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Abady MM, Jeong JS, Kwon HJ. Dried blood spot sampling coupled with liquid chromatography-tandem mass for simultaneous quantitative analysis of multiple cardiovascular drugs. J Chromatogr B Analyt Technol Biomed Life Sci 2024; 1242:124215. [PMID: 38917652 DOI: 10.1016/j.jchromb.2024.124215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2024] [Revised: 06/10/2024] [Accepted: 06/20/2024] [Indexed: 06/27/2024]
Abstract
Dried Blood Spots (DBS) revolutionize therapeutic drug monitoring using LC-MS for the precise quantification of cardiovascular drugs (CDs), enabling personalized treatment adapted to patient-specific pharmacokinetics with minimal invasiveness. This study aims to achieve simultaneous quantification of eight CDs in DBS, overcoming physicochemical challenges. A two-step protein precipitation method was used for simple and precise sample preparation. The drugs were analyzed using LC-MS/MS in ESI positive-ion mode, showing high sensitivity and linearity, with a correlation coefficient (r2) exceeding 0.999, after being separated on a reversed-phase chromatography by gradient elution of DW-acetonitrile containing 0.1 % formic acid + 2 mM ammonium formate. The validation results indicate good selectivity, with no observed matrix effect and carry-over. The intra- and inter-day accuracy and precision were within 6 % for most drugs, except for digoxin and deslanoside at low therapeutic levels where the variation was within 20 %. Stability tests confirmed suitable DBS handling and storage conditions, indicating drug stability for at least 30 days at room temperature. The analysis of whole spot has demonstrated remarkable precision and reliability in all target drugs. The analysis of 3 mm internal diameter discs, punched in and out of DBS, presumed to contain 3 µL of blood, showed acceptable accuracy for most drugs, with less polar drugs like digoxin and deslanoside showing lower accuracy, indicating a need for further correction due to non-uniform drug distribution. Consequently, the developed LC-MS/MS method enables the quantification of multiple CDs in a single DBS analysis, while suggesting the potential for accuracy-based analysis.
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Affiliation(s)
- Mariam M Abady
- Organic Metrology Group, Division of Chemical and Material Metrology, Korea Research Institute of Standards and Science, Yuseong-gu, Daejeon 34113, Republic of Korea; Department of Bio-Analytical Science, University of Science and Technology, 217 Gajeong-ro, Yuseong-gu, Daejeon 34113, Republic of Korea; Department of Nutrition and Food Science, National Research Centre, Dokki, Cairo 12622, Egypt
| | - Ji-Seon Jeong
- Organic Metrology Group, Division of Chemical and Material Metrology, Korea Research Institute of Standards and Science, Yuseong-gu, Daejeon 34113, Republic of Korea; Department of Bio-Analytical Science, University of Science and Technology, 217 Gajeong-ro, Yuseong-gu, Daejeon 34113, Republic of Korea
| | - Ha-Jeong Kwon
- Organic Metrology Group, Division of Chemical and Material Metrology, Korea Research Institute of Standards and Science, Yuseong-gu, Daejeon 34113, Republic of Korea.
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Boisson-Walsh A, Ravelomanana NLR, Tabala M, Malongo F, Kawende B, Babakazo P, Yotebieng M. Association of comprehensiveness of antiretroviral care and detectable HIV viral load suppression among pregnant and postpartum women in the Democratic Republic of the Congo: a cross-sectional study. Front Glob Womens Health 2024; 5:1308019. [PMID: 38903153 PMCID: PMC11188341 DOI: 10.3389/fgwh.2024.1308019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Accepted: 05/21/2024] [Indexed: 06/22/2024] Open
Abstract
Introduction Worldwide, over two-thirds of people living with HIV are on antiretroviral therapy (ART). Despite increased ART access, high virological suppression prevalence remains out of reach. Few studies consider the quality of ART services and their impact on recipients' viral suppression. We assessed the association between ART service readiness and HIV viral load suppression among pregnant and breastfeeding women living with HIV (WLH) receiving ART in maternal and child health (MCH) clinics in Kinshasa, Democratic Republic of Congo. Methods We performed a cross-sectional analysis leveraging data from a continuous quality improvement intervention on WLH's long-term ART outcomes. From November 2016 to May 2020, we enrolled WLH from the three largest clinics in each of Kinshasa'Łs 35 health zones. We measured clinic's readiness using three WHO-identified ART care quality indicators: relevant guidelines in ART service area, stocks of essential ART medicines, and relevant staff training in ≥24 months, scoring clinics 0-3 based on observed indicators. We defined viral load suppression as ≤1,000 cp/ml. Multilevel mixed-effect logistic models were used to estimate prevalence odds ratios (ORs) measuring the strength of the association between ART service readiness and viral suppression. Results Of 2,295 WLH, only 1.9% received care from a clinic with a score of 3, 24.1% received care from a 0-scoring clinic, and overall, 66.5% achieved virologically suppression. Suppression increased from 65% among WLH receiving care in 0-scoring clinics to 66.9% in 1-scoring clinics, 65.8% in 2-scoring clinics, and 76.1% in 3-scoring clinics. We did not observe a statistically significant association between ART service readiness score and increased viral suppression prevalence, however we did find associations between other factors, such as the location of the health center and pharmacist availability with suppressed viral load. Discussion A lack of comprehensive ART care underscores the need for enhanced structural and organizational support to improve virological suppression and overall health outcomes for women living with HIV..
