80_FR_80159 80 FR 79913 - Revised Recommendations for Reducing the Risk of Human Immunodeficiency Virus Transmission by Blood and Blood Products; Guidance for Industry; Availability

80 FR 79913 - Revised Recommendations for Reducing the Risk of Human Immunodeficiency Virus Transmission by Blood and Blood Products; Guidance for Industry; Availability

DEPARTMENT OF HEALTH AND HUMAN SERVICES
Food and Drug Administration

Federal Register Volume 80, Issue 246 (December 23, 2015)

Page Range79913-79915
FR Document2015-32250

The Food and Drug Administration (FDA or Agency) is announcing the availability of a document entitled ``Revised Recommendations for Reducing the Risk of Human Immunodeficiency Virus Transmission by Blood and Blood Products; Guidance for Industry.'' The guidance document provides blood establishments that collect blood or blood components, including Source Plasma, with revised donor deferral recommendations for individuals at increased risk for transmitting human immunodeficiency virus (HIV) infection. The guidance document recommends corresponding revisions to donor educational materials, donor history questionnaires and accompanying materials, along with revisions to donor requalification, product management, and testing procedures. The guidance announced in this notice finalizes the draft guidance of the same title dated May 2015 and supersedes the memorandum to blood establishments entitled ``Revised Recommendations for the Prevention of Human Immunodeficiency Virus (HIV) Transmission by Blood and Blood Products'' dated April 23, 1992 (1992 blood memo). While this guidance represents FDA's current thinking on the subject, our recommendations may evolve over time as new scientific evidence becomes available.

Federal Register, Volume 80 Issue 246 (Wednesday, December 23, 2015)
[Federal Register Volume 80, Number 246 (Wednesday, December 23, 2015)]
[Notices]
[Pages 79913-79915]
From the Federal Register Online  [www.thefederalregister.org]
[FR Doc No: 2015-32250]



[[Page 79913]]

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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Food and Drug Administration

[Docket No. FDA-2015-D-1211]


Revised Recommendations for Reducing the Risk of Human 
Immunodeficiency Virus Transmission by Blood and Blood Products; 
Guidance for Industry; Availability

AGENCY: Food and Drug Administration, HHS.

ACTION: Notice.

-----------------------------------------------------------------------

SUMMARY: The Food and Drug Administration (FDA or Agency) is announcing 
the availability of a document entitled ``Revised Recommendations for 
Reducing the Risk of Human Immunodeficiency Virus Transmission by Blood 
and Blood Products; Guidance for Industry.'' The guidance document 
provides blood establishments that collect blood or blood components, 
including Source Plasma, with revised donor deferral recommendations 
for individuals at increased risk for transmitting human 
immunodeficiency virus (HIV) infection. The guidance document 
recommends corresponding revisions to donor educational materials, 
donor history questionnaires and accompanying materials, along with 
revisions to donor requalification, product management, and testing 
procedures. The guidance announced in this notice finalizes the draft 
guidance of the same title dated May 2015 and supersedes the memorandum 
to blood establishments entitled ``Revised Recommendations for the 
Prevention of Human Immunodeficiency Virus (HIV) Transmission by Blood 
and Blood Products'' dated April 23, 1992 (1992 blood memo). While this 
guidance represents FDA's current thinking on the subject, our 
recommendations may evolve over time as new scientific evidence becomes 
available.

DATES: Submit either electronic or written comments on Agency guidances 
at any time.

ADDRESSES: You may submit comments as follows:

Electronic Submissions

    Submit electronic comments in the following way:
     Federal eRulemaking Portal: http://www.regulations.gov. 
Follow the instructions for submitting comments. Comments submitted 
electronically, including attachments, to http://www.regulations.gov 
will be posted to the docket unchanged. Because your comment will be 
made public, you are solely responsible for ensuring that your comment 
does not include any confidential information that you or a third party 
may not wish to be posted, such as medical information, your or anyone 
else's Social Security number, or confidential business information, 
such as a manufacturing process. Please note that if you include your 
name, contact information, or other information that identifies you in 
the body of your comments, that information will be posted on http://www.regulations.gov.
     If you want to submit a comment with confidential 
information that you do not wish to be made available to the public, 
submit the comment as a written/paper submission and in the manner 
detailed (see ``Written/Paper Submissions'' and ``Instructions'').

