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By decreasing the pre-seroconversion window period, nucleic acid testing (NAT) has improved the safety of blood products and reduced the risk of transfusion-transmitted infections. Between 2011 and 2017, NAT determinations for approximately 898,202 donations were performed at Fundação Pró-Sangue/Hemocentro de São Paulo (FPS-HSP). Three seronegative HIV-viremic donations were detected. The NAT yield rate per million donations was 3.34 for HIV, and the acute HIV-1 infections detected are described, followed by a brief review of the situation in Brazil.

In a randomized controlled trial (RCT) in a blood bank in São Paulo, we tested the hypotheses that offering client-centered human immunodeficiency virus (HIV) counseling and testing to blood donors would: 1) reduce the risk of HIV contamination in the blood supply by diverting higher-risk, test-seeking donors away from donation and 2) increase return for results and referrals to care.We randomly selected weeks between August 2012 and May 2013 when donors were offered HIV counseling and testing (n = 6298), leaving usual procedure weeks as control (n = 5569).Few candidate donors chose HIV testing (n = 81, 1.3%). There was no significant difference in herpes simplex virus Type 2 (HSV-2) prevalence (a marker of sexual risk) among donors during intervention weeks compared to control (10.4% vs. 11.1%, p = 0.245). No donor choosing testing was HIV infected, and there was no difference in HSV-2 prevalence between testers and donors (9.9% vs. 10.4%, p = 0.887). Returning for positive results did not differ between testers and donors (three of three vs. 58 of 80, p = 0.386). A higher proportion of donors acknowledged that HIV testing was a strong motivation to donate during intervention weeks compared to control (2.6% vs. 2.0%, p = 0.032).The evidence of our RCT is that offering HIV counseling and testing at the time of donation would not change the risk of contamination in the blood supply, nor improve results disclosure and referral to care.

OBJETIVO: Analisar a evolução, de 1991 a 2001, do descarte sorológico na Fundação Pró-Sangue/Hemocentro de São Paulo, o maior banco de sangue da América Latina, e verificar a prevalência de doenças infecciosas entre doadores dessa instituição no ano de 2001. MÉTODOS: Foram compilados os dados de descarte sorológico relativos aos anos de 1991 a 2001. Para determinar a prevalência de doenças infecciosas, foram analisadas 9 942 amostras triadas em novembro de 2001, sendo as amostras reativas submetidas a testes confirmatórios. RESULTADOS: Foi encontrada uma diminuição percentual significativa de descarte, de 20% em 1991 para 9% em 2001. A prevalência de doenças infecciosas entre doadores em 2001 foi de 0,04% para vírus da imunodeficiência humana (VIH); 0,21% para vírus da hepatite C (VHC); 0,06% para vírus T-linfotrópico humano (HTLV); para vírus da hepatite B (VHB), as prevalências foram de 0,14% para anti-HBc + HBsAg, 1,68% para anti-HBc + anti-HBs e 1,67% para anti-HBc isolado; 1,10% para sífilis; e 0,14% para doença de Chagas. CONCLUSÃO: A diminuição no descarte e a prevalência de doenças infecciosas entre doadores da Fundação Pró-Sangue/Hemocentro de São Paulo em 2001 refletem o aumento na porcentagem de doadores de repetição nesse banco de sangue.

Submitted by Maria Creuza Silva (mariakreuza@yahoo.com.br) on 2015-11-23T17:13:19Z No. of bitstreams: 1 DISS MP. Nanci Salles. 2014.pdf: 1621385 bytes, checksum: 95c8926dccbbf2e75b8ce1cd5eb0d231 (MD5) Approved for entry into archive by Maria Creuza Silva (mariakreuza@yahoo.com.br) on 2015-11-23T17:41:07Z (GMT) No. of bitstreams: 1 DISS MP. Nanci Salles. 2014.pdf: 1621385 bytes, checksum: 95c8926dccbbf2e75b8ce1cd5eb0d231 (MD5) Made available in DSpace on 2015-11-23T17:41:07Z (GMT). No. of bitstreams: 1 DISS MP. Nanci Salles. 2014.pdf: 1621385 bytes, checksum: 95c8926dccbbf2e75b8ce1cd5eb0d231 (MD5) As Comissões Intergestores Bipartite (CIB) foram instituídas com a NOB 93 para contribuir com a operacionalização do SUS. Com a sanção da Lei nº 12.466 e o Decreto nº 7508 que legalizaram a existência destas instâncias foi ratificado dentre as atribuições destas comissões, pactuar os aspectos operacionais do SUS, sendo a formulação de políticas de saúde um mecanismo possível de operacionalização deste Sistema. Entendendo a CIB como instância capaz de democratizar o processo de formulação das políticas, analisar como se deu o processo de negociação, pactuação e decisão intergestores na formulação da Política Estadual da Atenção Básica, atinente à esfera municipal, no período 2007-2013, pode proporcionar o suprimento de uma lacuna de conhecimento sobre a sua participação nesse processo. Portanto, trata-se de um Estudo descritivo, qualitativo sobre a CIB – BA, no período de 2007-2013, o qual utilizou a Análise Documental de Atas e Resoluções aprovadas nas Reuniões da CIB e reuniões do COSEMS no período supracitado. Para tanto, foi feita a análise de conteúdo destas Atas, à luz das Portarias da Atenção Básica, nas suas duas versões nacionais e a versão estadual, dos Regimentos da CIB e dos instrumentos de Planejamento – Plano Estadual de Saúde dos dois períodos. Buscou-se observar com isso como se deu o processo de negociação, pactuação e decisão da CIB para a formulação da Política da Atenção Básica, tendo como pano de fundo a Teoria do Jogo Social de Carlos Matus, identificando as situações de conflito e cooperação em momentos do processo decisório. Este estudo permitiu observar que estes momentos do processo decisório foram marcados por situações significativas de cooperação entre os representantes dos entes federados, município e estado, valendo ressaltar que tal movimento pode ter sido fruto de momentos de negociação em grupos de trabalho Bipartite e nas reuniões do COSEMS, que antecederam as reuniões da CIB. Tendo em vista as limitações do método adotado, a importância do aprofundamento da reflexão sobre os resultados apontados e a ponderação sobre os avanços da Política da Atenção Básica no Estado da Bahia, sugerimos a realização de outros estudos para maior avaliação sobre a formulação e implantação desta Política no estado, bem como, apresentamos proposta de desenvolvimento de Grupo Focal para promoção deste processo.

