, a quarantine storage of 6 months was introduced for plasma for transfusion and was reduced to 4 months in 2003, owing to the improvements of screening assays used in German blood establishments. The presented survey analyses the value of quarantine storage under the current screening conditions. Materials and Methods: From 2015 to 2019, we collected data on the total amount of released quarantine plasma as well as on the number of quarantine plasma not released due to a reactive screening test of a follow-up donation. Results: Responding establishments covered 84% of plasma units released within the sampled period. In 3,583,913 (99.98%) of the total 3,584,664 test pairs, all screening assays revealed a negative result, leading to plasma release from quarantine storage. In 442 out of the residual 751 cases, confirmed positive results for human immunodeficiency virus (24), hepatitis C virus (22), or hepatitis B virus (396) were obtained in the follow-up donations. Of them, 372 revealed negative ID-NAT results in their retain samples confirmed by using highly sensitive individual donor nucleic acid amplification technology. In 70 cases, no testing of retain samples was performed as plasma was released for fractionation. The maximum theoretical risk for an undetected human immunodeficiency virus, hepatitis C or B virus infection was less than 0.0001%. Conclusion: No positive donation were found under the current screening regime and the quarantine storage during the 5-year survey period. In view of the current type and sensitivity of screening tests in German blood establishments, the results allow a reassessment of the value of quarantine storage of plasma regarding duration and release modalities. Due to the more sensitive donor screening, shorter quarantine periods as well as dispensing quarantine storage can be discussed. A reduction in the safety standard of plasma transfusions need not be feared, and the availability of plasma for transfusions could be facilitated.

Evaluation and adjustment of screening algorithms for HBV, HCV, HIV and syphilis in an anatomical donation program for undergraduate education

Study objectiveUndergraduates and other users of anatomical donors are at risk of exposure to bloodborne pathogens. This study evaluated screening algorithms for hepatitis B and C virus, human immunodeficiency virus and Treponema pallidum during donor allocation and assessed the impact of postmortem time on hemolysis and how hemolysis affects test results and donor discard rate.MethodsFrom 2011‐2018, demographic data of donors, time of postmortem blood sampling, presence of sample hemolysis, serological test results (negative; active infection; false reactive screening test; historic infection; inconclusive; technically impracticable) and the actual donor allocation were collected.ResultsDonors (n=537) had a mean age of 77.53±13.67 year. Nine (1.68%) had test results indicative for active infection for hepatitis B (n=1) and C virus (n=2), human immunodeficiency virus (n=5) and Treponema pallidum (n=1). Negative screenings ranged from 74.67 to 97.58%, depending on the pathogen. Based on the screening algorithms, 479 (89.20%) donors should have been accepted. In practice, a donor acceptance rate of 91.20% was found. Analysis of potential donor allocation interpretation obstacles resulted in simplification of the testing algorithms and addition of a nucleic acid test to increase the reliability for identification of active (acute) human immunodeficiency virus infection. Hemolysis was more common when sampling was performed more than 24 hours after death (p&lt;0.001). Hemolytic samples more frequently showed a reactive or indeterminate human immunodeficiency virus test result (p&lt;0.001). Screening for human immunodeficiency virus and Treponema pallidum was technically more impracticable when hemolysis was present (p=0.042 and p=0.003, respectively). Donors with hemolytic blood samples were more often discarded (46.88%) compared to bodies with non‐hemolytic samples (6.32%) (p&lt;0.001).ConclusionsDespite the use of screening algorithms, many bodies used for undergraduate education have an inconsistent allocation. Simplified algorithms were made and are currently prospectively assessed. Early postmortem blood sampling is key as hemolysis can influence certain test results and donor allocation.

Screening algorithms for HBV, HCV, HIV and syphilis in an anatomical donation program

