Promoting HTLV-1 blood transfusion safety in an endemic country. Towards expanded, evidence-based HTLV-1 control strategies of Peruvian Blood Banks

Transfusion of whole blood can transmit the human T-cell lymphotropic virus 1 (HTLV-1), a neglected retrovirus that is associated with a vast list of potentially severe diseases. Several reports consistently indicate that HTLV-1 is an endemic infection in Peru; hence, HTLV-screening of blood donors was introduced in this country in 1998. As the majority of infected subjects do not develop clinical manifestations, the screening of blood donors for HTLV-1 infection relies on serological tests. Over a three-year period, in collaboration with the Peruvian National Blood Banks Program, we will (i) evaluate the impact and cost-effectiveness of the current blood donation screening strategy (based on a single Enzyme-Linked-Immunosorbent Assay (EIA); (ii) compare the current strategy with alternative approaches (parallel, sequential, pooled screening) based on multiple tests seeking to improve the diagnostic yield of HTLV-cases; (iii) evaluate the potential role of family contact screening of seropositive blood donors for HTLV-control; and (iv) develop and assess a quality improvement process focused on HTLV-1 post-test counseling, as this process is not currently adequately addressed at local health services. Ultimately, this PhD project is intended to contribute, through the generation of evidence, to HTLV-1 blood transfusion safety, and overall, to HTLV-1 control in Peru.