SEROPREVALENCE AND NAT-BASED DETECTION OF TRANSFUSION-TRANSMITTED INFECTIONS IN VOLUNTARY VERSUS REPLACEMENT BLOOD DONORS: A CROSS-SECTIONAL STUDY

Abstract

Background: Transfusion-transmitted infections (TTIs) remain a critical threat to blood safety globally. The comparative risk profile between voluntary non-remunerated blood donors (VNRBDs) and replacement/family donors (RDs) has been widely debated, particularly with the advent of nucleic acid testing (NAT) technologies that detect window-period infections missed by conventional serology. Methods: A cross-sectional study was conducted among 4,860 consecutive blood donors (2,748 VNRBDs; 2,112 RDs). All donations were screened using chemiluminescence immunoassay (CLIA) for HBV surface antigen, anti-HCV, anti-HIV-1/2, and rapid plasma reagin for syphilis. Serology-negative samples were further tested by individual-donor NAT (ID-NAT) for HBV-DNA, HCV-RNA, and HIV-1-RNA. Chi-square tests and odds ratios were used for group comparisons. Results: The overall TTI seroprevalence was significantly lower among VNRBDs (1.49%) than RDs (4.31%; p < 0.001). HBV was the most prevalent infection in both groups. The NAT yield among serology-negative donors was 0.11% (3/2,724) in VNRBDs versus 0.52% (11/2,121) in RDs (p = 0.004), with HBV accounting for the majority of NAT-only reactive cases. Conclusion: Replacement donors carry a significantly higher burden of both serologically detectable and window-period TTIs. Strengthening voluntary donation programs and integrating ID-NAT into routine screening are essential strategies for improving transfusion safety.