BackgroundUsers of anatomical donors are at risk of exposure to bloodborne pathogens. This study evaluated screening algorithms for hepatitis B and C virus, human immunodeficiency virus and Treponema pallidum during donor allocation and assessed the impact of postmortem time on hemolysis and how hemolysis affects test results and donor discard rate. MethodsFrom 2011 to 2018, demographic data of anatomical donors, time of postmortem blood sampling, presence of sample hemolysis, serological test results (negative; active infection; false reactive screening test; historic infection; inconclusive; technically impracticable) and the actual donor allocation were collected. ResultsDonors (n = 537) had a mean age of 77.53 ± 13.67 (24–103) year. Nine (1.68%) had laboratory test results indicative for active infection for hepatitis B (n = 1) and C virus (n = 2), human immunodeficiency virus (n = 5) and T. pallidum (n = 1). Negative screenings ranged from 74.67 to 97.58%, depending on the pathogen. According to the original screening algorithms, 479 (89.20%) donors should have been accepted. In practice, a donor acceptance rate of 91.20% was found. Analysis of potential donor allocation interpretation obstacles resulted in simplification of the in-house laboratory testing algorithms and addition of a nucleic acid test to increase the reliability for identification of active (acute) human immunodeficiency virus infection. Hemolysis was more common when sampling was performed more than 24 h after death (p < 0.001). Hemolytic samples more frequently showed a reactive or indeterminate human immunodeficiency virus test result (p < 0.001). Screening for human immunodeficiency virus and T. pallidum was technically more impracticable when hemolysis was present (p = 0.042 and p = 0.003, respectively). Donors with hemolytic blood samples were more often discarded (46.88%) compared to bodies with non-hemolytic samples (6.32%) (p < 0.001). ConclusionsDespite the implementation of donor screening algorithms, a significant number of bodies have an inconsistent allocation. New algorithms, to be evaluated in future research, were suggested. Early postmortem blood sampling is key as hemolysis can influence certain test results and donor allocation.

Donor notification and counseling: Experiences and challenges from a private multi-specialty hospital in South India.

BACKGROUND:Donor notification and counseling plays a vital role in both blood safety and comprehensive donor care. This process informs donors about their status as to transfusion-transmitted infections (TTI), modes of transmission of such infections and helps prevent secondary transmission of these infections in the community.AIMS AND OBJECTIVES:This study was initiated to see the response rate of notified reactive donors for counseling and to propose useful recommendations that could probably improve the response rate.MATERIALS AND METHODS:Total of 17025 donations was screened for TTIs, namely, human immunodeficiency virus (HIV), hepatitis B virus (HBV), hepatitis C virus (HCV), and syphilis, by serology. All TTI reactive donors were retested and notified of their status by telephone and called for repeat testing followed by face-to-face counseling and referral for treatment.RESULTS:We evaluated 183(1.07%) donors with reactive screening test results, i.e., 106(57.9%) HBV, 38(20.7%) HCV, 29(15.8%) HIV, and 11(0.6%) were syphilis reactive and all (100%) were from replacement blood donations. Only 58.4%(107) of donors could be personally communicated over telephone and only 49 (45.79%) of them returned for counseling. Three (6.1%) among the reactive donors knew their results earlier and 11(22.4%) donors had history of high-risk behavior.CONCLUSION:In spite of strict donor screening and self-exclusion option, donors conceal their high-risk behaviors or their reactive status and continue to donate blood. It reflects the need to implement thorough predonation counseling to extract the history of high-risk factors from the donors.

Screening of Donated Blood for Transfusion Transmitted Infections by Serology and Response Rate to Notification of Reactive Results: A Tertiary Care Institutional Experience

Background: Safety for blood Transfusion begins with healthy donors. A basic part of preventing transfusion transmitted infections (TTIs) is to notify and counsel reactive donors. This study analysed trends in the prevalence of transfusion-transmissible infectious pathogens among blood donors and notify them as well as to assess response rate among them. Donor notification and counselling protect the health of the donor and stop secondary transmission of infectious diseases.&#x0D; Methods: 38707 blood donations were screened for TTIs, namely, HIV, HBV, HCV, and syphilis, Malarial Parasite by serology. ELISA testing for anti-HIV antibody, anti-HCV antibody and HBsAg and RPR test for syphilis, Rapid card test for Malarial Parasite. All reactive donors were retested in duplicate and notified of their status by communicating through telephone. &#x0D; Result: We evaluated 341 (0.88%) cases with reactive screening test results (0.617% HBV, 0.016% HCV, 0.134% HIV, 0.08% syphilis, 0.031% Malaria ). Only 179 donors (52.5%) responded to notification. The response among voluntary donors was better as compared to the replacement donors (54.1 % versus 40.7 %). Only 101 (57.22%) responsive donors followed their first attendance at referral clinic. &#x0D; Conclusion: Our study provides prevalence rate of TTIs among blood donors and importance of proper donor counselling and notification of TTI status to all reactive donors who opt to receive this information.

The contribution of HIV point-of-care tests in early HIV diagnosis: community-based HIV testing monitoring in Catalonia, 1995 to 2018.