Written/Paper Submissions

    Submit written/paper submissions as follows:
     Mail/Hand delivery/Courier (for written/paper 
submissions): Division of Dockets Management (HFA-305), Food and Drug 
Administration, 5630 Fishers Lane, Rm. 1061, Rockville, MD 20852.
     For written/paper comments submitted to the Division of 
Dockets Management, FDA will post your comment, as well as any 
attachments, except for information submitted, marked and identified, 
as confidential, if submitted as detailed in ``Instructions.''
    Instructions: All submissions received must include the Docket No. 
FDA-2015-D-1211 for ``Revised Recommendations for Reducing the Risk of 
Human Immunodeficiency Virus Transmission by Blood and Blood Products; 
Guidance for Industry.'' Received comments will be placed in the docket 
and, except for those submitted as ``Confidential Submissions,'' 
publicly viewable at http://www.regulations.gov or at the Division of 
Dockets Management between 9 a.m. and 4 p.m., Monday through Friday.
     Confidential Submissions--To submit a comment with 
confidential information that you do not wish to be made publicly 
available, submit your comments only as a written/paper submission. You 
should submit two copies total. One copy will include the information 
you claim to be confidential with a heading or cover note that states 
``THIS DOCUMENT CONTAINS CONFIDENTIAL INFORMATION''. The Agency will 
review this copy, including the claimed confidential information, in 
its consideration of comments. The second copy, which will have the 
claimed confidential information redacted/blacked out, will be 
available for public viewing and posted on http://www.regulations.gov. 
Submit both copies to the Division of Dockets Management. If you do not 
wish your name and contact information to be made publicly available, 
you can provide this information on the cover sheet and not in the body 
of your comments and you must identify this information as 
``confidential.'' Any information marked as ``confidential'' will not 
be disclosed except in accordance with 21 CFR 10.20 and other 
applicable disclosure law. For more information about FDA's posting of 
comments to public dockets, see 80 FR 56469, September 18, 2015, or 
access the information at: http://www.fda.gov/regulatoryinformation/dockets/default.htm.
    Docket: For access to the docket to read background documents or 
the electronic and written/paper comments received, go to http://www.regulations.gov and insert the docket number, found in brackets in 
the heading of this document, into the ``Search'' box and follow the 
prompts and/or go to the Division of Dockets Management, 5630 Fishers 
Lane, Rm. 1061, Rockville, MD 20852.
    Submit written requests for single copies of the guidance to the 
Office of Communication, Outreach, and Development, Center for 
Biologics Evaluation and Research (CBER), Food and Drug Administration, 
10903 New Hampshire Ave., Bldg. 71, Rm. 3128, Silver Spring, MD 20993-
0002. Send one self-addressed adhesive label to assist the office in 
processing your requests. The guidance may also be obtained by mail by 
calling CBER at 1-800-835-4709 or 240-402-8010. See the SUPPLEMENTARY 
INFORMATION section for electronic access to the guidance document.

FOR FURTHER INFORMATION CONTACT: Valerie A. Butler, Center for 
Biologics Evaluation and Research, Food and Drug Administration, 10903 
New Hampshire Ave., Bldg. 71, Rm. 7301, Silver Spring, MD 20993-0002, 
240-402-7911.

SUPPLEMENTARY INFORMATION: 

I. Background

    FDA is announcing the availability of a document entitled, 
``Revised Recommendations for Reducing the Risk of Human 
Immunodeficiency Virus Transmission by Blood and Blood Products; 
Guidance for Industry.'' The emergence of Acquired Immune Deficiency 
Syndrome (AIDS) in the early 1980s and the recognition that it could be 
transmitted by blood and blood products had profound effects on the

[[Page 79914]]

