Published in PLOS One on 2025-10-31, this study is presented as an attributed evidence briefing. The excerpts below are the original researchers’ words, reproduced under their Creative Commons Attribution licence. Health Signal has selected the abstract and, where needed, opening background paragraphs; the complete methods, results, limitations and references remain in the linked paper.
Original authors: Alice Charwudzi, Edward Morkporkpor Adela, Kingsley Kwadwo Asare Pereko, Martin Ampofo, Aaron Fenuku, Daniel Edem Azumah, Abdul Raman Asemah, Edward Ahiakwah, Angela Animwaah Osei, Emmanuel Kobina Mesi Edzie, Enoch Aninagyei
Source: PLOS One • DOI 10.1371/journal.pone.0335544
Read the complete primary study ↗ · Creative Commons Attribution licence
From the researchers
Abstract
Transfusion-transmitted infections (TTIs), notably hepatitis B virus (HBV), hepatitis C virus (HCV), human immunodeficiency virus (HIV), and syphilis, remain a major threat to blood safety in resource-limited settings. Ghana mainly uses rapid diagnostic tests (RDTs) for initial screening, which may affect the accuracy of detecting TTIs.
This study estimated the prevalence, identified sociodemographic and donor-type predictors of TTIs and compared the diagnostic yield of RDTs versus ELISA in a teaching hospital in the Central Region of Ghana.
This retrospective study analysed 10,152 available blood donors’ records screened from January 2022 to March 2024. Fixed-site donors were initially screened using RDTs (SD Biosensor Standard Q® HBsAg/HCV Ab, First Response® HIV 1-2.0, Advanced Quality™ Syphilis) followed by confirmatory ELISA testing for RDT-non-reactive samples. Mobile donors underwent ELISA (ChemWell® FUSION analyser) testing only. Multivariable logistic regression was used to identify independent TTI predictors.
The overall prevalence of TTIs (infection with at least one tested pathogen) was 16.5% (95% CI: 15.80-17.20; N = 1,675), with syphilis 8.4% (95% CI: 7.83-8.91; N = 850) being the most common. Voluntary donors had a lower TTI prevalence than replacement donors (10.6% vs 19.9%, p < 0.001). Repeat donors exhibited reduced risk of HBV (aOR: 0.254, 95% CI: 0.206-0.313, p < 0.001), HCV (aOR: 0.734, 95% CI: 0.568-0.949, p = 0.018), and syphilis (aOR: 0.486, 95% CI: 0.417-0.567, p < 0.001). However, donor type itself was not a significant predictor of TTIs after adjusting for sociodemographic variables. ELISA testing identified an additional 7.3% (95% CI: 6.67-8.01; N = 422/5,754) TTI cases among RDT non-reactive fixed-site donors (missed cases).
The high prevalence of TTIs highlights persistent blood safety challenges. Repeat donation was independently protective, reducing risks of HBV, HCV, and syphilis. To improve blood safety, it will be essential to encourage regular voluntary donations. It will also require supplementing RDTs with ELISA where feasible, and strengthening haemovigilance systems, while accounting for the cost and logistical constraints. Although NAT is the gold standard for TTI detection, nationwide implementation in Ghana is currently not feasible.
Introduction
Transfusion-transmitted infections (TTIs), including hepatitis B virus (HBV), hepatitis C virus (HCV), human immunodeficiency virus (HIV), and syphilis, remain major public health concerns globally, particularly in Sub-Saharan Africa (SSA), where prevalence rates are disproportionately high [1,2]. Despite global advances in blood safety, such as nucleic acid testing (NAT) and HBV vaccination, many low-and middle-income countries (LMICs), including Ghana, rely heavily on rapid diagnostic tests (RDTs) and replacement donation, increasing the risk of TTIs [2–4]. In high-income countries with stringent donor selection and advanced screening technologies such as NAT, the prevalence is typically below 1% [3–5]. In contrast, higher rates are consistently reported in SSA. In Ghana, overall TTI prevalence as high as 13–36% [6–9] has been documented, while comparable SSA settings report rates of 10–15% [1,10,11]. Ghanaian studies reported seroprevalence of HBV (3.1-13.2%), HCV (1.3-8.7%), HIV (1.6-4.5%), and syphilis (3.8-15.3%), indicating persistent gaps in blood safety [6–9]. Specifically, Walana et al., in their multiregional study (Oti, Greater Accra, Northern and Upper West Regions), reported HBV (6.6%), HCV (4.9%), HIV (2.9%), and syphilis (6.8%) [6]. In the Volta Region, Hadfield et al. reported HBV (3.1%), HCV (5.0.%), HIV (1.6%), and syphilis (6.4%) [7]. Another study by Addai-Mensah et al., in the Ashanti Region, found HBV (6.8%), HCV (1.3%), HIV (1.8%), and syphilis (3.8%) [8]. Lastly, Alomatu et al., in the Eastern Region, found HBV (13.2%), HCV (8.7%), HIV (4.5%), and syphilis (15.3%) [9]. This disparity indicates the need to improve screening methodologies and blood donor management strategies in resource-constrained settings.
Reading this evidence
Use the full paper to check the study design, participant selection, comparator and outcome definitions before drawing a practical conclusion. An association does not by itself show cause and effect. A reported performance measure needs its denominator and uncertainty. A finding from a particular facility, sample or time period should retain that scope when it is discussed elsewhere.
This briefing makes the source accessible within the wider technology & industry desk. It does not assess an individual patient or certify a product. When considering relevance to another health system, examine the original authors’ account of context and limitations, then seek local implementation evidence. The related reporting below provides other studies to read alongside this one; it is a topic connection, rather than a claim that their results are directly comparable.
© 2025 Alice Charwudzi, Edward Morkporkpor Adela, Kingsley Kwadwo Asare Pereko, Martin Ampofo, Aaron Fenuku, Daniel Edem Azumah, Abdul Raman Asemah, Edward Ahiakwah, Angela Animwaah Osei, Emmanuel Kobina Mesi Edzie, Enoch Aninagyei. Excerpts reproduced under CC BY. Selection, formatting and contextual notes by Health Signal. The researchers are the authors of the source study, not members of Health Signal’s staff.
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