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Nucleic acid testing (NAT) in high prevalence-low resource settings.

Magdy El Ekiaby¹, Nico Lelie, Jean-Pierre Allain

¹Shabrawishi Hospital Blood Transfusion Center, Finni Square, Dokki, Giza, Egypt. elekiaby@tedata.net.eg

Biologicals : Journal of the International Association of Biological Standardization

|January 19, 2010

Summary

Nucleic acid testing (NAT) for transfusion-transmitted viral infections (TTIs) shows higher yield in resource-limited countries due to higher TTI prevalence. Cost and infrastructure challenges remain significant barriers to widespread NAT blood screening implementation.

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Area of Science:

Transfusion Medicine
Infectious Diseases
Public Health

Background:

Nucleic acid testing (NAT) was introduced to enhance blood safety by detecting transfusion-transmitted viral infections (TTIs).
Developed countries report minimal yield from NAT due to low TTI prevalence, with limited impact on overall blood safety.
Conversely, resource-limited countries often exhibit high TTI prevalence, suggesting a greater potential yield from NAT screening.

Purpose of the Study:

To evaluate the yield and implications of NAT blood screening for major TTIs in diverse healthcare settings.
To address the challenges and explore alternatives for NAT implementation in resource-limited countries.
To propose models for assessing the feasibility and cost-effectiveness of NAT blood screening.

Main Methods:

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Review of existing reports on NAT blood screening yield for HBV, HCV, and HIV-1 globally.
Comparison of NAT yield data between developed and resource-limited countries.
Discussion of challenges associated with NAT implementation, including cost, infrastructure, and personnel.
Exploration of alternative screening methods such as antigen-antibody combos and in-house NAT.

Main Results:

Developed countries show very low NAT yield (e.g., HBV 1:0.6 million, HCV <1:M, HIV-1 <1:M).
Resource-limited countries report significantly higher NAT yields (e.g., HBV 1:2800, HCV 1:3100 in specific regions).
High costs and infrastructure requirements are major barriers to NAT adoption in low-resource settings.

Conclusions:

NAT blood screening offers a higher incremental yield for TTIs in regions with high endemicity.
Addressing cost and infrastructure barriers is crucial for expanding NAT in resource-limited settings.
Further comparative studies and cost-effectiveness models are needed to guide decision-making for NAT implementation.