U.S. blood system. Although initially identified in men who have sex 
with men (MSM) and associated with male-to-male sexual contact, AIDS 
was soon noted to be potentially transmitted by transfusion of blood 
products, and by infusion of clotting factor concentrates in 
individuals with hemophilia. Beginning in 1983, FDA issued 
recommendations for providing donors with educational material on risk 
factors for AIDS and for deferring donors at increased risk for AIDS in 
an effort to prevent transmission of the agent responsible for AIDS 
(later understood to be caused by HIV) by blood and blood products. MSM 
(originally identified as gay or bisexual men) were deferred due to the 
strong clustering of AIDS illness among MSM and the subsequent 
discovery of high rates of HIV infection in that population. FDA's 
recommendation for deferral of MSM was modified over time to improve 
its clarity and to promote compliance, including a shift of focus from 
a deferral based on group identification to a deferral based on 
specific behavior (male sex with another male).
    Since September 1985, FDA has recommended that blood establishments 
indefinitely defer male donors who have had sex with another male, even 
one time, since 1977. On April 23, 1992, FDA issued the 1992 blood 
memo, which consolidated its recommendations regarding the deferral of 
donors at risk of HIV, including the deferral for MSM, as well as 
deferral recommendations for other persons with behaviors associated 
with high rates of HIV exposure, namely commercial sex workers, those 
who inject non-prescription drugs, and certain other individuals with 
HIV risk factors.
    The use of donor educational material, specific deferral questions, 
and advances in HIV donor testing have reduced the risk of HIV 
transmission from blood transfusion from about 1 in 2500 transfusions 
prior to HIV testing to a current estimated residual risk of about 1 in 
1.47 million transfusions. Since the implementation in 1985 of donor 
testing for antibodies to HIV, FDA and the U.S. Department of Health 
and Human Services (HHS) have held a number of public meetings, 
including public scientific workshops and meetings of the Blood 
Products Advisory Committee and the HHS Advisory Committee on Blood 
Safety and Availability (ACBSA) to further review evidence and discuss 
FDA's blood donor deferral policies to reduce the risk of transmission 
of HIV by blood and blood products. Consistent with recommendations of 
the ACBSA in June 2010, studies that might support a policy change were 
carried out by the Public Health Service in 2011 to 2014. A 
recommendation for a policy change to the blood donor deferral period 
for MSM from indefinite deferral to 1 year since the last sexual 
contact was announced by the Commissioner of Food and Drugs in December 
2014. This guidance implements that recommended policy change.
    In addition, the guidance provides donor deferral recommendations 
for other individuals at increased risk for transmitting HIV infection, 
including commercial sex workers, non-prescription injection drug 
users, women who have sex with MSM, and certain other individuals with 
other risk factors. The guidance provides revised recommendations for 
donor educational materials, donor history questionnaires and 
accompanying materials, as well as for donor requalification and 
product management procedures.
    In the Federal Register of May 15, 2015 (80 FR 27973), FDA 
announced the availability of the draft guidance of the same title 
dated May 2015. FDA received over 700 comments on the draft guidance 
and those comments were carefully considered as the guidance was 
finalized. Comments were received from a variety of organizations, 
including patient advocacy groups representing users of blood products; 
lesbian, gay, bisexual and transgender advocacy groups; medical and 
professional societies; academic institutions; human rights 
organizations; local governments; members of Congress; and, the blood 
industry. Comments were also received from hundreds of individual 
commenters.
    Approximately one-half of the comments opposed FDA's time-based 
deferral policy for MSM and considered the proposed policy to be 
discriminatory and lacking a scientific rationale. Many of these 
comments recommended that FDA adopt an individual risk assessment based 
approach, regardless of an individual's sexual orientation or gender 
identity. Other comments supported a time-based deferral policy shorter 
than 1year, or no deferral period at all, because of advances in blood 
donor testing technologies that permit earlier detection of new HIV 
infections. Comments requested that FDA commit to reexamining its 
deferral policies as new technologies, such as pathogen reduction 
technology are implemented and data regarding compliance with the 
revised policies become available.
    Most of the remaining comments advocated for the continuation of 
the indefinite deferral policy for MSM and expressed concern regarding 
the safety of the blood should the revised policy for MSM donors be 
adopted. Opponents of the proposed change commented on the HIV 
incidence and prevalence rates among MSM; the potential failure of HIV 
tests to capture window-period infections; the risk of emerging 
pathogens for which testing does not exist; and, the potential for 
decreased compliance rates with the new deferral policy. Other comments 
argued that FDA should not compromise public health and the safety of 
the blood supply to satisfy special interest groups.
    A smaller number of comments, including those from certain patient 
advocacy organizations, supported the proposed 1-year deferral policy 
for MSM predicated on the establishment of a transfusion-transmitted 
infectious disease monitoring system to enhance safety monitoring and 
allow rapid responses to emerging threats to the blood supply. Further, 
similar comments advocated for an evaluation of the effectiveness of 
the donor educational materials and donor history questionnaires prior 
to the implementation of new donor deferral policies.
    Finally, comments received from the blood industry were generally 
supportive of the revised MSM donor deferral policy. However, some 
comments noted that manufacturers of plasma for further manufacturing 
use (i.e., to make injectable products), including Source Plasma, 
collected in the United States and intended for further manufacturing 
use in other countries, may need to retain an indefinite deferral 
policy for MSM to comply with the indefinite deferral policies 
established in other countries. Industry commenters also requested 
revisions to certain other donor deferral criteria for HIV risk and 
disagreed with FDA's proposal to include the signs and symptoms 
associated with HIV infection in the donor educational materials. 
Comments requested clarification regarding the eligibility of donors 
with false-positive HIV tests and on recommendations for product 
retrieval and notification of consignees of distributed blood 
components collected from a donor who should have been deferred for HIV 
risk factors. Some comments were also supportive of the additional 
guidance provided by FDA regarding transgender donors.
    Finally numerous commenters requested FDA to clarify the 
recommendation for deferral of women who have had sex with MSM.
    FDA carefully considered all of the comments received in response 
to the draft guidance and the available scientific data, including the 
results of

[[Page 79915]]

