Improving Blood Safety and HIV Testing in Brazil

Study Description

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Brief Summary:

Conduct a randomized controlled trial (RCT) to test the hypothesis that offering client-centered HIV counseling and testing (HCT) to blood donor candidates will reduce the risk of HIV contamination in the blood supply and also increase appropriate referrals to preventive and care services to persons in need in São Paulo, Brazil.

Condition or disease	Intervention/treatment	Phase
HIV; Herpes Simplex 2; Hepatitis C; Hepatitis B; Chagas Disease	Behavioral: HIV Counseling and Testing; Behavioral: Blood Donation	Not Applicable

Detailed Description:

Although all donated blood is screened for HIV antibodies, a residual risk of contamination persists due to the immunological window period before antibodies are detectable. Deferral of donors with behavioral risks for HIV is one means to reduce window period contamination; recruitment of voluntary donors from the community (versus family replacement donors) is held to be another. Contrary to expectation, a shift to community donors has not resulted in a decrease in HIV prevalence in units of blood collected by the investigators transfusion service. The investigators preliminary research indicates that some persons at elevated risk use donation as a means of testing for HIV. These test-seeking donors have high trust in the blood bank, do not know other places to receive testing, have low understanding of the immunological window period and believe it is acceptable to deny risk in order to be tested through donation. The test-seeking phenomenon may therefore threaten the safety of the blood supply. Test seeking at blood banks also ill serves persons who need risk reduction counseling because they cannot disclose their true behavior during the donation process and still be tested. Donors also have a low rate of return for test results and therefore do not receive confirmation or referrals to care.

To assess whether HCT at the time of donation will improve blood safety and address prevention and care needs, the investigators will randomize donor candidates to be offered this service on-site. As a biological marker for elevated risk for HIV, the investigators will compare the prevalence of HSV-2 among donors choosing testing to those choosing to donate when offered the choice (Aim 1). The impact of the intervention will be measured as an increase in persons receiving their test results, disclosure counseling and referrals (Aim 2). Secondary outcomes include differences in prevalence of transfusion-transmitted infections (HIV, HCV, HBV, syphilis, HTLV I/II, Chagas disease), donor motivations (e.g., test-seeking vs. altruism), donor deferral rates, use of confidential unit exclusion, satisfaction with procedures of the blood bank and volume of blood available for use. RCT results will provide rigorous evidence for or against the provision of on-site HCT as an effective means to improve blood safety and link individuals to needed health services.

Study Design

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Study Type :	Interventional (Clinical Trial)
Actual Enrollment :	11900 participants
Allocation:	Randomized
Intervention Model:	Factorial Assignment
Masking:	None (Open Label)
Primary Purpose:	Prevention
Official Title:	Improving Blood Safety and HIV Testing in Brazil: a Randomized Controlled Trial
Actual Study Start Date :	August 1, 2012
Actual Primary Completion Date :	May 31, 2013
Actual Study Completion Date :	January 31, 2015

Arms and Interventions

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Study Description Study Design Arms and Interventions Outcome Measures Eligibility Criteria Contacts and Locations More Information

Arm	Intervention/treatment
Experimental: Approved Intervention Counseling; Approved blood donors randomized to intervention and choosing HIV counseling option with no donation.	Behavioral: HIV Counseling and Testing; HIV counseling and testing in lieu of blood donation.
Experimental: Approved Intervention Donation; Approved blood donors randomized to intervention and choosing donation with no HIV counseling.	Behavioral: Blood Donation; Blood donation without HIV counseling
Experimental: Deferred Intervention; Deferred blood donors randomized to intervention with HIV counseling.	Behavioral: HIV Counseling and Testing; HIV counseling and testing in lieu of blood donation.

Outcome Measures

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Primary Outcome Measures :

1. HSV-2 Prevalence in Blood Donors [ Time Frame: Up to three years. ]
   As a biological marker for elevated risk for HIV, we will compare the prevalence of HSV-2 among donors choosing testing to those choosing to donate when offered the choice.
2. Intervention Impact in Blood Donors [ Time Frame: Up to three years. ]
   The impact of the intervention will be measured as an increase in persons receiving their test results, disclosure counseling and referrals.

Secondary Outcome Measures :

1. Prevalence of Transfusion-Transmitted Infections in Blood Donors [ Time Frame: Up to three years. ]
   Differences in prevalence of transfusion-transmitted infections (HIV, HCV, HBV, syphilis, HTLV I/II, Chagas disease) between arms.

Eligibility Criteria

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Ages Eligible for Study:	18 Years to 65 Years (Adult)
Sexes Eligible for Study:	All
Accepts Healthy Volunteers:	Yes

Criteria

Inclusion Criteria:

• Study subjects will be Portuguese-speaking persons age 18-65 years (determined by Brazilian law to be the age of donation), who present to donate blood at our center during the study period and who provide written informed consent.

Exclusion Criteria:

• All those not meeting inclusion criteria.

Contacts and Locations

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Locations

Brazil
Fundação Pró-sangue Hemocentro de São Paulo
Sao Paulo, Brazil, 05403-000

Sponsors and Collaborators

Blood Systems Research Institute

Investigators

Principal Investigator:	Thelma T. Goncalez, MD, PhD	Blood Systems Research Institute

More Information

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Publications automatically indexed to this study by ClinicalTrials.gov Identifier (NCT Number):

Goncalez TT, Blatyta PF, Santos FM, Montebello S, Esposti SP, Hangai FN, Salles NA, Mendrone A, Truong HM, Sabino EC, McFarland W. Does offering human immunodeficiency virus testing at the time of blood donation reduce transfusion transmission risk and increase disclosure counseling? Results of a randomized controlled trial, São Paulo, Brazil. Transfusion. 2015 Jun;55(6):1214-22. doi: 10.1111/trf.13009. Epub 2015 Feb 3.

Responsible Party:	Blood Systems Research Institute
ClinicalTrials.gov Identifier:	NCT01681420 History of Changes
Other Study ID Numbers:	10849
First Posted:	September 10, 2012
Last Update Posted:	January 18, 2018
Last Verified:	January 2018

Keywords provided by Blood Systems Research Institute:

HIV counseling; Blood donor HIV testing; Brazil; Blood banks; Blood donors

Additional relevant MeSH terms:

Hepatitis; Hepatitis A; Hepatitis C; Hepatitis B; Herpes Simplex; Chagas Disease; Liver Diseases; Digestive System Diseases; Hepatitis, Viral, Human; Virus Diseases; Enterovirus Infections; Picornaviridae Infections	RNA Virus Infections; Flaviviridae Infections; Hepadnaviridae Infections; DNA Virus Infections; Herpesviridae Infections; Skin Diseases, Viral; Skin Diseases, Infectious; Skin Diseases; Trypanosomiasis; Euglenozoa Infections; Protozoan Infections; Parasitic Diseases