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Affiliation(s)
- Alix Boisson-Walsh
- Department of Health Policy and Management, University of Carolina at Chapel Hill, Chapel Hill, NC, United States
| | | | - Martine Tabala
- School of Public Health, University of Kinshasa, Kinshasa, Democratic Republic of Congo
| | - Fathy Malongo
- School of Public Health, University of Kinshasa, Kinshasa, Democratic Republic of Congo
| | - Bienvenu Kawende
- School of Public Health, University of Kinshasa, Kinshasa, Democratic Republic of Congo
| | - Pélagie Babakazo
- School of Public Health, University of Kinshasa, Kinshasa, Democratic Republic of Congo
| | - Marcel Yotebieng
- Division of General Internal Medicine, Department of Medicine, Albert Einstein College of Medicine, Bronx, NY, United States
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3
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Schildknecht K, Samans B, Gussmann J, Baron U, Raschke E, Babel N, Oppatt J, Gellhaus K, Rossello A, Janack I, Olek S. Specifications of qPCR based epigenetic immune cell quantification. Clin Chem Lab Med 2024; 62:615-626. [PMID: 37982750 DOI: 10.1515/cclm-2023-1056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Accepted: 10/25/2023] [Indexed: 11/21/2023]
Abstract
OBJECTIVES Immune monitoring is an important aspect in diagnostics and clinical trials for patients with compromised immune systems. Flow cytometry is the standard method for immune cell counting but faces limitations. Best practice guidelines are available, but lack of standardization complicates compliance with e.g., in vitro diagnostic regulations. Limited sample availability forces immune monitoring to predominantly use population-based reference intervals. Epigenetic qPCR has evolved as alternative with broad applicability and low logistical demands. Analytical performance specifications (APS) have been defined for qPCR in several regulated fields including testing of genetically modified organisms or vector-shedding. METHODS APS were characterized using five epigenetic qPCR-based assays quantifying CD3+, CD4+, CD8+ T, B and NK cells in light of regulatory requirements. RESULTS Epigenetic qPCR meets all specifications including bias, variability, linearity, ruggedness and sample stability as suggested by pertinent guidelines and regulations. The assays were subsequently applied to capillary blood from 25 normal donors over a 28-day period. Index of individuality (IoI) and reference change values were determined to evaluate potential diagnostic gains of individual reference intervals. Analysis of the IoI suggests benefits for individual over population-based references. Reference change values (RCVs) show that changes of approx. Fifty percent from prior measurement are suggestive for clinically relevant changes in any of the 5 cell types. CONCLUSIONS The demonstrated precision, long-term stability and obtained RCVs render epigenetic cell counting a promising tool for immune monitoring in clinical trials and diagnosis.
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Affiliation(s)
- Konstantin Schildknecht
- Ivana Türbachova Laboratory for Epigenetics, Epiontis, Precision for Medicine GmbH, Berlin, Germany
| | - Björn Samans
- Ivana Türbachova Laboratory for Epigenetics, Epiontis, Precision for Medicine GmbH, Berlin, Germany
| | - Jasmin Gussmann
- Ivana Türbachova Laboratory for Epigenetics, Epiontis, Precision for Medicine GmbH, Berlin, Germany
| | - Udo Baron
- Ivana Türbachova Laboratory for Epigenetics, Epiontis, Precision for Medicine GmbH, Berlin, Germany
| | - Eva Raschke
- Ivana Türbachova Laboratory for Epigenetics, Epiontis, Precision for Medicine GmbH, Berlin, Germany
| | - Nina Babel
- Marienhospital Herne, Klinik I für Innere Medizin, Centrum für Translationale Medizin, Herne, Germany
| | - Julia Oppatt
- Ivana Türbachova Laboratory for Epigenetics, Epiontis, Precision for Medicine GmbH, Berlin, Germany
| | | | - Araceli Rossello
- Ivana Türbachova Laboratory for Epigenetics, Epiontis, Precision for Medicine GmbH, Berlin, Germany
| | - Isabell Janack
- Ivana Türbachova Laboratory for Epigenetics, Epiontis, Precision for Medicine GmbH, Berlin, Germany
| | - Sven Olek
- Ivana Türbachova Laboratory for Epigenetics, Epiontis, Precision for Medicine GmbH, Berlin, Germany
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4
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Vloemans D, Van Hileghem L, Ordutowski H, Dal Dosso F, Spasic D, Lammertyn J. Self-Powered Microfluidics for Point-of-Care Solutions: From Sampling to Detection of Proteins and Nucleic Acids. Methods Mol Biol 2024; 2804:3-50. [PMID: 38753138 DOI: 10.1007/978-1-0716-3850-7_1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/21/2024]
Abstract
Self-powered microfluidics presents a revolutionary approach to address the challenges of healthcare in decentralized and point-of-care settings where limited access to resources and infrastructure prevails or rapid clinical decision-making is critical. These microfluidic systems exploit physical and chemical phenomena, such as capillary forces and surface tension, to manipulate tiny volumes of fluids without the need for external power sources, making them cost-effective and highly portable. Recent technological advancements have demonstrated the ability to preprogram complex multistep liquid operations within the microfluidic circuit of these standalone systems, which enabled the integration of sensitive detection and readout principles. This chapter first addresses how the accessibility to in vitro diagnostics can be improved by shifting toward decentralized approaches like remote microsampling and point-of-care testing. Next, the crucial role of self-powered microfluidic technologies to enable this patient-centric healthcare transition is emphasized using various state-of-the-art examples, with a primary focus on applications related to biofluid collection and the detection of either proteins or nucleic acids. This chapter concludes with a summary of the main findings and our vision of the future perspectives in the field of self-powered microfluidic technologies and their use for in vitro diagnostics applications.
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Affiliation(s)
- Dries Vloemans
- Department of Biosystems - Biosensors Group, KU Leuven, Leuven, Belgium
| | | | - Henry Ordutowski
- Department of Biosystems - Biosensors Group, KU Leuven, Leuven, Belgium
| | | | - Dragana Spasic
- Department of Biosystems - Biosensors Group, KU Leuven, Leuven, Belgium
| | - Jeroen Lammertyn
- Department of Biosystems - Biosensors Group, KU Leuven, Leuven, Belgium.
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Vubil A, Zicai AF, Sitoe N, Nhachigule C, da Costa P, Magul C, Meggi B, Viegas S, Mabunda N, Jani I. Performance of two plasma separation devices for HIV-1 viral load measurement in primary healthcare settings. Microbiol Spectr 2023; 11:e0054623. [PMID: 37812011 PMCID: PMC10715000 DOI: 10.1128/spectrum.00546-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Accepted: 08/25/2023] [Indexed: 10/10/2023] Open
Abstract
IMPORTANCE Burnett and HemaSpot are two novel technologies that allow whole blood collection and plasma separation and stabilization at room temperature without the need of additional equipment. Hence, these devices are potential alternatives to fresh plasma as a suitable specimen for viral load scale-up to monitor antiretroviral therapy in resource-limited settings.