recent studies conducted by the Public Health Service and revised the 
guidance accordingly. FDA considered several options to address the 
comments in response to the revised MSM donor deferral policy. Because 
evidence indicates that the indefinite deferral policy for MSM may have 
become less effective over time, FDA has determined that a change in 
policy is warranted at this time. Data on the limitations of nucleic 
acid tests to identify antibody negative window period HIV infections 
suggests that donor testing alone, absent any deferral for MSM, would 
result in an unacceptable increased risk of transfusion-transmitted 
HIV. Similarly, pretesting at risk donors with a rapid HIV test prior 
to donation would be logistically challenging and would not necessarily 
identify newly HIV-infected individuals. While individual donor 
assessment for risk has been implemented in a few countries, the 
implementation of this strategy in the United States would present 
significant practical challenges and currently there is no validated 
and accepted individual risk assessment tool or questionnaire. 
Therefore, FDA concluded a time-based deferral for history of male-male 
sex is the most appropriate policy to maintain the safety of the U.S. 
blood supply. Scientific data regarding the effectiveness of a 1-year 
deferral in Australia, a country with similar HIV epidemiology to the 
United States, supports FDA's policy change to the blood donor deferral 
period for MSM from indefinite deferral to 1 year since the last sexual 
contact. Scientifically robust data are not available for time-based 
deferrals of less than 1 year. FDA also concluded that scientific data 
are not currently available that would support revisions to the 
indefinite deferral policy for commercial sex workers or intravenous 
drug users.
    In response to comments, FDA made the following changes when 
finalizing the guidance: (1) Amended the recommendations regarding the 
inclusion of signs and symptoms associated with HIV in the donor 
educational materials; (2) revised the recommendation for the deferral 
of female donors who have had sex with MSM; (3) stated that FDA no 
longer recommends deferral for individuals who have had sex with an 
individual with hemophilia or related clotting deficiencies requiring 
treatment with clotting factor concentrates; and (4) revised the 
recommendations regarding product retrieval and consignee notification 
of distributed blood products collected from a donor who should have 
been deferred for HIV risk factors. In addition, FDA made the following 
changes to clarify certain recommendations in the guidance, which are 
consistent with current policy: (1) Clarified that donors who have been 
determined to have a false-positive HIV test may be reentered according 
to a requalification method found acceptable to FDA; (2) noted that 
recipients of allogeneic blood transfusions (i.e., not autologous 
transfusions), should be temporarily deferred; (3) provided reference 
to an FDA guidance on the collection of blood components from donors at 
risk of HIV infection; and (4) clarified the deferral by the 
responsible physician of a blood establishment of any donor if the 
donation could affect the health of the donor or the safety of the 
blood component. Additionally, the background section has been expanded 
to summarize FDA's evaluation of the available policy options under the 
available evidence relevant to the MSM deferral policy. Minor editorial 
changes have also been made to the guidance.
    FDA remains committed to exploring options and engaging in public 
discussions regarding enhancements to donor and public education 
regarding safe blood donors and evaluating the effectiveness of the 
donor history questionnaire. Further, with the implementation of a 
transfusion transmitted infectious disease monitoring system, FDA will 
be able to monitor donor risk factors and the safety of the blood 
supply, as well as investigate and refine blood safety measures in the 
future. FDA's recommendations may evolve over time as new scientific 
data become available on strategies to maintain or improve blood 
safety.
    The guidance announced in this notice finalizes the draft guidance 
dated May 2015 and supersedes the 1992 blood memo.
    This guidance is being issued consistent with FDA's good guidance 
practices regulation (21 CFR 10.115). The guidance represents the 
current thinking of FDA on recommendations for reducing the risk of HIV 
transmission by blood and blood products. It does not establish any 
rights for any person and is not binding on FDA or the public. You can 
use an alternative approach if it satisfies the requirements of the 
applicable statutes and regulations.

II. Paperwork Reduction Act of 1995

    The guidance refers to previously approved collections of 
information found in FDA regulations. These collections of information 
are subject to review by the Office of Management and Budget (OMB) 
under the Paperwork Reduction Act of 1995 (44 U.S.C. 3501-3520). The 
collections of information in 21 CFR 601.12 have been approved under 
OMB control number 0910-0338; the collections of information in 21 CFR 
606.171 have been approved under OMB control number 0910-0458; and the 
collections of information in 21 CFR 610.46, 630.6, 640.3 and 640.63 
have been approved under OMB control number 0910-0116.

III. Electronic Access

    Persons with access to the Internet may obtain the guidance at 
either http://www.fda.gov/BiologicsBloodVaccines/GuidanceComplianceRegulatoryInformation/Guidances/default.htm or http://www.regulations.gov.

    Dated: December 17, 2015.
Leslie Kux,
Associate Commissioner for Policy.
[FR Doc. 2015-32250 Filed 12-22-15; 8:45 am]
BILLING CODE 4164-01-P



                                                                       Federal Register / Vol. 80, No. 246 / Wednesday, December 23, 2015 / Notices                                         79913

