Background: Cameroon remains a country with high HIV prevalence among blood donors so there is a need for
surveillance of HIV transmission through blood transfusion in order to evaluate blood safety and justify the change of
screening strategy. The last evaluation of the HIV screening strategy in Cameroon in 2011 revealed that 55 HIV
transmissions per 10,000 of blood donations could have prevented using a four generation assay than using a
combination of third generation Rapid diagnostic test and Enzyme immuno-Assay.
Aims and objectives: This study aimed to estimated and compare the HIV transmission risk among blood banks using
different testing strategies.
Study design and setting: A one year multi-center data records review study was conducted in five Blood Banks located
in five regions of Cameroon in 2018. These Blood Banks were made of Yaounde Central Hospital (YCH), Douala
Laquintinie Hospital (DLH), Bertoua Regional Hospital (BRH), Ebolowa Regional Hospital (ERH) and Maroua Regional
Material and methods: Records were reviewed using data from the 1st January to the 31st December 2017. Five blood
banks out of 18 were selected based on the use of national standardized registries and properly completed data. The
World Health Organisation incidence/window period model was used to estimate the residual risk.
Statistics: The incidence (percentage and 95% confidence interval) of HIV was calculated per 100,000 blood donations
in 2017. The chi-square test was used to measure the association between groups and P-values <0.05 were considered
significant. The study was approved by the National Institutional Ethics Committee.
Results: Overall, 22,980 blood donor candidates were received and 20,430 (88.90%) [95% CI, 88.49-89.30] were tested
for HIV. Among the 20,430 tested for HIV, 1827 (8.94%) [95% CI, 8.55-9.34] donated at least twice. HIV prevalence was
estimated at 471/20,430 (2.31%) [95% CI, 2.11-2.52] among blood donors with an inconclusive rate of 701/20,430
(3.43%) [95% CI, 3.19-3.69]. Comparing HIV prevalence per Region between blood donors and the general population,
the prevalence was mostly lower among blood donors than in the general population except in YCH and MRH. The rate
of reactivity of the first-line test differ with the one of the second-line test with a kappa agreement of 0.556 (0.526-
0.585: CI 95%) giving a moderate level of agreement between first and second-line test. Considering the HIV testing
algorithm, incidence rates ranged from 411.52 to 1946.47 per 100,000 person-year corresponding to a residual risk to
transmit HIV associated with the window period varied from 1 in 669.7 donations to 1 in 5543.54 donations. At the
blood banks level, the incidence rates ranged from 382.41 to 2834.01 per 100,000 person-year and the residual risk to
transmit HIV associated with the window period varied from 1 in 460 donations to 1 in 5965 donations.
Conclusion: The residual risk of HIV transmission remains high in Cameroon and varies according to the screening
strategies. Thus, there is a need to revise the HIV testing strategy and implement an existing plan to recruit and retain
voluntary and regular blood donor.