Post-transfusion Hepatitis C Virus Infection and the Hidden Burden of Warm Blood Transfusion in a Resource-Limited Setting: An Analytical Cross-Sectional Study from Mbujimayi, Democratic Republic of Congo

Background Blood transfusion remains essential in clinical care, but unsafe transfusion pathways continue to expose recipients to transfusion transmitted infections (TTIs). In the Democratic Republic of the Congo (DRC), more than 90% of transfusions are delivered as warm transfusions, in which blood is released before full infectious marker screening is completed. This study aimed to quantify the additional risk of hepatitis C virus (HCV) transmission associated with this practice in Mbujimayi. Methods We conducted a prospective analytical cross-sectional study in four high transfusion-volume hospitals of Mbujimayi from April 8 to 24, 2024. A total of 223 previously transfused individuals (≥ 2 months post-transfusion) were enrolled and stratified into exposed (warm transfusion) and unexposed (cold transfusion) groups. Anti-HCV antibodies were detected using an HCV Scan rapid immunochromatographic assay performed on serum. Crude (cOR) and adjusted (aOR) odds ratios with 95% confidence intervals were estimated using bivariate analyses and multivariable logistic regression in IBM SPSS Statistics version 27, p < 0.05 was considered statistically significant. Results The post-transfusion HCV seroprevalence was 4.9% (11/223). After adjustment, two factors remained independently associated with HCV seropositivity: receiving more than one transfusion (aOR = 5.41; 95% CI: 1.22–24.02; p = 0.027) and unemployment (aOR = 4.66; 95% CI: 1.18–18.41; p = 0.028). Among those exposed to warm transfusion, repeated transfusions increased the likelihood of HCV infection tenfold (aOR = 10.03; 95% CI: 3.85–26.16; p < 0.001). Conclusion Warm transfusion, the prevailing modality in the DRC, constitutes a significant additional route of HCV transmission. Strengthening voluntary non-remunerated blood donation, ensuring uninterrupted screening for transfusion-transmitted infections, and enforcing systematic use of pre-tested blood units are critical strategies to reduce this preventable burden.