We evaluate the current prevalence of serologic markers for hepatitis B virus (HBV) and hepatitis C virus (HCV) in blood donors and estimated HCV incidence and residual transfusion-transmitted risk at three large Brazilian blood centers.Data on whole blood and platelet donations were collected from January through December 2007, analyzed by center; donor type; age; sex; donation status; and serologic results for hepatitis B surface antigen (HBsAg), antibody to hepatitis B core antigen (anti-HBc), and anti-HCV. HBV and HCV prevalence rates were calculated for all first-time donations. HCV incidence was derived including interdonation intervals that preceded first repeat donations given during the study, and HCV residual risk was estimated for transfusions derived from repeat donors.There were 307,354 donations in 2007. Overall prevalence of concordant HBsAg and anti-HBc reactivity was 289 per 100,000 donations and of anti-HCV confirmed reactivity 191 per 100,000 donations. There were significant associations between older age and hepatitis markers, especially for HCV. HCV incidence was 3.11 (95% confidence interval, 0.77-7.03) per 100,000 person-years, and residual risk of HCV window-phase infections was estimated at 5.0 per million units transfused.Improvement in donor selection, socioeconomic conditions, and preventive measures, implemented over time, may have helped to decrease prevalence of HBV and HCV, relative to previous reports. Incidence and residual risk of HCV are also diminishing. Ongoing monitoring of HBV and HCV markers among Brazilian blood donors should help guide improved recruitment procedures, donor selection, laboratory screening, and counseling strategies.

In Brazil nationally representative donor data are limited on human immunodeficiency virus (HIV) prevalence, incidence, and residual transfusion risk. The objective of this study was to analyze HIV data obtained over 24 months by the Retrovirus Epidemiology Donor Study-II program in Brazil.Donations reactive to third- and fourth-generation immunoassays (IAs) were further confirmed by a less-sensitive (LS) IA algorithm and Western blot (WB). Incidence was calculated for first-time (FT) donors using the LS-EIA results and for repeat donors with a model developed to include all donors with a previous negative donation. Residual risk was projected by multiplying composite FT and repeat donor incidence rates by HIV marker-negative infectious window periods.HIV prevalence among FT donors was 92.2/10(5) donations. FT and repeat donor and composite incidences were 38.5 (95% confidence interval [CI], 25.6-51.4), 22.5 (95% CI, 17.6-28.0), and 27.5 (95% CI, 22.0-33.0) per 100,000 person-years, respectively. Male and community donors had higher prevalence and incidence rates than female and replacement donors. The estimated residual risk of HIV transfusion transmission was 11.3 per 10(6) donations (95% CI, 8.4-14.2), which could be reduced to 4.2 per 10(6) donations (95% CI, 3.2-5.2) by use of individual-donation nucleic acid testing (NAT).The incidence and residual transfusion risk of HIV infection are relatively high in Brazil. Implementation of NAT will not be sufficient to decrease transmission rates to levels seen in the United States or Europe; therefore, other measures focused on decreasing donations by at-risk individuals are also necessary.

In Brazil it is mandatory to screen donors for human immunodeficiency virus (HIV) antibodies using two immunoassays (IAs) in parallel. Confirmatory testing is performed only on reactive donors who return for counseling. The goal of this analysis was to determine if concordant IA reactivity accurately predicts infection and can be used for HIV incidence and/or prevalence analyses.We reviewed HIV screening and confirmatory results obtained for 307,407 donations in the first year of the REDS-II study in Brazil (2007) and for 2,304,755 donations collected from 1996 to 2006 in one of the REDS-II sites (São Paulo, Brazil).In the São Paulo site, 11,410 (0.50%) HIV IA-reactive donations were discarded, but only 2095 (0.09%) were reactive to both IAs. Western blot was positive on 1002 (48%) dual-IA-reactive donors who returned for counseling. Only four HIV-infected donors were detected who had been missed at screening by one of the IAs; all occurred before 2002. The positive predictive value (PPV) of dual-IA reactivity varied from 45.8 to 100%, with 80% to 90% PPVs when using IAs from different manufacturers. If both assays yielded signal-to-cutoff (S/C) values of 3.0 or more, PPVs ranged from 91% to 99%, with approximately 99% sensitivity for true HIV seropositivity.Parallel testing of all donations has limited efficacy when highly sensitive IAs are used. Reactivity by two sequential IAs is useful for prevalence studies if the assays are from different manufacturers and especially if high S/C values are considered.