BackgroundCommunity-based HIV testing services combined with the use of point-of-care tests (POCT) have the potential to improve early diagnosis through increasing availability, accessibility and uptake of HIV testing.AimTo describe community-based HIV testing activity in Catalonia, Spain, from 1995 to 2018, and to evaluate the impact of HIV POCT on the HIV continuum of care.MethodsA community-based network of voluntary counselling and testing services in Catalonia, Spain has been collecting systematic data on activity, process and results since 1995. A descriptive analysis was performed on pooled data, describing the data in terms of people tested and reactive screening test results.ResultsBetween 1995 and 2018, 125,876 HIV tests were performed (2.1% reactive). Since the introduction of HIV POCT in 2007, a large increase in the number of tests performed was observed, reaching 14,537 tests alone in 2018 (1.3% reactive). Men who have sex with men (MSM), as a proportion of all people tested, has increased greatly over time reaching 74.7% in 2018. The highest percentage of reactive tests was found in people who inject drugs followed by MSM. The contribution of community-based HIV testing to the overall total notified cases in the Catalonia HIV registry has gradually increased, reaching 37.9% in 2018, and 70% of all MSM cases. In 2018, the percentage of individuals with a reactive screening test who were linked to care was 89.0%.ConclusionOur study reinforces the important role that community-based HIV POCT has on the diagnosis of HIV in key populations.

199 False Positive or Acute Seroconversion? Examination of Patterns of Equivocal HIV Screening in the ED.

We consider the clinical presentation of patients with equivocal HIV test results in the ED (HIV Ab/Ag +, HIV Ab -) found through routine ED-based HIV screening and further describe those patients who presented to the ED during acute seroconversion (acute +) compared to the clinical characteristics of patients who were ultimately found to have false + initial screening results. We analyzed 4 years of HIV testing data (2016-2020) and determined the number of patients who had a Ab/Ag + screen. Patients with Ab/Ag + but a non-equivocal HIV+ lab signature (Ab/Ag +, Ab +, viral load > 0) were removed. Then we determined the remaining number with an equivocal laboratory signature (Ab/Ag +, Ab -). We separated those patients into 2 groups: false + (Ab/Ag +, Ab -, viral load 0) and acute + (Ab/Ag +, Ab -, viral load > 0). We conducted chart review on all patients with an equivocal laboratory signature and the clinical presentation was considered to detail patterns in false + compared to acute + patients presenting to the ED. We screened approximately 55,224 patients for HIV (16% volume) in 4 years. 787 patients had a Ab/Ag + result (1.4%) and, of those, 688 had non-equivocal positive HIV results (87.4% of Ab/Ag +, 1.2% of tested). 99 (12.5% of Ab/Ag +, 0.13% tested) were Ab/Ag +, Ab -. Of those 99, 73 had no detectable HIV RNA (false +, 9.3% of Ab/Ag +, 0.13% tested). 26 of the 99 with equivocal results had viral load > 0 (acute +, 3.3% of Ab/Ag +, 0.05% tested). Qualitative review of equivocal patient charts during the Ab/Ag reactive screening encounter showed statistically significance for acute positive results in younger male patients who have sex with men. 787 patients had a reactive screening test but 99 had an equivocal laboratory signature (12.5% of Ab/Ag+), making the information difficult to interpret during an ED encounter in high prevalence populations and challenging the ability to scale up ED based HIV screening, especially given the long turn around time for HIV RNA testing via PCR. ED based screening is an important strategy to help reach the WHO goal of eliminating HIV as a public health threat by 2030. However, the current algorithm and existing testing technology may not be best designed for acute clinical encounters and false + encounters are higher than previously reported. The results of this study detail characteristics of patients with equivocal test results that may improve clinical decision making in patients with false + compared to acute + laboratory signatures and suggest that young men who have sex with men and have a reactive HIV screening test in the ED should be considered HIV positive.

Polymerase chain reaction primer sets for the detection of genetically diverse human sapoviruses.

Sapoviruses are increasingly being recognized as pathogens associated with gastroenteritis in humans. Human sapoviruses are currently assigned to 18 genotypes (GI.1-7, GII.1-8, GIV.1, and GV.1-2) based on the sequence of the region encoding the major structural protein. In this study, we evaluated 11 polymerase chain reaction (PCR) assays using published and newly designed/modified primers and showed that four PCR assays with different primer combinations amplified all of the tested human sapovirus genotypes using either synthetic DNA or cDNA prepared from human sapovirus-positive fecal specimens. These assays can be used as improved broadly reactive screening tests or as tools for molecular characterization of human sapoviruses.

