Beyond the first call: unveiling the gray areas in reactive donor notification and counseling in lower-middle-income countries—a systematic scoping review

Abstract Introduction Donor notification and counseling after reactive screening for transfusion-transmitted infections (TTIs) are critical to transfusion safety and public health, yet practices in low- and middle-income countries (LMIC) remain inconsistent and poorly evaluated. Methods A Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for scoping reviews–guided scoping review was conducted to map evidence on TTI-reactive donor notification and follow-up in LMIC. We searched PubMed, EMBASE, Scopus, and Web of Science for English-language studies published between January 2005 and June 2025. Eligible studies reported notification strategies, donor psychological factors, linkage-to-care outcomes, digital health interventions, or system-level integration. Data were extracted and narratively synthesized across 5 thematic domains, as mentioned in the “Results” section. Results Notification success and donor response varied widely. Telephone-based notification consistently achieved higher return rates than letters or text messaging, while replacement donors demonstrated lower follow-up than did voluntary donors. Stigma, fear, and inaccurate contact information were major barriers to counseling. Evidence on linkage to confirmatory testing and treatment was limited; digital health approaches were largely absent. No studies evaluated cost-effectiveness or workforce impact. Discussion Overall, TTI-reactive donor notification in LMIC remains fragmented, with critical gaps in digital innovation, psychosocial support, and linkage-to-care evaluation. Strengthening system-integrated, technology-enabled, culturally sensitive notification models is essential to improve donor and public health outcomes.