China is a large developing country that has been seriously affected by the HIV/AIDS epidemic. This proposal is developed to address scientific questions to improve the safety and adequacy of the blood supply in China through a multi blood center collaboration. The objective of this proposal is to conduct epidemiologic, laboratory, and survey research on blood donors in representative Chinese regions and to help increase the safety and availability of blood for transfusion. This study is a collaboration between Johns Hopkins University (JHU) and Chinese Institute of blood Transfusion (IBT, under Chinese Academy of Medical Sciences) and five regional Chinese blood centers. This study will build on and further expand the existing established collaborative relationship between JHU and Chinese blood bank institutions. JHU will take direct responsibility for performance of the work.

Together with Chinese blood centers, we will address critical issues related to transmission of HIV and other established and emerging transfusion-transmitted agents that are prevalent in Asia. Through the proposed work, we also hope to take advantage of the higher disease prevalence and incidence rates in Chinese blood donors to address some of the evolving issues faced by United States (US) blood centers in testing for transfusion transmitted viral infections (TTVI) such as hepatitis B virus (HBV).

Previous successful collaborations between JHU and Chinese blood centers and recent development in China in building and strengthening blood baking infrastructure have provided the feasibility of conducting sophisticated epidemiologic studies in China. All Chinese participating sites are located in cities with the necessary facilities and equipment to conduct such investigations. Scientific issues that will be addressed in this proposal include but are not limited to the following:

* Identify characteristics of blood donors and donation behavior.
* Monitor known blood-borne infectious agents. Determine the prevalence and incidence of HIV-1, and TTVI in Chinese donors from five representative five Chinese regions.
* Assess the current level of residual risks of transfusion transmitted HIV infection
* Conduct targeted studies in blood donors for the purposes of understanding risk factors for acquiring HIV and other blood-borne agents.
* Understand donor motivations and deterrents, and strategies for recruitment and retention.
* Conduct test performance studies on HBV to search for optimal testing strategies in donor screening
* Examine blood supply and availability issues in the context of blood safety.
* Establish pathogen specific donor sample repositories for use in molecular epidemiologic studies (such as HIV subtype determination), monitoring new and emerging infectious agents and rapid assessment of the safety implications of changes in laboratory practice and blood donor screening

Major Projects:
* Project I: Establishing a longitudinal blood donor and donation data base
* Project II: Analyzing risk factors associated with HIV, HBV and HCV infection among Chinese blood donors
* Project III: Laboratory studies to evaluate better strategies for HBV testing in donor screening
* Project IV: Establishing donor disease specific (HIV, HBV and HCV) sample repositories