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Affiliation(s)
- Adolfo Vubil
- Laboratory Reference Service, Instituto Nacional de Saúde, Marracuene, Mozambique
| | - Ana Flora Zicai
- Laboratory Reference Service, Instituto Nacional de Saúde, Marracuene, Mozambique
| | - Nádia Sitoe
- Laboratory Reference Service, Instituto Nacional de Saúde, Marracuene, Mozambique
| | - Carina Nhachigule
- Laboratory Reference Service, Instituto Nacional de Saúde, Marracuene, Mozambique
| | - Paulino da Costa
- Laboratory Reference Service, Instituto Nacional de Saúde, Marracuene, Mozambique
| | - Cacildo Magul
- Laboratory Reference Service, Instituto Nacional de Saúde, Marracuene, Mozambique
| | - Bindiya Meggi
- Laboratory Reference Service, Instituto Nacional de Saúde, Marracuene, Mozambique
| | - Sofia Viegas
- Laboratory Reference Service, Instituto Nacional de Saúde, Marracuene, Mozambique
| | - Nédio Mabunda
- Laboratory Reference Service, Instituto Nacional de Saúde, Marracuene, Mozambique
| | - Ilesh Jani
- Laboratory Reference Service, Instituto Nacional de Saúde, Marracuene, Mozambique
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Nguyen LBL, Soumah AA, Hoang VT, Nguyen AT, Pham TH, Royer-Devaux S, Madec Y. Performances of Dried Blood Spots and Point-of-Care Devices to Identify Virological Failure in HIV-Infected Patients: A Systematic Review and Meta-Analysis. AIDS Patient Care STDS 2023; 37:66-83. [PMID: 36787410 DOI: 10.1089/apc.2022.0135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2023] Open
Abstract
To broaden access to HIV viral load monitoring (VLM), the use of blood samples from dried blood spots (DBS) or point-of-care (POC) devices, could be of great help in settings where plasma is not easily accessible. The variety of assays available makes the choice complex. This systematic review and meta-analysis aims to estimate the sensitivity and specificity of DBS and POC devices to identify patients in virological failure using World Health Organization (WHO) recommendations (viral load ≥1000 copies/mL), compared with plasma, for the assays currently available. Four databases were searched for articles, and two reviewers independently identified articles reporting sensitivity and specificity of DBS and/or POC to identify patients in virological failure. We excluded articles that used other thresholds as well as articles with a total number of participants below 50 to avoid reporting bias. Heterogeneity and factors associated with assays' performances were assessed by I2 statistics and metaregression. The protocol of this review follows the PRISMA guidelines. Out of 941 articles, 47 were included: 32 DBS evaluations and 16 POC evaluations. Overall, when using DBS, the Abbott RT HIV-1, Roche CAP-CTM, NucliSENS BioMerieux and Aptima assays presented sensitivity and specificity exceeding 85%, but reported results were highly heterogeneous. Factors associated with better performances were high volume of blood and the use of the same assay for DBS and plasma VLM. Regarding the POC devices, SAMBA I, SAMBA II, and GeneXpert devices presented high sensitivity and specificity exceeding 90%, with less heterogeneity. DBS is suitable VLM, but performances can vary greatly depending on the protocols, and should be performed in trained centers. POC is suitable for VLM with less risk of heterogeneity but is more intensive in costs and logistics.
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Affiliation(s)
- Liem Binh Luong Nguyen
- Epidemiology of Emerging Diseases, Université de Paris, Institut Pasteur, Paris, France.,Assistance Publique Hôpitaux de Paris (AP-HP), CIC 1417 Cochin Pasteur, Hôpital Cochin, Paris, France
| | - Abou Aissata Soumah
- Epidemiology of Emerging Diseases, Université de Paris, Institut Pasteur, Paris, France
| | - Van Thuan Hoang
- Thai Binh University of Medicine and Pharmacy, Thai Binh, Vietnam
| | - Anh Tuan Nguyen
- National Institute of Health and Epidemiology (NIHE), Hanoi, Vietnam
| | - Thang Hong Pham
- National Institute of Health and Epidemiology (NIHE), Hanoi, Vietnam
| | | | - Yoann Madec
- Epidemiology of Emerging Diseases, Université de Paris, Institut Pasteur, Paris, France
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7
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Carey B, Chalk C, Stock J, Toth A, Klingler M, Greenberg H, Uchida K, Arumugam P, Trapnell BC. A dried blood spot test for diagnosis of autoimmune pulmonary alveolar proteinosis. J Immunol Methods 2022; 511:113366. [PMID: 36198356 PMCID: PMC10026347 DOI: 10.1016/j.jim.2022.113366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Revised: 09/28/2022] [Accepted: 09/28/2022] [Indexed: 01/12/2023]
Abstract
Granulocyte/macrophage colony-stimulating factor autoantibodies (GMAbs) mediate the pathogenesis of autoimmune pulmonary alveolar proteinosis (autoimmune PAP) and their quantification in serum by enzyme-linked immunosorbent assay (ELISA) - the serum GMAb test - is the 'gold standard' for diagnosis of autoimmune PAP. Because GMAbs are high in autoimmune PAP and low or undetectable in healthy people, we hypothesized that the ELISA could be adapted for evaluation of blood obtained from the fingertip using a dried blood spot card (DBSC) for specimen collection. Here, we report development of such a method - the DBSC GMAb test - and evaluate its ability to measure GMAb concentration in blood and to diagnose autoimmune PAP. Fresh, heparinized whole blood was obtained from 60 autoimmune PAP patients and 19 healthy people and used to measure the GMAb concentration in blood (by the DBSC GMAb test). After optimization, the DBSC GMAb test was evaluated for accuracy, precision, reliability, sensitivity, specificity, and ruggedness. The coefficient of variation among repeated measurements was low with regard to well-to-well, plate-to-plate, day-to-day, and inter-operator variation, and results were unaffected by exposure of prepared DBSC specimens to a wide range of temperatures (from -80 °C to 65 °C), repeated freeze-thaw cycles, or storage for up to 2.5 months before testing. The limit of blank (LoB), limit of detection (LoD), and lower limit of quantification (LLoQ), were 0.01, 0.21, and 3.5 μg/ml of GMAb in the blood, respectively. Receiver operating curve characteristic analysis identified 2.7 μg/ml as the optimal GMAb concentration cutoff value to distinguish autoimmune PAP from healthy people. This cutoff value was less than the LLoQ and the ranges of GMAb results for autoimmune PAP patients and healthy people were widely separated (median (interquartile range): 22.6 (13.3-43.8) and 0.23 (0.20-0.30) μg/ml, respectively). Consequently, the LLoQ is recommended as the lower limit of the range indicating a positive test result (i.e., that autoimmune PAP is present); lower values indicate a negative test result (i.e., autoimmune PAP is not present). Among the 30 autoimmune PAP patients and 19 healthy people evaluated, the sensitivity and specificity of the DBSC GMAb test were both 100% for a diagnosis of autoimmune PAP. Results demonstrate the DBSC GMAb test reliably measures GMAbs in blood and performs well in the diagnosis of autoimmune PAP.
