# Blood Safety: The Madhya Pradesh Centralized Nucleic Acid Testing (NAT) Model for Blood Donor Screening

## TL;DR

This paper describes a successful blood safety model in Madhya Pradesh using centralized nucleic acid testing to detect infections missed by traditional methods.

## Contribution

The study presents a replicable hub-and-spoke NAT model for blood screening in a developing country context.

## Key findings

- 158,493 seronegative samples were tested, identifying 943 NAT-reactive cases that would have been missed.
- The model maintained a 48-hour turnaround time and prevented an estimated 2829 transfusion-transmitted infections.
- Operational challenges were managed through standardized protocols and training.

## Abstract

Background: Ensuring safe blood transfusion is a public health priority in India, where reliance on serological screening alone may miss early infections. Centralized nucleic acid testing (NAT) offers an opportunity to strengthen blood safety through advanced molecular diagnostics.

Aim: This study aimed to highlight the successful implementation of the Madhya Pradesh centralized NAT hub and spoke model for enhancing blood transfusion safety.

Methods: The current project was implemented through a public-private partnership (PPP) using a hub-and-spoke model. To assess its merit, a retrospective analysis of program data was conducted between January 2023 and September 2024 across Madhya Pradesh, India. Deidentified records from 24 satellite blood centers, including district hospitals and specialized blood banks, were processed at central hubs in Indore and Bhopal, which used the Roche cobas® TaqScreen MPX test (version 2.0). Operational challenges and performance indicators were reviewed.

Results: A total of 158,493 seronegative samples were processed, of which 943 (1 in 168) were NAT-reactive and would have been missed by routine serological screening, potentially preventing 2829 transfusion-transmitted infections. The program maintained a 48-hour turnaround time from sample collection to reporting. Operational challenges, such as standardization of sample handling, maintenance of the cold chain during transport, and high testing volumes, were successfully addressed through rigorous protocols and training.

Conclusion: The Madhya Pradesh centralized NAT model is feasible, effective, and efficient, demonstrating its potential to reform blood safety in India. This model may serve as a replicable framework for other developing countries facing similar challenges in transfusion medicine.