Abstract
Risk modelling of transfusion transmissible infections
Blood transfusion can be a lifesaving medical treatment, especially in sub-Saharan Africa. However, there is inherent risk of transfusion transmissible infections (TTIs), which can be minimized by appropriate blood donor selection and testing of blood. Despite these safety interventions, zero-risk is not achievable because of the remaining (residual) risk, hence the need for risk modelling. This thesis focuses on risk modelling of TTIs in sub-Saharan Africa.
We explored the HIV dynamics in the general and blood donor populations in Zimbabwe. This allows the identification of low-risk populations for blood donation purposes. We used three methods for the estimation of the risk of transmitting HBV, HCV and HIV. Comparable results were obtained and this gives confidence on their use for blood safety decision-making. The high HBV prevalence in Zimbabwean blood donors was a striking result. Globalisation is presenting a challenge due to travelling blood donors to risky areas. We developed a novel method to estimate the risk of TTIs by traveller’s, which enables authorities in blood services settings to proactively assess the traveller’s TTIs risk on their domestic blood supply. A cost-effectiveness analysis of introducing individual donation nucleic acid of HBV, HCV and HIV testing in addition to serologic testing in Zimbabwe was conducted. Results were unfavourable on the additional testing option due to cost constraints. However, compared to high-income countries the cost-effectiveness is rather good.
The thesis results indicate the need for more risk modelling studies in resource-constrained settings to optimise blood safety.
Blood transfusion can be a lifesaving medical treatment, especially in sub-Saharan Africa. However, there is inherent risk of transfusion transmissible infections (TTIs), which can be minimized by appropriate blood donor selection and testing of blood. Despite these safety interventions, zero-risk is not achievable because of the remaining (residual) risk, hence the need for risk modelling. This thesis focuses on risk modelling of TTIs in sub-Saharan Africa.
We explored the HIV dynamics in the general and blood donor populations in Zimbabwe. This allows the identification of low-risk populations for blood donation purposes. We used three methods for the estimation of the risk of transmitting HBV, HCV and HIV. Comparable results were obtained and this gives confidence on their use for blood safety decision-making. The high HBV prevalence in Zimbabwean blood donors was a striking result. Globalisation is presenting a challenge due to travelling blood donors to risky areas. We developed a novel method to estimate the risk of TTIs by traveller’s, which enables authorities in blood services settings to proactively assess the traveller’s TTIs risk on their domestic blood supply. A cost-effectiveness analysis of introducing individual donation nucleic acid of HBV, HCV and HIV testing in addition to serologic testing in Zimbabwe was conducted. Results were unfavourable on the additional testing option due to cost constraints. However, compared to high-income countries the cost-effectiveness is rather good.
The thesis results indicate the need for more risk modelling studies in resource-constrained settings to optimise blood safety.
| Original language | English |
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| Qualification | Doctor of Philosophy |
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| Supervisors/Advisors |
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| Award date | 9-Dec-2016 |
| Place of Publication | [Groningen] |
| Publisher | |
| Print ISBNs | 978-94-6233-462-5 |
| Electronic ISBNs | 978-94-6233-463-2 |
| Publication status | Published - 2016 |