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Affiliation(s)
- Brenna Carey
- Translational Pulmonary Science Center, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Claudia Chalk
- Translational Pulmonary Science Center, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Jennifer Stock
- Translational Pulmonary Science Center, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Andrea Toth
- Translational Pulmonary Science Center, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Maria Klingler
- Translational Pulmonary Science Center, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Henry Greenberg
- Translational Pulmonary Science Center, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Kanji Uchida
- Tokyo University Graduate School of Medicine, Tokyo, Japan
| | - Paritha Arumugam
- Translational Pulmonary Science Center, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Bruce C Trapnell
- Translational Pulmonary Science Center, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA; Department of Medicine, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
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Vojnov L, Carmona S, Zeh C, Markby J, Boeras D, Prescott MR, Mayne ALH, Sawadogo S, Adje-Toure C, Zhang G, Perez Gonzalez M, Stevens WS, Doherty M, Yang C, Alexander H, Peter TF, Nkengasong J. The performance of using dried blood spot specimens for HIV-1 viral load testing: A systematic review and meta-analysis. PLoS Med 2022; 19:e1004076. [PMID: 35994520 PMCID: PMC9447868 DOI: 10.1371/journal.pmed.1004076] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Revised: 09/06/2022] [Accepted: 07/13/2022] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Accurate routine HIV viral load testing is essential for assessing the efficacy of antiretroviral treatment (ART) regimens and the emergence of drug resistance. While the use of plasma specimens is the standard for viral load testing, its use is restricted by the limited ambient temperature stability of viral load biomarkers in whole blood and plasma during storage and transportation and the limited cold chain available between many health care facilities in resource-limited settings. Alternative specimen types and technologies, such as dried blood spots, may address these issues and increase access to viral load testing; however, their technical performance is unclear. To address this, we conducted a meta-analysis comparing viral load results from paired dried blood spot and plasma specimens analyzed with commonly used viral load testing technologies. METHODS AND FINDINGS Standard databases, conferences, and gray literature were searched in 2013 and 2018. Nearly all studies identified (60) were conducted between 2007 and 2018. Data from 40 of the 60 studies were included in the meta-analysis, which accounted for a total of 10,871 paired dried blood spot:plasma data points. We used random effects models to determine the bias, accuracy, precision, and misclassification for each viral load technology and to account for between-study variation. Dried blood spot specimens produced consistently higher mean viral loads across all technologies when compared to plasma specimens. However, when used to identify treatment failure, each technology compared best to plasma at a threshold of 1,000 copies/ml, the present World Health Organization recommended treatment failure threshold. Some heterogeneity existed between technologies; however, 5 technologies had a sensitivity greater than 95%. Furthermore, 5 technologies had a specificity greater than 85% yet 2 technologies had a specificity less than 60% using a treatment failure threshold of 1,000 copies/ml. The study's main limitation was the direct applicability of findings as nearly all studies to date used dried blood spot samples prepared in laboratories using precision pipetting that resulted in consistent input volumes. CONCLUSIONS This analysis provides evidence to support the implementation and scale-up of dried blood spot specimens for viral load testing using the same 1,000 copies/ml treatment failure threshold as used with plasma specimens. This may support improved access to viral load testing in resource-limited settings lacking the required infrastructure and cold chain storage for testing with plasma specimens.