                                              DEPARTMENT OF HEALTH AND                                solely responsible for ensuring that your             for public viewing and posted on
                                              HUMAN SERVICES                                          comment does not include any                          http://www.regulations.gov. Submit
                                                                                                      confidential information that you or a                both copies to the Division of Dockets
                                              Food and Drug Administration                            third party may not wish to be posted,                Management. If you do not wish your
                                              [Docket No. FDA–2015–D–1211]                            such as medical information, your or                  name and contact information to be
                                                                                                      anyone else’s Social Security number, or              made publicly available, you can
                                              Revised Recommendations for                             confidential business information, such               provide this information on the cover
                                              Reducing the Risk of Human                              as a manufacturing process. Please note               sheet and not in the body of your
                                              Immunodeficiency Virus Transmission                     that if you include your name, contact                comments and you must identify this
                                              by Blood and Blood Products;                            information, or other information that                information as ‘‘confidential.’’ Any
                                              Guidance for Industry; Availability                     identifies you in the body of your                    information marked as ‘‘confidential’’
                                                                                                      comments, that information will be                    will not be disclosed except in
                                              AGENCY:    Food and Drug Administration,                posted on http://www.regulations.gov.                 accordance with 21 CFR 10.20 and other
                                              HHS.                                                      • If you want to submit a comment                   applicable disclosure law. For more
                                              ACTION:   Notice.                                       with confidential information that you                information about FDA’s posting of
                                                                                                      do not wish to be made available to the               comments to public dockets, see 80 FR
                                              SUMMARY:   The Food and Drug
                                                                                                      public, submit the comment as a                       56469, September 18, 2015, or access
                                              Administration (FDA or Agency) is
                                                                                                      written/paper submission and in the                   the information at: http://www.fda.gov/
                                              announcing the availability of a
                                                                                                      manner detailed (see ‘‘Written/Paper                  regulatoryinformation/dockets/
                                              document entitled ‘‘Revised
                                                                                                      Submissions’’ and ‘‘Instructions’’).                  default.htm.
                                              Recommendations for Reducing the Risk
                                              of Human Immunodeficiency Virus                         Written/Paper Submissions                                Docket: For access to the docket to
                                              Transmission by Blood and Blood                                                                               read background documents or the
                                                                                                         Submit written/paper submissions as                electronic and written/paper comments
                                              Products; Guidance for Industry.’’ The                  follows:                                              received, go to http://
                                              guidance document provides blood                           • Mail/Hand delivery/Courier (for
                                              establishments that collect blood or                                                                          www.regulations.gov and insert the
                                                                                                      written/paper submissions): Division of
                                              blood components, including Source                                                                            docket number, found in brackets in the
                                                                                                      Dockets Management (HFA–305), Food
                                              Plasma, with revised donor deferral                                                                           heading of this document, into the
                                                                                                      and Drug Administration, 5630 Fishers
                                              recommendations for individuals at                                                                            ‘‘Search’’ box and follow the prompts
                                                                                                      Lane, Rm. 1061, Rockville, MD 20852.
                                              increased risk for transmitting human                      • For written/paper comments                       and/or go to the Division of Dockets
                                              immunodeficiency virus (HIV)                            submitted to the Division of Dockets                  Management, 5630 Fishers Lane, Rm.
                                              infection. The guidance document                        Management, FDA will post your                        1061, Rockville, MD 20852.
                                              recommends corresponding revisions to                                                                            Submit written requests for single
                                                                                                      comment, as well as any attachments,
                                              donor educational materials, donor                                                                            copies of the guidance to the Office of
                                                                                                      except for information submitted,
                                              history questionnaires and                                                                                    Communication, Outreach, and
                                                                                                      marked and identified, as confidential,
                                              accompanying materials, along with                                                                            Development, Center for Biologics
                                                                                                      if submitted as detailed in
                                              revisions to donor requalification,                                                                           Evaluation and Research (CBER), Food
                                                                                                      ‘‘Instructions.’’
                                              product management, and testing                            Instructions: All submissions received             and Drug Administration, 10903 New
                                              procedures. The guidance announced in                   must include the Docket No. FDA–                      Hampshire Ave., Bldg. 71, Rm. 3128,
                                              this notice finalizes the draft guidance                2015–D–1211 for ‘‘Revised                             Silver Spring, MD 20993–0002. Send
                                              of the same title dated May 2015 and                    Recommendations for Reducing the Risk                 one self-addressed adhesive label to
                                              supersedes the memorandum to blood                      of Human Immunodeficiency Virus                       assist the office in processing your
                                              establishments entitled ‘‘Revised                       Transmission by Blood and Blood                       requests. The guidance may also be
                                              Recommendations for the Prevention of                   Products; Guidance for Industry.’’                    obtained by mail by calling CBER at 1–
                                              Human Immunodeficiency Virus (HIV)                      Received comments will be placed in                   800–835–4709 or 240–402–8010. See
                                              Transmission by Blood and Blood                         the docket and, except for those                      the SUPPLEMENTARY INFORMATION section
                                              Products’’ dated April 23, 1992 (1992                   submitted as ‘‘Confidential                           for electronic access to the guidance
                                              blood memo). While this guidance                        Submissions,’’ publicly viewable at                   document.
                                              represents FDA’s current thinking on                    http://www.regulations.gov or at the                  FOR FURTHER INFORMATION CONTACT:
                                              the subject, our recommendations may                    Division of Dockets Management                        Valerie A. Butler, Center for Biologics
                                              evolve over time as new scientific                      between 9 a.m. and 4 p.m., Monday                     Evaluation and Research, Food and
                                              evidence becomes available.                             through Friday.                                       Drug Administration, 10903 New
                                              DATES: Submit either electronic or                         • Confidential Submissions—To                      Hampshire Ave., Bldg. 71, Rm. 7301,
                                              written comments on Agency guidances                    submit a comment with confidential                    Silver Spring, MD 20993–0002, 240–
                                              at any time.                                            information that you do not wish to be                402–7911.
                                              ADDRESSES: You may submit comments                      made publicly available, submit your                  SUPPLEMENTARY INFORMATION:
                                              as follows:                                             comments only as a written/paper
                                                                                                      submission. You should submit two                     I. Background
                                              Electronic Submissions                                  copies total. One copy will include the                  FDA is announcing the availability of
                                                Submit electronic comments in the                     information you claim to be confidential              a document entitled, ‘‘Revised
                                              following way:                                          with a heading or cover note that states              Recommendations for Reducing the Risk
                                                • Federal eRulemaking Portal: http://                 ‘‘THIS DOCUMENT CONTAINS                              of Human Immunodeficiency Virus
tkelley on DSK3SPTVN1PROD with NOTICES




