HIV incidence and correlates of incident infection among Brazilian blood donors following adoption of individual donor assessment

Background and Objectives In 2020, Brazil implemented individual donor assessment (IDA), expanding eligibility to include individuals previously deferred, such as men who have sex with men (MSM). We assessed human immunodeficiency virus (HIV) incidence and correlates of incident infection among blood donors following this policy change. Materials and Methods We analysed donation data from five Brazilian blood centres from 2020 to 2024. Routine HIV screening included fourth‐generation antigen/antibody (Ag/Ab) assays and nucleic acid testing (NAT). Additional testing (limiting antigen [LAg] avidity, viral load) was used to identify recent infections. Incidence was estimated separately for first‐time donors (FTD) and repeat donors (RD), and multivariable Poisson regression was used to assess correlates of incident infection. Results Among 1.66 million screened donations, 2598 (0.16%) were HIV‐reactive on routine screening. Residual serum was available for 74% ( n = 1927), and following additional testing, 98 were classified as recent HIV infections. HIV incidence was higher among FTD (20.9/100,000 person‐years) than RD (18.3/100,000). Higher incidence was observed among male and younger donors as well as those identifying as Black or multiracial ( Pardo ). Incidence varied between blood centres, with overall incidence stable across the study period. No increase in the residual risk (RR) of HIV transfusion‐transmission was observed. Conclusion Our findings indicate that the adoption of IDA in Brazil did not change blood safety. HIV incidence remained stable, with varying HIV infection patterns reflecting known disparities in the epidemiology of HIV in Brazil.