The Incidence Of HIV In Blood Donors

Project and Seminar Material for Science Laboratory Technology SLT

The Incidence Of HIV In Blood Donors


Abstract


This study of the incidence of HIV in blood donors was carried out at Bishop Shanahan Hospital Nsukka of Enugu state, Nigeria. Blood samples from two hundred donors were collected examined and analyzed for HIV positive result showed that 12% of the total number of donors were seropositive. Comprising of male and female donors. When tested statistically using chi-square distribution, the result showed that there is no significance difference in the incidence of HIV between the male and female donors in Nsukka Local Government Area. A good number of recommendations have been made for the purpose of future improvement of the ignorant recipients.


Chapter One


Introduction

1.1 Background of the Study

Human immunodeficiency virus (HIV) is an enveloped lentivirus with cylindrical core inside it’s capsid which posses reverse transcriptase. Infection of this virus to human body causes AIDS (Acquired immunodeficiency syndrome). The HIV/AIDs epidemic has devastated individuals and families affected by the virus. The virus is spread through blood, semen, vaginal secretion and breast mills of infected patients. Other modes of transmission are unprotected sexual intercourse with HIV positive partner, transfusion of HIV infected blood, use of unsterilized needle and syringe, razor or any other skin piercing objective used by HIV infected person (Peter et al , 2002).

Human immunodeficiency virus is extremely fragile and cannot survive outside the body’s fluids therefore, HIV is not transmitted by causal physical contact such kissing, holding hands, sneezing or coughing, sharing toilets, using the same eating utensils among other. Also HIV cannot spread by mosquitoes and can not destroyed by bleach, strong detergents and hot water (Maura, 2010).

There are two types of HIV, HIV-1 and HIV – 2. HIV 1 is the type of that accounts for the majority of infections in the world and has at least ten genetic sub-types while HIV -2 is found primarily in west Africa and U.S. The types of less easily transmitted and progress more slowly to disease than type 1.

The infected person may feel healthy but he or she can infect other the virus during the window stage. Window stage is the stage in which HIV positive is carrying the virus in the body bit the antibodies to HIV has not appeared when screening (Maura, 2010).


1.2 Statement of the Problem

There have been cases of the presence of the HIV/AIDs in blood donated for use on patients in many hospitals of Nigeria. This has led to the creation of fears in a good number of patients when the case arises that blood has to be transfused. The fear alone is another dimension of illness that leads to serious consequences. This condition also has contributed to high spread of new HIV infections to people and is especially more with people in low-income countries that have inadequate health care service. Also HIV infected blood transfused to patients have devastated many individuals and families since AIDs is incurable (Watson, 1992).

Finally, presence of HIV in blood donated for use has resulted in gotten a now born baby of HIV positive which have increased the morbidity and mortality among children in many countries (Peter, et al, 2002).


1.3 Objective of the Study

The general objective of this study is to determine the incidence of HIV in blood donors at Shanahan Hospital Nsukka in Enugu state.

Other specific objectives are:

  1. To test for the presence of HIV antibody in donors serum or plasma.
  2. To determine the possible way of transmitting HIV/AIDs.
  3. To detect whether the incidence of HIV in blood donors is more in males than in females.

1.4 Significance of the Study

This study which have bothered much on screening of human plasma or serum is not significant importance to all personal involved in these project work. It also serves as a useful supplement to all laboratory scientists that shall be adopted in any sphere for the control of the incidence of HIV/AIDs in blood donors.


1.5 Limitation of the Study

The major problem of this work is the high cost of the latex reagent used for screening. Also financial problem have contributed in limiting my case study area to Nsukka zone rather than Enugu state.


1.6 Hypothesis

Null Hypothesis (Ho)

Ho: There is no significant difference in the incidence of HIV between male and female blood donors in Nsukka Local Government Area.

Hi: There is significant difference in the incidence of HIV between male and female blood donors in Nsukka Local Government Area.