                                              www.regulations.gov. Follow the                         CONFIDENTIAL INFORMATION’’. The                       Transmission by Blood and Blood
                                              instructions for submitting comments.                   Agency will review this copy, including               Products; Guidance for Industry.’’ The
                                              Comments submitted electronically,                      the claimed confidential information, in              emergence of Acquired Immune
                                              including attachments, to http://                       its consideration of comments. The                    Deficiency Syndrome (AIDS) in the
                                              www.regulations.gov will be posted to                   second copy, which will have the                      early 1980s and the recognition that it
                                              the docket unchanged. Because your                      claimed confidential information                      could be transmitted by blood and blood
                                              comment will be made public, you are                    redacted/blacked out, will be available               products had profound effects on the


                                         VerDate Sep<11>2014   18:05 Dec 22, 2015   Jkt 238001   PO 00000   Frm 00097   Fmt 4703   Sfmt 4703   E:\FR\FM\23DEN1.SGM   23DEN1


                                              79914                    Federal Register / Vol. 80, No. 246 / Wednesday, December 23, 2015 / Notices

                                              U.S. blood system. Although initially                   policy change were carried out by the                 of the blood should the revised policy
                                              identified in men who have sex with                     Public Health Service in 2011 to 2014.                for MSM donors be adopted. Opponents
                                              men (MSM) and associated with male-                     A recommendation for a policy change                  of the proposed change commented on
                                              to-male sexual contact, AIDS was soon                   to the blood donor deferral period for                the HIV incidence and prevalence rates
                                              noted to be potentially transmitted by                  MSM from indefinite deferral to 1 year                among MSM; the potential failure of
                                              transfusion of blood products, and by                   since the last sexual contact was                     HIV tests to capture window-period
                                              infusion of clotting factor concentrates                announced by the Commissioner of                      infections; the risk of emerging
                                              in individuals with hemophilia.                         Food and Drugs in December 2014. This                 pathogens for which testing does not
                                              Beginning in 1983, FDA issued                           guidance implements that                              exist; and, the potential for decreased
                                              recommendations for providing donors                    recommended policy change.                            compliance rates with the new deferral
                                              with educational material on risk factors                  In addition, the guidance provides                 policy. Other comments argued that
                                              for AIDS and for deferring donors at                    donor deferral recommendations for                    FDA should not compromise public
                                              increased risk for AIDS in an effort to                 other individuals at increased risk for               health and the safety of the blood
                                              prevent transmission of the agent                       transmitting HIV infection, including                 supply to satisfy special interest groups.
                                              responsible for AIDS (later understood                  commercial sex workers, non-                             A smaller number of comments,
                                              to be caused by HIV) by blood and blood                 prescription injection drug users,                    including those from certain patient
                                              products. MSM (originally identified as                 women who have sex with MSM, and                      advocacy organizations, supported the
                                              gay or bisexual men) were deferred due                  certain other individuals with other risk             proposed 1-year deferral policy for
                                              to the strong clustering of AIDS illness                factors. The guidance provides revised                MSM predicated on the establishment of
                                              among MSM and the subsequent                            recommendations for donor educational                 a transfusion-transmitted infectious
                                              discovery of high rates of HIV infection                materials, donor history questionnaires               disease monitoring system to enhance
                                              in that population. FDA’s                               and accompanying materials, as well as                safety monitoring and allow rapid
                                              recommendation for deferral of MSM                      for donor requalification and product                 responses to emerging threats to the
                                              was modified over time to improve its                   management procedures.                                blood supply. Further, similar
                                              clarity and to promote compliance,                         In the Federal Register of May 15,                 comments advocated for an evaluation
                                              including a shift of focus from a deferral              2015 (80 FR 27973), FDA announced the                 of the effectiveness of the donor
                                              based on group identification to a                      availability of the draft guidance of the             educational materials and donor history
                                              deferral based on specific behavior                     same title dated May 2015. FDA                        questionnaires prior to the
                                              (male sex with another male).                           received over 700 comments on the                     implementation of new donor deferral
                                                 Since September 1985, FDA has                        draft guidance and those comments                     policies.
                                              recommended that blood establishments                   were carefully considered as the                         Finally, comments received from the
                                              indefinitely defer male donors who have                 guidance was finalized. Comments were                 blood industry were generally
                                              had sex with another male, even one                     received from a variety of organizations,             supportive of the revised MSM donor
                                              time, since 1977. On April 23, 1992,                    including patient advocacy groups                     deferral policy. However, some
                                              FDA issued the 1992 blood memo,                         representing users of blood products;                 comments noted that manufacturers of
                                              which consolidated its                                  lesbian, gay, bisexual and transgender                plasma for further manufacturing use
                                              recommendations regarding the deferral                  advocacy groups; medical and                          (i.e., to make injectable products),
                                              of donors at risk of HIV, including the                 professional societies; academic                      including Source Plasma, collected in
                                              deferral for MSM, as well as deferral                   institutions; human rights organizations;             the United States and intended for
                                              recommendations for other persons with                  local governments; members of                         further manufacturing use in other
                                              behaviors associated with high rates of                 Congress; and, the blood industry.                    countries, may need to retain an
                                              HIV exposure, namely commercial sex                     Comments were also received from                      indefinite deferral policy for MSM to
                                              workers, those who inject non-                          hundreds of individual commenters.                    comply with the indefinite deferral
                                              prescription drugs, and certain other                      Approximately one-half of the                      policies established in other countries.
                                              individuals with HIV risk factors.                      comments opposed FDA’s time-based                     Industry commenters also requested
                                                 The use of donor educational                         deferral policy for MSM and considered                revisions to certain other donor deferral
                                              material, specific deferral questions, and              the proposed policy to be                             criteria for HIV risk and disagreed with
                                              advances in HIV donor testing have                      discriminatory and lacking a scientific               FDA’s proposal to include the signs and
                                              reduced the risk of HIV transmission                    rationale. Many of these comments                     symptoms associated with HIV infection
                                              from blood transfusion from about 1 in                  recommended that FDA adopt an                         in the donor educational materials.
                                              2500 transfusions prior to HIV testing to               individual risk assessment based                      Comments requested clarification
                                              a current estimated residual risk of                    approach, regardless of an individual’s               regarding the eligibility of donors with
                                              about 1 in 1.47 million transfusions.                   sexual orientation or gender identity.                false-positive HIV tests and on
                                              Since the implementation in 1985 of                     Other comments supported a time-based                 recommendations for product retrieval
                                              donor testing for antibodies to HIV, FDA                deferral policy shorter than 1year, or no             and notification of consignees of
                                              and the U.S. Department of Health and                   deferral period at all, because of                    distributed blood components collected
                                              Human Services (HHS) have held a                        advances in blood donor testing                       from a donor who should have been
                                              number of public meetings, including                    technologies that permit earlier                      deferred for HIV risk factors. Some
                                              public scientific workshops and                         detection of new HIV infections.                      comments were also supportive of the
                                              meetings of the Blood Products                          Comments requested that FDA commit                    additional guidance provided by FDA
                                              Advisory Committee and the HHS                          to reexamining its deferral policies as               regarding transgender donors.
                                              Advisory Committee on Blood Safety                      new technologies, such as pathogen                       Finally numerous commenters
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                                              and Availability (ACBSA) to further                     reduction technology are implemented                  requested FDA to clarify the
                                              review evidence and discuss FDA’s                       and data regarding compliance with the                recommendation for deferral of women
                                              blood donor deferral policies to reduce                 revised policies become available.                    who have had sex with MSM.
                                              the risk of transmission of HIV by blood                   Most of the remaining comments                        FDA carefully considered all of the
                                              and blood products. Consistent with                     advocated for the continuation of the                 comments received in response to the
                                              recommendations of the ACBSA in June                    indefinite deferral policy for MSM and                draft guidance and the available
                                              2010, studies that might support a                      expressed concern regarding the safety                scientific data, including the results of