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Affiliation(s)
- Lara Vojnov
- Clinton Health Access Initiative, Boston, Massachusetts, United States of America
- * E-mail:
| | - Sergio Carmona
- National Health Laboratory Service, Johannesburg, South Africa
| | - Clement Zeh
- Center for Global Health, Division of Global HIV/TB, US Centers for Disease Control, Atlanta, Georgia, United States of America
| | | | - Debrah Boeras
- Center for Global Health, Division of Global HIV/TB, US Centers for Disease Control, Atlanta, Georgia, United States of America
| | - Marta R. Prescott
- Clinton Health Access Initiative, Boston, Massachusetts, United States of America
| | | | - Souleymane Sawadogo
- Center for Global Health, Division of Global HIV/TB, US Centers for Disease Control, Windhoek, Namibia
| | - Christiane Adje-Toure
- Center for Global Health, Division of Global HIV/TB, US Centers for Disease Control, Abidjan, Cote d’Ivoire
| | - Guoqing Zhang
- Center for Global Health, Division of Global HIV/TB, US Centers for Disease Control, Atlanta, Georgia, United States of America
| | | | - Wendy S. Stevens
- National Health Laboratory Service, Johannesburg, South Africa
- Department of Molecular Medicine and Haematology, University of the Witwatersrand, Johannesburg, South Africa
| | - Meg Doherty
- World Health Organization, Geneva, Switzerland
| | - Chunfu Yang
- Center for Global Health, Division of Global HIV/TB, US Centers for Disease Control, Atlanta, Georgia, United States of America
| | - Heather Alexander
- Center for Global Health, Division of Global HIV/TB, US Centers for Disease Control, Atlanta, Georgia, United States of America
| | - Trevor F. Peter
- Clinton Health Access Initiative, Boston, Massachusetts, United States of America
| | - John Nkengasong
- Center for Global Health, Division of Global HIV/TB, US Centers for Disease Control, Atlanta, Georgia, United States of America
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9
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Pham MD, Nguyen HV, Anderson D, Crowe S, Luchters S. Viral load monitoring for people living with HIV in the era of test and treat: progress made and challenges ahead - a systematic review. BMC Public Health 2022; 22:1203. [PMID: 35710413 PMCID: PMC9202111 DOI: 10.1186/s12889-022-13504-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Accepted: 05/24/2022] [Indexed: 11/10/2022] Open
Abstract
Background In 2016, we conducted a systematic review to assess the feasibility of treatment monitoring for people living with HIV (PLHIV) receiving antiretroviral therapy (ART) in low and middle-income countries (LMICs), in line with the 90-90-90 treatment target. By 2020, global estimates suggest the 90-90-90 target, particularly the last 90, remains unattainable in many LMICs. This study aims to review the progress and identify needs for public health interventions to improve viral load monitoring and viral suppression for PLHIV in LMICs. Methods A literature search was conducted using an update of the initial search strategy developed for the 2016 review. Electronic databases (Medline and PubMed) were searched to identify relevant literature published in English between Dec 2015 and August 2021. The primary outcome was initial viral load (VL) monitoring (the proportion of PLHIV on ART and eligible for VL monitoring who received a VL test). Secondary outcomes included follow-up VL monitoring (the proportion of PLHIV who received a follow-up VL after an initial elevated VL test), confirmation of treatment failure (the proportion of PLHIV who had two consecutive elevated VL results) and switching treatment regimen rates (the proportion of PLHIV who switched treatment regimen after confirmation of treatment failure). Results The search strategy identified 1984 non-duplicate records, of which 34 studies were included in the review. Marked variations in initial VL monitoring coverage were reported across study settings/countries (range: 12–93% median: 74% IQR: 46–82%) and study populations (adults (range: 25–96%, median: 67% IQR: 50–84%), children, adolescents/young people (range: 2–94%, median: 72% IQR: 47–85%), and pregnant women (range: 32–82%, median: 57% IQR: 43–71%)). Community-based models reported higher VL monitoring (median: 85%, IQR: 82-88%) compared to decentralised care at primary health facility (median: 64%, IRQ: 48-82%). Suboptimal uptake of follow-up VL monitoring and low regimen switching rates were observed. Conclusions Substantial gaps in VL coverage across study settings and study populations were evident, with limited data availability outside of sub-Saharan Africa. Further research is needed to fill the data gaps. Development and implementation of innovative, community-based interventions are required to improve VL monitoring and address the “failure cascade” in PLHIV on ART who fail to achieve viral suppression.
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Affiliation(s)
- Minh D Pham
- Burnet Institute, Melbourne, Australia. .,Department of Epidemiology and Preventive Medicine, Faculty of Medicine Nursing and Health Science, Monash University, Melbourne, Australia.
| | - Huy V Nguyen
- Health Innovation and Transformation Centre, Federation University, Victoria, Australia.,School of Medicine and Dentistry, Griffith University, Brisbane, Australia
| | - David Anderson
- Burnet Institute, Melbourne, Australia.,Department of Microbiology, Faculty of Medicine Nursing and Health Science, Monash University, Melbourne, Australia
| | - Suzanne Crowe
- Burnet Institute, Melbourne, Australia.,Central Clinical School, Faculty of Medicine Nursing and Health Science, Monash University, Melbourne, Australia
| | - Stanley Luchters
- Department of Epidemiology and Preventive Medicine, Faculty of Medicine Nursing and Health Science, Monash University, Melbourne, Australia.,Centre for Sexual Health and HIV & AIDS Research, Harare, Zimbabwe.,Department of Public health and Primary care, Ghent University, Ghent, Belgium
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10
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Dzobo M, Dzinamarira T, Murewanhema G, Madziva R, Herrera H, Musuka G. Limited syphilis testing for key populations in Zimbabwe: A silent public health threat. S Afr J Infect Dis 2022; 37:385. [PMID: 35815225 PMCID: PMC9257705 DOI: 10.4102/sajid.v37i1.385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2021] [Accepted: 03/31/2022] [Indexed: 11/01/2022] Open
Abstract
In this article, the authors discuss the problem of high prevalences of active syphilis amongst key populations (KPs) in Zimbabwe, in combination with low testing rates, partly because of a difficult legal and social environment for these populations. The article highlights the need to develop strategies to address the high prevalence of syphilis amongst KPs. The authors discuss requirements for addressing deficits in existing clinical services, predominantly primary care settings, in providing primary healthcare, including sexually transmitted infection (STI) management, to Zimbabwe’s KP communities and utility of point-of-care testing and self-testing and other innovations to improve testing uptake.