1072: Evaluating the clinical impact of implementing reverse syphilis screening at a large public hospital

To compare the frequency, staging, and treatment of maternal syphilis cases and infant evaluations before and after implementing a reverse screening algorithm (using a treponemal-specific antibody assay) at a high-volume public hospital. On May 16, 2018, our hospital laboratory switched from a Traditional to a Reverse Sequence Screening algorithm. We prospectively identified deliveries to women with reactive syphilis screening tests between May 16-Dec 31, 2018, and compared these to a retrospective cohort of deliveries identified one year prior, May 16-Dec 31, 2017. We compared the number of women with reactive screening tests according to study week in each cohort. We evaluated maternal demographics, syphilis staging and treatment, and infant outcomes in 2017 and 2018. The number of women with reactive screening tests was higher throughout the study period following implementation of the reverse algorithm (Figure 1). The total number of women with reactive screening tests more than doubled, from 45 (2017) to 122 (2018); total deliveries were similar. There was no difference in age, parity, mode of delivery, or gestational age at delivery. There were more Black women with reactive treponemal antibodies in the 2018 cohort (57% in 2018 vs 36% in 2017, p=0.02). Compared with 2017, the proportion of women with previously treated syphilis increased in 2018 (43% from 20%), the frequency of untreated syphilis remained relatively unchanged (51% in 2017 vs 47% in 2018), and the frequency of false positive tests declined (29% in 2017 vs 13% in 2018) (overall p=0.003) (Table 1). Relative to 2017, the proportion with nonreactive RPR increased (61% vs 16%, p< 0.001). Although the proportion of treated women remained similar, absolute numbers requiring treatment doubled. Similarly, absolute numbers of infants undergoing lumbar puncture and receiving treatment increased two to three-fold. Implementation of the reverse syphilis screening algorithm results in a three to four-fold increase in the frequency of RPR-nonreactive maternal cases requiring evaluation and possible treatment.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Hepatitis C Screening in Community-Based Voluntary Counselling and Testing Services in Europe: An Observational Study from the COBATEST Network 2014-2018.

The COBATEST Network links community-based voluntary counselling and testing (CBVCT) services in the European region and collects testing data using standardised data collection tools. This study aims to describe the population being screened for anti-HCV antibodies in the COBATEST Network and identify risk factors associated with a reactive HCV screening test result in the period 2014–2018. Clients aged > 16 screened for HCV in the period 2014–2018 at one of the Network’s CBVCT services were included in the study. In the 5 year period, 7426 clients were screened for HCV in 22 centres in 10 countries and anti-HCV antibodies were detected in 113 (1.5%). The majority of people screened were aged 25–44, men who have sex with men (MSM), not HIV+ , not reporting a history of injecting drug use or sex work. Detection of anti-HCV antibodies was associated with being HIV + MSM (aOR 9.1, 95% CI 3.8; 21.8 compared to HIV-clients) and being a person who injects drugs (PWID, aOR 28.1, 95% CI 17.6; 45.0, compared to people with no history of injecting drug use). This study demonstrates that HIV-MSM with no history of injection drug use are using CBVCT services for HCV screening, but reactive screening test is associated with being HIV+ or PWID. The integration of HCV screening into the CBVCT service model may widen access to testing for populations that may otherwise not be tested.Electronic supplementary materialThe online version of this article (10.1007/s10900-019-00780-0) contains supplementary material, which is available to authorized users.

The COBATEST network: monitoring and evaluation of HIV community-based practices in Europe, 2014-2016.

The objective of this paper is to describe the data collected by the CBVCT services from the Community-based testing (COBATEST) network, from 2014 to 2016, in order to provide an insight into community-based voluntary counselling and testing (CBVCT) services' testing activity in Europe. A descriptive analysis of HIV testing activity in CBVCT services that are using the COBATEST tools was performed for the period 2014-2016. During the study period, a total of 30329 HIV tests were performed on 27934 individuals, of which 1.8% were reactive. Of these reactive tests, 75.8% had a confirmatory test, 92.2% of those were confirmed as positive, and 90.38% of the confirmed positives were linked to care. The total number of tests performed over the study period increased 19.31%. The proportion of confirmatory tests increased from 63.0% to 90.0% and proportion linked to care increased from 84.1% to 93.8%. Most of the tested individuals were men (70.6%), aged between 21 and 35years (58.5%) and non-foreign born (68.1%). A high proportion of individuals tested were men who have sex with men (MSM; 42.2%). The percentage of reactive screening tests was particularly high among transgender people (8.37%) and among male sex workers (6.38%). Repeat testers had a higher percentage of reactive tests (2.02%) than those tested for first time (1.1%). These results prove the feasibility of collecting standardized data from CBVCT services in different countries across Europe and demonstrate the usefulness of such data.