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                                                                       Federal Register / Vol. 80, No. 246 / Wednesday, December 23, 2015 / Notices                                                79915

                                              recent studies conducted by the Public                  factors. In addition, FDA made the                    Budget (OMB) under the Paperwork
                                              Health Service and revised the guidance                 following changes to clarify certain                  Reduction Act of 1995 (44 U.S.C. 3501–
                                              accordingly. FDA considered several                     recommendations in the guidance,                      3520). The collections of information in
                                              options to address the comments in                      which are consistent with current                     21 CFR 601.12 have been approved
                                              response to the revised MSM donor                       policy: (1) Clarified that donors who                 under OMB control number 0910–0338;
                                              deferral policy. Because evidence                       have been determined to have a false-                 the collections of information in 21 CFR
                                              indicates that the indefinite deferral                  positive HIV test may be reentered                    606.171 have been approved under
                                              policy for MSM may have become less                     according to a requalification method                 OMB control number 0910–0458; and
                                              effective over time, FDA has determined                 found acceptable to FDA; (2) noted that               the collections of information in 21 CFR
                                              that a change in policy is warranted at                 recipients of allogeneic blood                        610.46, 630.6, 640.3 and 640.63 have
                                              this time. Data on the limitations of                   transfusions (i.e., not autologous                    been approved under OMB control
                                              nucleic acid tests to identify antibody                 transfusions), should be temporarily                  number 0910–0116.
                                              negative window period HIV infections                   deferred; (3) provided reference to an
                                                                                                      FDA guidance on the collection of blood               III. Electronic Access
                                              suggests that donor testing alone, absent
                                              any deferral for MSM, would result in                   components from donors at risk of HIV                   Persons with access to the Internet
                                              an unacceptable increased risk of                       infection; and (4) clarified the deferral             may obtain the guidance at either
                                              transfusion-transmitted HIV. Similarly,                 by the responsible physician of a blood               http://www.fda.gov/BiologicsBlood
                                              pretesting at risk donors with a rapid                  establishment of any donor if the                     Vaccines/GuidanceCompliance
                                              HIV test prior to donation would be                     donation could affect the health of the               RegulatoryInformation/Guidances/
                                              logistically challenging and would not                  donor or the safety of the blood                      default.htm or http://
                                              necessarily identify newly HIV-infected                 component. Additionally, the                          www.regulations.gov.
                                              individuals. While individual donor                     background section has been expanded                    Dated: December 17, 2015.
                                              assessment for risk has been                            to summarize FDA’s evaluation of the
                                                                                                                                                            Leslie Kux,
                                              implemented in a few countries, the                     available policy options under the
                                                                                                      available evidence relevant to the MSM                Associate Commissioner for Policy.
                                              implementation of this strategy in the
                                                                                                      deferral policy. Minor editorial changes              [FR Doc. 2015–32250 Filed 12–22–15; 8:45 am]
                                              United States would present significant
                                              practical challenges and currently there                have also been made to the guidance.                  BILLING CODE 4164–01–P

