INTRODUCTION:
Transfusion-transmissible infections (TTIs) remain a major threat to blood safety, especially in resource-limited settings. In the Tigray region, where blood demand is high due to trauma, obstetric emergencies, and other medical needs, ensuring the safety of donated blood is critical. Limited data exist on the prevalence and trends of TTIs among blood donors in the region.

METHODS:
the study was conducted utilizing data from the Tigray Regional Blood Bank from 2020 to 2023. A total of 35,034 blood donations were analyzed, focusing on the prevalence of four key infections: HIV, syphilis, hepatitis B (HBV), and hepatitis C (HCV). Independent t-test, Wilcoxen sign rank, tests were performed to assess trends and fluctuations in infection rates over the designated period. We have used 95% level of confidence (CL) and statistical significance was declared at p-value less than 0.05.

RESULTS:
The overall positivity rate for TTIs exhibited fluctuations over the study period, rising from 4.3% in 2020 to a peak of 4.64% in 2022, before stabilizing at 4.3% in 2023. HIV cases declined steadily from 20 (0.376%) in 2020 to 13 (0.15%) in 2023. Statistical analysis revealed a significant decline in HIV detection rates among blood donors post-war (t = 4.34, p = 0.0492). In contrast, no significant differences were found for HBV, and HCV, across years or war status (p > 0.05). The Wilcoxen sign rank test indicated that no significant difference in Syphilis and overall TTI detection over time (p >0.05). Conclusion and recommendation: The analysis revealed a significant decline in HIV detection rates among blood donors over time and after the war, while HBV, HCV, Syphilis and Total TTIs remained stable. These findings highlight the need for continued donor screening, and improved data collection to strengthen blood safety and ensure early detection of transfusion-transmitted infections.