Comparison of Anti-HLA Antibody Production According to Gestational Periods in Pregnant Women

BackgroundTo evaluate paternal anti-HLA antibody profiles, sera samples were collected from pregnant women in different trimesters and the panel-reactive antibody (PRA) specificities were identified. MethodsFrom 2013 to 2015, serum samples were obtained from 41 pregnant women who had registered at the Izmir Tepecik Education and Research Hospital Gynecology Clinic. Anti-HLA antibodies were screened by using the panel reactive antibody screening and identification tests. Sera samples were obtained at the first, second, and third trimesters. The primary outcome was to determine the anti-HLA antibody production term during pregnancy; the secondary outcome was identification of anti-HLA antibodies. ResultsNone of the women had a sensitization history except during pregnancy. We observed that 54% of the women produced paternal antibodies, either class I or II. Class I PRA positivity of the women who had a first or second pregnancy was the same in all 3 trimesters, whereas class II positivity was increased in the third trimester. Class II and both class I and II positivity increased in the third trimester; class I positivity was decreased in the third trimester. PRA positivity could be affected by the history of pregnancy and could be raised, but no impact was observed from the history of abortion and miscarriage (odds ratios, 1.9, 0.4, and 0.5 [95% confidence intervals, 0.5–7.8, 0.1–2.0, and 0.3–0.7], respectively; P > .05). The most frequently detected antibodies were A2, B7, DR7, DR4, DR11, DR13, DQ2, and DQ8. ConclusionsAnti-HLA antibodies against paternal HLA antigens were detected more in multiparous women than in primiparous women. Anti-HLA antibody detection ratios did not change until the third trimester and were followed by a specific increase in class II anti-HLA antibody production.

Reactive donor notification and counseling: Reveals concealed risk factors

Background and Objective: In spite of newer sensitive screening techniques, blood transfusion is still associated with a small risk of transmitting infectious diseases. A very important and efficient method of curtailing transfusion transmitted infections (TTIs) is notifying and counseling the TTI reactive donors. Materials and Methods: Totally, 4281 donations were screened for TTI, namely, human immunodeficiency virus (HIV), hepatitis B virus (HBV), hepatitis C virus (HCV), and syphilis, by serology. All TTI reactive donors were retested and notified of their status by telephone or letter and called for repeat testing followed by face-to-face counseling and referral for treatment. Results: We evaluated 116 (2.7%) donors with reactive screening test results, i.e., 41 (1%) HBV, 61 (1.4%) HCV, 12 (0.3%) HIV, and 2 (0.05%) reactive for both HIV and HCV while none of donors were syphilis reactive. Only 35.34% (41) of donors responded to notification. The response from voluntary donors was comparatively less as compared to the replacement donors (34.6% vs. 41.7%). Around 22 (53.7%) of counseled reactive donors revealed history of high-risk behavior/factors which were not disclosed during donor registration and screening. Conclusion: In spite of strict donor screening and self-exclusion option, donors conceal their high-risk behaviors and continue to donate blood. It reflects the need to implement predonation counseling to extract the history of high-risk factors from the donors. Maintenance of privacy during donor screening, predonation education and counseling and postnotification counseling of reactive donors are recommended. National guidelines for notification of reactive donors need to be formulated.

A randomized trial to evaluate the use of text messaging, letter, and telephone call reminders to improve return of blood donors with reactive serologic tests.

Low return rates for notification and counseling among donors with reactive serologic screening tests have been reported worldwide. A randomized trial to test the effectiveness of text message, letter, or telephone call reminders to improve return among nonresponding first-time blood donors with reactive serologic tests was conducted. Donors with serologically reactive screening test results who had a cell phone and resided in the metropolitan telephone area code of São Paulo in the period from August 2013 through July 2014 were eligible. A consecutive sample of first-time donors with reactive screening tests who had not responded to a standard letter requesting the donor return to the blood center were randomly assigned to receive a text, a new letter, or a telephone call requesting return for notification and counseling. Return rates were measured over the subsequent 30 days. The return rate after a phone call reminder was better than that for a text message (39.8% vs. 28.4%; odds ratio [OR], 1.66; 95% confidence interval [CI], 1.05-2.64) but not better than that for a letter (39.8% vs. 34.4%; OR, 1.26; 95% CI, 0.80-1.99). Older age was a predictor of higher rate of return with each year increase in age associated with a 2% increase in the odds of return (OR, 1.02; 95% CI, 1.01-1.04). In nonresponding serologic reactive donors, telephone call led to a higher return rate than text message. The results of this study suggest that use of text messages, while attractive for its simplicity, will not lead to increased donor notification success after serologically reactive marker results from blood donation in Brazil.