Residual risk of HIV, HBV, and HCV transmission through blood transfusion in Borgou, Benin, 2023–2025

Résumé

Background Blood transfusion is a cornerstone of modern healthcare, particularly in maternal and pediatric care. However, it continues to carry a residual risk of transmitting transfusion-transmissible infections (TTIs), especially human immunodeficiency virus (HIV), hepatitis B virus (HBV), and hepatitis C virus (HCV). Quantifying this residual risk is critical for optimizing transfusion safety, particularly in resource-limited settings. This study aimed to estimate the residual risk of HIV, HBV, and HCV transmission among blood donors in the Borgou department of Benin. Methods A retrospective cohort study of repeat donors was conducted from January 2023 to December 2025 among repeat blood donors in Borgou. Serological screening was performed using enzyme-linked immunosorbent assay (ELISA) with Bio-Rad® kits. Residual risk was estimated using the Schreiber model based on incidence/window period methodology. Data were analyzed using SPSS software, and associations were assessed using the Chi-square test, with statistical significance set at p < 0.05. Results A total of 11,113 repeat donors were included, with a marked male predominance (male-to-female ratio: 14.14). The majority were aged 18–30 years (72%) and were students (54%). Overall, 145 incident infections were identified. Incidence rates per 100,000 donor-years were 5.98 for HIV, 350.28 for HBV, and 77.84 for HCV. No significant association was observed between HIV incidence and sociodemographic characteristics. In contrast, HBV and HCV incidences were significantly associated with age ( p < 0.001 and p = 0.03, respectively), with higher rates observed among donors aged 18–24 years. Estimated residual risks were 1 in 277,000 donations for HIV, 1 in 1,862 for HBV, and 1 in 7,070 for HCV. Conclusion Although the residual risk of TTIs in Borgou is lower than that reported in several sub-Saharan African settings, it remains substantially higher than in high-income countries. These findings highlight the urgent need to strengthen donor selection strategies, enhance targeted health education, and implement more sensitive screening technologies, such as nucleic acid testing, to further improve blood safety.

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