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Affiliation(s)
- Mathias Dzobo
- School of Health Systems and Public Health, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
| | - Tafadzwa Dzinamarira
- School of Health Systems and Public Health, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
| | - Grant Murewanhema
- Unit of Obstetrics and Gynecology, Faculty of Medicine and Health Sciences, University of Zimbabwe, Harare, Zimbabwe
| | - Roda Madziva
- School of Sociology and Social Policy, University of Nottingham, Nottingham, United Kingdom
| | - Helena Herrera
- School of Pharmacy and Biomedical Sciences, University of Portsmouth, Portsmouth, United Kingdom
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Samsonova JV, Saushkin NY, Osipov AP. Dried Samples of Biological Fluids on Porous Membranes as a Promising Sample Preparation Method for Biomedical and Veterinary Diagnostics. JOURNAL OF ANALYTICAL CHEMISTRY 2022. [DOI: 10.1134/s1061934822040104] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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12
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Sultana R, Bhuiyan TR, Sathi AS, Sharmin S, Yeasmin S, Uddin MI, Bhuiyan MS, Mannoor K, Karim MM, Zaman K, Qadri F. Developing and validating a modified enzyme linked immunosorbent assay method for detecting HEV IgG antibody from dried blood spot (DBS) samples in endemic settings. Microbes Infect 2022; 24:104890. [PMID: 34628012 PMCID: PMC8960178 DOI: 10.1016/j.micinf.2021.104890] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2021] [Revised: 09/22/2021] [Accepted: 09/22/2021] [Indexed: 12/20/2022]
Abstract
Serological analysis is an integral part of laboratory practice nowadays. The present study was aimed to develop and validate a modified Enzyme linked Immunosorbent Assay (ELISA) for determination of IgG antibody against Hepatitis E Virus (HEV) using dried blood spots (DBS) and corresponding plasma samples. A total of 65 samples (45 HEV patients, 20 healthy controls) were analyzed. DBS and plasma samples demonstrated equivalent optical densities for detecting anti-HEV IgG. A highly significant correlation was observed between plasma and DBS sample absorbances (R2 = 0.98; p < 0.001) at dilution 1:200, indicating true agreement between the two procedures. The assay exhibited decent linearity and showed no effect of physiological hematocrit on assay performance. Data suggested recommendable promise in using DBS as a suitable alternative to plasma samples to determine HEV IgG antibody evidenced by significant correlation with plasma results. Therefore, identical method for processing DBS specimens including it's proper storage is recommended for implementation of a modified ELISA in different settings.
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Affiliation(s)
- Rosy Sultana
- Institute for Developing Science and Health Initiatives (ideSHi), Mohakhali, Dhaka, Bangladesh; Department of Microbiology, University of Dhaka, Dhaka, Bangladesh; Department of Immunology, Bangladesh University of Health Sciences, Dhaka, Bangladesh
| | - Taufiqur Rahman Bhuiyan
- Enteric and Respiratory Infections, Infectious Diseases Division, International Centre for Diarrheal Disease Research, Bangladesh (icddr,b), Bangladesh
| | - Afsana Shirin Sathi
- Enteric and Respiratory Infections, Infectious Diseases Division, International Centre for Diarrheal Disease Research, Bangladesh (icddr,b), Bangladesh
| | - Salma Sharmin
- Enteric and Respiratory Infections, Infectious Diseases Division, International Centre for Diarrheal Disease Research, Bangladesh (icddr,b), Bangladesh
| | - Sharmina Yeasmin
- Department of Gynecology and Obstetrics, Bangladesh Institute of Health Sciences and General Hospital, Dhaka, Bangladesh
| | - Muhammad Ikhtear Uddin
- Enteric and Respiratory Infections, Infectious Diseases Division, International Centre for Diarrheal Disease Research, Bangladesh (icddr,b), Bangladesh
| | - Md Saruar Bhuiyan
- Enteric and Respiratory Infections, Infectious Diseases Division, International Centre for Diarrheal Disease Research, Bangladesh (icddr,b), Bangladesh
| | - Kaiissar Mannoor
- Institute for Developing Science and Health Initiatives (ideSHi), Mohakhali, Dhaka, Bangladesh
| | | | - K Zaman
- Enteric and Respiratory Infections, Infectious Diseases Division, International Centre for Diarrheal Disease Research, Bangladesh (icddr,b), Bangladesh
| | - Firdausi Qadri
- Institute for Developing Science and Health Initiatives (ideSHi), Mohakhali, Dhaka, Bangladesh; Enteric and Respiratory Infections, Infectious Diseases Division, International Centre for Diarrheal Disease Research, Bangladesh (icddr,b), Bangladesh; Department of Immunology, Bangladesh University of Health Sciences, Dhaka, Bangladesh.
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13
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Catlett B, Hajarizadeh B, Cunningham E, Wolfson-Stofko B, Wheeler A, Khandaker-Hussain B, Feld JJ, Martró E, Chevaliez S, Pawlotsky JM, Bharat C, Cunningham PH, Dore GJ, Applegate T, Grebely J. Diagnostic accuracy of assays using point-of-care testing or dried blood spot samples for the determination of HCV RNA: a systematic review. J Infect Dis 2022; 226:1005-1021. [PMID: 35150578 DOI: 10.1093/infdis/jiac049] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Accepted: 02/10/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Fingerstick point-of-care and dried-blood-spot (DBS) HCV RNA testing increases testing uptake and linkage to care. This systematic review evaluated the diagnostic accuracy of point-of-care testing and DBS to detect HCV RNA. METHODS Bibliographic databases and conference presentations were searched for eligible studies. Meta-analysis was used to pool estimates. RESULTS Of 359 articles identified, 43 studies were eligible and included. When comparing the Xpert HCV Viral Load Fingerstick assay to venous blood samples (7 studies with 987 samples), the sensitivity and specificity for HCV RNA detection was 99% (95% CI:98%-100%) and 99% (95% CI:96%-100%) and for HCV RNA quantification was 100% (95% CI:93%-100%) and 100% (95% CI:94%-100%). The proportion of invalid results following Xpert HCV Viral Load Fingerstick testing was 6% (95% CI:3%-11%). When comparing DBS to venous blood samples (28 studies with 3988 samples), the sensitivity and specificity for HCV RNA detection was 97% (95% CI:95%-98%) and 100% (95% CI:98%-100%) and for HCV RNA quantification was 98% (95% CI:96%-99%) and 100% (95% CI:95%-100%). CONCLUSION Excellent diagnostic accuracy was observed across assays for detection of HCV RNA from fingerstick and DBS samples. The proportion of invalid results following Xpert HCV Viral Load Fingerstick testing highlights the importance of operator training and quality assurance programs.
