Undeclared pre-exposure or post-exposure prophylaxis (PrEP/PEP) use among syphilis-positive blood donors, England, 2020 to 2021

An individualised blood donor selection policy was implemented in the United Kingdom from summer 2021. We have investigated the impact of this policy by comparing the extent of undeclared use of HIV preexposure or post-exposure prophylaxis (PrEP/PEP) before and after this change. The rate of PrEP usage in syphilis-positive male blood donors has not changed since individualised donor assessment was implemented but provides continuing evidence of undisclosed PrEP use which may be associated with current or past higher-risk sexual behaviours. A more individualised blood donor selection policy was implemented in the United Kingdom (UK) from summer 2021 [1]. It replaced the previous 3-month deferral of men who have sex with men (MSM), and for the first time in the UK, allowed MSM to donate if in a longterm relationship. Pre-exposure prophylaxis (PrEP) is a very effective means to prevent sexual transmission of HIV [2]. It is also considered as a marker of recent likely high-risk sexual activity and can potentially hinder the detection of early HIV infection if not taken as prescribed [ 3]. Although individuals taking PrEP are deferred from blood donations for 3 months after completion of the course, we have previously found evidence of PrEP use in male blood donors with syphilis infection [4]. To evaluate the impact of this new donor selection policy on blood donation safety, we assessed the extent of PrEP use among syphilis-infected male donors before and after the change.