#OA3-AM25-SN-02 - The Transfusion-Transmissible Infections Monitoring System (TTIMS): 10 Years of Key Insights in Policy Change and Blood Safety

Background/Case Studies: TTIMS was established in 2015 as a collaboration between US government agencies and blood collection and testing organizations. TTIMS is a program integrating blood collection and screening data, and research tools to monitor HIV, HBV, HCV, and syphilis infections in US blood donors and donations.

Study

Design/Methods: TTIMS has two functional components, a Donation Database Coordinating Center (DDCC) and a Laboratory and Risk Coordinating Center (LRCC). Four large blood collection organizations (BCO) and their affiliated blood testing laboratories, representing over 60% of ~11 million voluntary blood donations collected in the US each year, provide data to the DDCC and samples and data to the LRCC. TTIMS also conducts behavioral risk factor assessment in donors using a case-control study design.

Results/Findings: TTIMS has monitored impact as policies for donor eligibility have evolved from indefinite deferral of men who have sex with men (MSM) and those reporting other behaviors to 12-month, 3-month, and now individual donor assessment for potential donors. Other behaviors include injection drug use, exchanging money or drugs for sex, receiving a blood transfusion, and additional exposures that were reduced to 3-months since exposure. DDCC reported on HIV, HBV, HCV and recently syphilis infection incidence and prevalence, showing no residual risk increase for the major transfusion-transmitted viral infections following policy changes. Current estimated residual risks of HIV, HBV, and HCV are 1:3,846,000, 1:2,325,500 and 1:6,250,000 in all donations, respectively. In contrast, syphilis rates have mirrored increases observed in the general population. LRCC conducted recent infection testing algorithms to estimate HIV incidence cross-sectionally in first-time donors, demonstrating no increase in HIV incidence and residual risk. Risk factor interviews demonstrated relatively stable donor risk behaviors over different donation policy periods. Anonymized samples from TTIMS are included in virus isolate panels used for national and global quality assurance programs. Responding to concern over blood screening assays’ ability to detect infections, TTIMS assessed undisclosed antiretroviral use in donors with HIV; 23% of tested samples had evidence of antiretrovirals. Importantly, while TTIMS was conceived as a tool to monitor blood safety, this program also has provided key data on demographic changes in the blood pool over the past 10 years.

Conclusions:

TTIMS is a public-private partnership monitoring for potential changes in the safety of the US blood supply and guiding policy responses through integrated epidemiology and laboratory studies. The program can be leveraged to respond to other threats impacting the safety of transfusion.