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Affiliation(s)
- Beth Catlett
- The Kirby Institute, UNSW Sydney, Sydney, Australia.,St Vincent's Centre for Applied Medical Research, Sydney, Australia
| | | | | | - Brett Wolfson-Stofko
- Toronto Centre for Liver Disease, University Health Network, University of Toronto, Toronto, Canada
| | | | | | - Jordan J Feld
- Toronto Centre for Liver Disease, University Health Network, University of Toronto, Toronto, Canada
| | - Elisa Martró
- Microbiology Department, Laboratori Clínic Metropolitana Nord, Hospital Universitari Germans Trias I Pujol, Institut d'Investigació Germans Trias I Pujol (IGTP), Badalona (Barcelona), Spain.,Group 27, Biomedical Research Networking Centre in Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain
| | - Stéphane Chevaliez
- French National Reference Centre for viral hepatitis B, C and delta, Department of Virology, Hôpital Henri Mondor, Université Paris-Est, Créteil, France
| | - Jean-Michel Pawlotsky
- French National Reference Centre for viral hepatitis B, C and delta, Department of Virology, Hôpital Henri Mondor, Université Paris-Est, Créteil, France
| | - Chrianna Bharat
- National Drug and Alcohol Research Centre, Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Philip H Cunningham
- The Kirby Institute, UNSW Sydney, Sydney, Australia.,St Vincent's Centre for Applied Medical Research, Sydney, Australia
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14
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Colucci G, Uceda Renteria S, Ceriotti F, Lampertico P. Clinical Evaluation of Plasma Separation Cards as a Tool to Collect, Store, and Test Blood Samples for Hepatitis B and C Serological Markers. Clin Chem 2021; 68:214-217. [PMID: 34969104 DOI: 10.1093/clinchem/hvab170] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Accepted: 07/16/2021] [Indexed: 11/13/2022]
Abstract
BACKGROUND The plasma separation card (PSC) is a new device for collecting finger-pricking-derived small amount of blood in a solid support that is stable at room temperature and can be archived, mailed, and processed at a later time. This tool can facilitate screening at risk populations located in rural areas without local health care infrastructures. We evaluated the performance of PSC in the collection and preparation of blood samples for the determination of hepatitis B and C serological markers. METHODS Blood obtained from 334 consecutive patients referred for the detection of hepatitis B surface antigens (HBsAg), hepatitis B surface antibodies (anti-HBs) and hepatitis C antibodies (anti-HCV) was analyzed in parallel using standard (STD) and PSC-based sample collection and preparation procedures. Results obtained from STD or PSC processed samples were compared for their detection rate and correlation. RESULTS Using STD, we detected 5 samples positive for HBsAg, 150 for anti-HBs, and 23 for anti-HCV with a rate of concordance with PSC of 100%, 100%, and 91% respectively. The 100% concordance observed for anti-HBs was based on a cutoff of 2.6 IU/L for PSC-derived sample corresponding to the 10 IU/L threshold associated with immunity to hepatitis B. STD and PSC showed a good correlation (R2 = 0.85) in the detection of anti-HBs titers. The 2 anti-HCV PSC negative samples had no detectable viremia. CONCLUSIONS These data confirm the utility of PSC as a tool to support viral hepatitis screening programs in rural areas lacking local clinical infrastructures and testing facilities.
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Affiliation(s)
- Giuseppe Colucci
- Division of Gastroenterology and Hepatology, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Sara Uceda Renteria
- Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Department of Clinical Laboratory, Virology Unit, Milan, Italy
| | - Ferruccio Ceriotti
- Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Department of Clinical Laboratory, Virology Unit, Milan, Italy
| | - Pietro Lampertico
- Division of Gastroenterology and Hepatology, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- CRC "A. M. and A. Migliavacca" Center for Liver Disease, Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
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15
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Turgeon CT, Sanders KA, Rinaldo P, Granger D, Hilgart H, Matern D, Theel ES. Validation of a multiplex flow immunoassay for detection of IgG antibodies against SARS-CoV-2 in dried blood spots. PLoS One 2021; 16:e0252621. [PMID: 34048503 PMCID: PMC8162624 DOI: 10.1371/journal.pone.0252621] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 05/18/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Dried blood spots (DBS) are an established specimen type for clinical testing given their low cost, ease of collection and storage, and convenient shipping capabilities through the postal system. These attributes are complementary to the expansion of SARS-CoV-2 serologic testing, which may be used to inform community seroprevalence rates. METHODS The Luminex xMAP SARS-CoV-2 Multi-Antigen assay utilizes magnetic beads labeled with three viral antigens (nucleocapsid [NC], receptor binding domain [RBD], spike S1 subunit) to detect anti-viral IgG-class antibodies, and has Food and Drug Administration (FDA) Emergency Use Authorization (EUA) for use in serum and plasma. This assay was modified for use with DBS and validated against paired sera tested by one of two reference assays: the Roche Diagnostics Elecsys anti-SARS-CoV-2 ECLIA or the Euroimmun anti-SARS-CoV-2 IgG ELISA. RESULTS 159 paired DBS and serum specimens analyzed using the modified Luminex xMAP assay on DBS and the reference methods on serum showed an overall concordance of 96.9% (154/159). Use of multivariate pattern recognition software (CLIR) for post-analytical interpretation of the Luminex xMAP DBS assay results, instead of manufacturer provided interpretive thresholds, increased overall qualitative result concordance to 99.4% (158/159) between the modified Luminex xMAP DBS and reference results. CONCLUSIONS Use of DBS for detection of antibodies against SARS-CoV-2 provides comparable results to those obtained using serum. DBS concordance was improved with multivariate pattern recognition software (CLIR). We demonstrate that DBS are a reliable specimen type for SARS-CoV-2 antibody detection using the modified Luminex xMAP assay.