1.7 Definitions of Terms

ARC

Aids related complex

ARV

Antiretroviral

AIDS

Acquired immunodeficiency syndrome

HIV

Human immunodeficiency virus

HAART

Highly active antiretroviral therapy.

CDt4 or T4 cell

Subset of T lymphocyte which help to initiative immune system.

STI

Sexual transmitted infection

PCP

Pneumocustic carinii pneumonia

TB

tuberculosis

IL-2

Stimulates CDt4 production

GP41

Glycoprotein with weight of 41.

KS

Kaposi sarcoma (Tumor)

Lumphadenopathy

Enlargement of lumph mode

Pathophysiology

The Replication process of HIV in the body


Chapter Five


Discussion, Conclusions and Recommendations

5.1 Discussion

5.1.1 HIV prevalence among student blood donors in Enugu state

The prevalence of HIV among student blood donors in this study was 0.7 %. Recruitment of safe blood donors is still a major challenge for many developing countries like Nigeria, yet safe blood donors free from risks of transmitting diseases is the cornerstone of blood safety. In some countries taboos, socio-cultural beliefs and religion are still major obstacles towards altruistic donations and discourage people from engaging in benevolent donations. HIV/AIDS and associated stigma also tend to discourage a number of people from donating blood fearing to discover their status.

The general HIV prevalence in the population in the specific country, public awareness regarding HIV and blood donation, the selection of donors and steps taken to ensure thorough pre-screening of blood donors are all important factors requiring due attention (Aldebert et al., 2012). In high-income countries, much emphasis has been put on proper donor selection and the HIV prevalence is as low as 0.001 % while in low-income countries the prevalence has remained high (WHO, 2009). Hassan et al (2008) reported an average incidence of 2.8 % of HIV among apparently healthy blood donors in Kaduna Northern central Nigeria, but Zachariah et al (2002) reported HIV incidence of 22 % among blood donors in Kampala Uganda in East Africa, which is significantly higher than the Nigerian studies. The prevalence of HIV infection among blood donors varies from one geographical location to another and can provide a reasonable ‘proxy’ for HIV infection levels in a larger adult population (WHO, 2002). The majority of blood donors in Sub-Saharan Africa are family members and friends. This group of donors is considered particularly high risk since relatives and friends are likely to donate without considering their health conditions and only donate because they feel obligated to save a family member or friend (Nwankwo et al., 2012). A comparative study on HIV prevalence between voluntary donors in Nigeria found a great variation, with the HIV prevalence among voluntary donors at 1.7 % and 10 % among family replacement donors respectively (Kimani et al., 2011).

The frequency of HIV found in this study (0.7 %) is much lower than that found by other studies like the one carried out by Nyamongo et al (2001) involving all donor groups in five provinces of Nigeria, which reported prevalence rate of 9.7 %. Although relatively low HIV prevalence is seen among secondary school student blood donors, the figures contrast sharply to those observed by Glynn et al. (2000) when they analyzed the trends in viral infections among blood donors in the USA and only found a prevalence rate of 0.15 % for HIV. The American Red Cross Blood Services (ARCBS) in a study conducted between 1992 through 2001; found HIV sero-prevalence rates of 0.002 % amongst the general donor population, but only 0.00006 % amongst high school student donors (ARCBS, 2012). The figures in the ARCBS study are almost 10,000 times lower than those found in this study, suggesting that a lot still needs to be done in order to assure the safety of blood donated by secondary school students in Nigeria. A study in a rural population India showed a HIV prevalence of 1.56 % among voluntary donors and 2.11% in replacement donors (Sonwane et al., 2003), but another study by Kumar et al., (1996), in Bangalore found a HIV prevalence among voluntary donors to be much lower at only 0.042 % (p=14266). In Uganda, the MOH surveillance reports showed a HIV prevalence of 0.7 % among school going blood donors (MOH, 2001). In the more developed countries, chances of transmitting HIV through donated blood is low due to stringent blood screening measures in place. The use of whole-virus lysate ELISAs and p24 antigen based assays has increased the sensitivity of the assays and thus viral products are detectable early during the window period. The average window period for the most sensitive ELISA for HIV is now to about 20 days (Shimian et al., 2012)