                                              is no validated and accepted individual                    FDA remains committed to exploring
                                              risk assessment tool or questionnaire.                  options and engaging in public
                                                                                                      discussions regarding enhancements to                 DEPARTMENT OF HEALTH AND
                                              Therefore, FDA concluded a time-based                                                                         HUMAN SERVICES
                                              deferral for history of male-male sex is                donor and public education regarding
                                              the most appropriate policy to maintain                 safe blood donors and evaluating the
                                                                                                      effectiveness of the donor history                    Health Resources and Services
                                              the safety of the U.S. blood supply.                                                                          Administration
                                              Scientific data regarding the                           questionnaire. Further, with the
                                              effectiveness of a 1-year deferral in                   implementation of a transfusion                       Agency Information Collection
                                              Australia, a country with similar HIV                   transmitted infectious disease                        Activities: Proposed Collection; Public
                                              epidemiology to the United States,                      monitoring system, FDA will be able to                Comment Request
                                              supports FDA’s policy change to the                     monitor donor risk factors and the safety
                                              blood donor deferral period for MSM                     of the blood supply, as well as                       AGENCY: Health Resources and Services
                                              from indefinite deferral to 1 year since                investigate and refine blood safety                   Administration, HHS.
                                              the last sexual contact. Scientifically                 measures in the future. FDA’s                         ACTION: Notice.
                                              robust data are not available for time-                 recommendations may evolve over time
                                                                                                      as new scientific data become available               SUMMARY:   In compliance with the
                                              based deferrals of less than 1 year. FDA
                                                                                                      on strategies to maintain or improve                  requirement for opportunity for public
                                              also concluded that scientific data are
                                                                                                      blood safety.                                         comment on proposed data collection
                                              not currently available that would
                                                                                                         The guidance announced in this                     projects (Section 3506(c)(2)(A) of the
                                              support revisions to the indefinite
                                                                                                      notice finalizes the draft guidance dated             Paperwork Reduction Act of 1995), the
                                              deferral policy for commercial sex
                                                                                                      May 2015 and supersedes the 1992                      Health Resources and Services
                                              workers or intravenous drug users.
                                                                                                      blood memo.                                           Administration (HRSA) announces
                                                 In response to comments, FDA made                       This guidance is being issued                      plans to submit an Information
                                              the following changes when finalizing                   consistent with FDA’s good guidance                   Collection Request (ICR), described
                                              the guidance: (1) Amended the                           practices regulation (21 CFR 10.115).                 below, to the Office of Management and
                                              recommendations regarding the                           The guidance represents the current                   Budget (OMB). Prior to submitting the
                                              inclusion of signs and symptoms                         thinking of FDA on recommendations                    ICR to OMB, HRSA seeks comments
                                              associated with HIV in the donor                        for reducing the risk of HIV                          from the public regarding the burden
                                              educational materials; (2) revised the                  transmission by blood and blood                       estimate, below, or any other aspect of
                                              recommendation for the deferral of                      products. It does not establish any rights            the ICR.
                                              female donors who have had sex with                     for any person and is not binding on                  DATES: Comments on this ICR should be
                                              MSM; (3) stated that FDA no longer                      FDA or the public. You can use an                     received no later than February 22,
                                              recommends deferral for individuals                     alternative approach if it satisfies the              2016.
                                              who have had sex with an individual                     requirements of the applicable statutes
                                              with hemophilia or related clotting                     and regulations.                                      ADDRESSES:  Submit your comments to
                                                                                                                                                            paperwork@hrsa.gov or mail the HRSA
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                                              deficiencies requiring treatment with
                                              clotting factor concentrates; and (4)                   II. Paperwork Reduction Act of 1995                   Information Collection Clearance
                                              revised the recommendations regarding                      The guidance refers to previously                  Officer, Room 10C–16, 5600 Fishers
                                              product retrieval and consignee                         approved collections of information                   Lane, Rockville, MD 20857.
                                              notification of distributed blood                       found in FDA regulations. These                       FOR FURTHER INFORMATION CONTACT: To
                                              products collected from a donor who                     collections of information are subject to             request more information on the
                                              should have been deferred for HIV risk                  review by the Office of Management and                proposed project or to obtain a copy of


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Document Created: 2018-03-02 09:21:02
Document Modified: 2018-03-02 09:21:02
CategoryRegulatory Information
CollectionFederal Register
sudoc ClassAE 2.7:
GS 4.107:
AE 2.106:
PublisherOffice of the Federal Register, National Archives and Records Administration
SectionNotices
ActionNotice.
DatesSubmit either electronic or written comments on Agency guidances at any time.
ContactValerie A. Butler, Center for Biologics Evaluation and Research, Food and Drug Administration, 10903 New Hampshire Ave., Bldg. 71, Rm. 7301, Silver Spring, MD 20993-0002, 240-402-7911.
FR Citation80 FR 79913 

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