Majority of cases of transfusion-associated HIV transmission may be the result of blood donated during the window period when the viral load of individuals is still low. Using whole-Virus lysate enzyme immuno assays (EIA’S) to screen blood may reduce the window period to about 45 days (95 % , CI 34-55 days). Studies show that the average window period for the most sensitive ELISA for HIV antibodies is now about 20 days giving an average infectious window period of 25 days (95 % , CI= 9-41 days) (Shimian et al, 2012). For effective exclusion of blood donors percieved to bear risk and to protect the blood supply from viral contamination, the criteria used must take into account the specific epidemiological situation of any given country or region. The general observation in this study was that blood donated by secondary school students in Enugu state has a significantly lower frequency of HIV antibodies (0.53-0.81 %) compared to the general population (6.1 %) (NASCOP, 2015).

5.1.2 Students knowledge on blood donation and blood transfusion practices

This study also aimed to establish the level of knowledge on blood donation and blood transfusion practices among student blood donors in Enugu state, Nigeria. The mean knowledge on blood donation and blood transfusion practices among student blood donors was not satisfactory at 33.2 % and SD 30.58± 394(86.2 %) of students who participated in the survey. Age range suitable for donation, and the acceptable interval between two donations were known to 44(11.16 %) and 98(24.87 %) student donors respectively. Complications of blood and component transfusion were areas that elicited a poor response with only 22.58 % of the student blood donors possessing good knowledge. On some of the basic parameters, namely, the age range of donors, minimum weight, the acceptable interval between two donations and diseases for which a donor is usually deferred (Misje et al., 2009), the student blood donors in this study revealed major gaps in knowledge.

As non-remunerated donated blood is the only blood source in Nigeria, peoples’ motivation is imperative to keep blood source sufficient. Their level of knowledge on risks of blood transfusion and steps taken to prevent and treat such incidences was also not satisfactory (MOH, 2014). Knowledge about risks associated with donated blood was only 8.12 %, indicating an overall misconception about risks to the recipients of donated blood. Blood donors come from the local communities and thus awareness of the community members and their motivation to participate voluntary blood donations is essential (Devi et al., 2012)


5.3 Conclusions

  1. From the results of the study, it can be concluded that the prevalence of HIV among secondary school student blood donors is still low (0.7 %) compared to the general population (6.1 %). As such, this category of donors still constitutes a much safer population compared to other groups of donors.
  2. The results do not show any significant differences in the prevalence of HIV among students attending the different categories of schools suggesting that the category of school had no effect on the HIV prevalence among the students.
  3. The results did not show a significant positive correlation between age and HIV status suggesting that older students and younger students had an equal chance of being HIV- positive.
  4. From the results of the study, it can also be concluded that the student’s knowledge on blood donation and blood transfusion practices is low. Male students appeared slightly more knowledgeable (55.7 %) on blood donation and blood transfusion practices compared to the female students (44.1 %) though there was no statistical correlation between knowledge and the students’ gender.

5.4 Recommendations

  1. Campaigns on recruitment of secondary school students as voluntary unremunerated blood donors requires strengthening as a more cost effective strategy. Strengthening efforts to recruit donors from only low risk populations such as secondary schools is also recommended
  2. Efforts for the development and extensive use of effective communication materials to sensitize the community on blood donations and blood transfusion practices should be implemented to improve secondary school student’s knowledge on blood donation and transfusion practices. An interventional strategy in the form of repeated short blood donation awareness campaigns with respect to blood donation and blood transfusion practices have to be taken up because a significant number of students faltered in the basic aspects of blood donation and blood transfusion practices.
  3. Comprehensive screening of blood donors for HIV and other TTI’S using quality assured methods is highly recommended. Implementation of more sensitive tests (such as nucleic acid amplification testing) for HIV that detect early stages of HIV infections (i.e. reduce the window period) will further decrease risks of transfusion-transmitted HIV infections and improve safety of donated blood.

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