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Affiliation(s)
- Coleman T. Turgeon
- Divisions of Laboratory Genetics and Genomics and Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Karen A. Sanders
- Divisions of Laboratory Genetics and Genomics and Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Piero Rinaldo
- Divisions of Laboratory Genetics and Genomics and Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Dane Granger
- Clinical Microbiology, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Heather Hilgart
- Clinical Microbiology, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Dietrich Matern
- Divisions of Laboratory Genetics and Genomics and Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Elitza S. Theel
- Clinical Microbiology, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, United States of America
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16
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Hans L, Marins EG, Simon CO, Magubane D, Seiverth B, Carmona S. Classification of HIV-1 virological treatment failure using the Roche cobas plasma separation card on cobas 8800 compared to dried blood spots on Abbott RealTime HIV-1. J Clin Virol 2021; 140:104839. [PMID: 33991979 DOI: 10.1016/j.jcv.2021.104839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 03/30/2021] [Accepted: 04/15/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Measurement of HIV-1 viral load (VL) is essential for monitoring antiretroviral treatment (ART) efficacy. In remote settings, dried blood spots (DBS) may be used as the specimen type. However, cellular components in DBS not present in the gold standard specimen type, plasma, may result in low specificity i.e., over-estimation of VL results from DBS compared to plasma. The Abbott RealTime HIV-1 assay system has been reported to have improved specificity using DBS compared to other tests. A new specimen collection matrix, the cobas plasma separation card (PSC, Roche Molecular Systems), enables specimen collection from a finger prick or venous blood, using a multi-layer absorption and filtration design that results in a specimen similar to plasma. OBJECTIVES AND STUDY DESIGN We performed a direct comparison between VL results from PSC tested with the cobas 6800/8800 assay (c8800) and DBS tested with the Abbott RealTime HIV-1 assay. RESULTS Overall concordance between PSC and plasma around the 1000 copies/mL threshold was high (>97%). Compared to VL measured using DBS and the RealTime assay, PSC and c8800 showed improved sensitivity (96.9% vs 90.6%) and specificity (97.4% vs. 87.2%) using plasma as the reference, as there were fewer patients with VL below 1000 copies/mL in plasma in whom VL was over this threshold using PSC compared to DBS. The limit of detection for PSC was lower than for DBS (575 vs. 2314 copies/mL). CONCLUSIONS cobas PSC represents a promising specimen type for use with the cobas 6600/8800 system in settings where plasma cannot be used.
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Affiliation(s)
- Lucia Hans
- University of the Witwatersrand, School of Pathology, Department of Molecular Medicine and Haematology, Johannesburg, South Africa; National Health Laboratory Service, Johannesburg, South Africa.
| | - Ed G Marins
- Roche Molecular Systems, Inc., Pleasanton, United States
| | | | - Dieketseng Magubane
- University of the Witwatersrand, School of Pathology, Department of Molecular Medicine and Haematology, Johannesburg, South Africa; National Health Laboratory Service, Johannesburg, South Africa
| | | | - Sergio Carmona
- University of the Witwatersrand, School of Pathology, Department of Molecular Medicine and Haematology, Johannesburg, South Africa; National Health Laboratory Service, Johannesburg, South Africa
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17
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A practical, low-cost, short-term storage method for genomic DNA. Biotechniques 2021; 70:194-201. [PMID: 33749333 DOI: 10.2144/btn-2020-0158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
The aim of this study was to assess the DNA preservation capability of cellulose paper towel and blotting paper as low-cost alternatives to commercial DNA preservation products. Chicken blood was applied as DNA source to each paper towel, blotting paper, FTA® cards and DNA/RNA Shield™. All samples were stored at room temperature for 130 days. DNA extraction from dried blood spots was performed after various time periods using Tris-EDTA and NaOH protocols. PCR activity and the mean amount of DNA isolated from paper towels were reliable. The results of this study demonstrated that cellulose-based blotting paper and especially paper towel had considerable DNA binding and preservation capacity for at least 130 days at room temperature without DNA degradation.
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18
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Prabdial‐Sing N, Gaelejwe L, Makhathini L, Thaver J, Manamela MJ, Malfeld S, Spearman CW, Sonderup M, Scheibe A, Young K, Hausler H, Puren AJ. The performance of hepatitis C virus (HCV) antibody point-of-care tests on oral fluid or whole blood and dried blood spot testing for HCV serology and viral load among individuals at higher risk for HCV in South Africa. Health Sci Rep 2021; 4:e229. [PMID: 33614978 PMCID: PMC7876859 DOI: 10.1002/hsr2.229] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Revised: 11/10/2020] [Accepted: 12/04/2020] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND AND AIMS To enhance screening and diagnosis in those at-risk of hepatitis C virus (HCV), efficient and improved sampling and testing is required. We investigated the performance of point-of-care (POC) tests and dried blood spots (DBS) for HCV antibody and HCV RNA quantification in individuals at higher risk for HCV (people who use and inject drugs, sex workers and men who have sex with men) in seven South African cities. METHODS Samples were screened on the OraQuick HCV POC test (471 whole blood and 218 oral fluid); 218 whole blood and DBS paired samples were evaluated on the ARCHITECT HCV antibody (Abbott) and HCV viral load (COBAS Ampliprep/COBAS TaqMan version 2) assays. For HCV RNA quantification, 107 dB were analyzed with and without normalization coefficients. RESULTS POC on either whole blood or oral fluid showed an overall sensitivity of 98.5% (95% CI 97.4-99.5), specificity of 98.2% (95% CI 98.8-100) and accuracy of 98.4% (95% CI 96.5-99.3). On the antibody immunoassay, DBS showed a sensitivity of 96.0% (95% CI 93.4-98.6), specificity of 97% (95% CI 94.8-99.3) and accuracy of 96.3% (95% CI 93.8-98.8). A strong correlation (R 2 = 0.90) between viral load measurements for DBS and plasma samples was observed. After normalization, DBS viral load results showed an improved bias from 0.5 to 0.16 log10 IU/mL. CONCLUSION The POC test performed sufficiently well to be used for HCV screening in at-risk populations. DBS for diagnosis and quantification was accurate and should be considered as an alternative sample to test. POC and DBS can help scale up hepatitis services in the country, in light of our elimination goals.
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Affiliation(s)
- Nishi Prabdial‐Sing
- Centre for Vaccines and ImmunologyNational Institute for Communicable DiseasesJohannesburgSouth Africa
- Faculty of Health SciencesUniversity of WitwatersrandJohannesburgSouth Africa
| | - Lucinda Gaelejwe
- Centre for Vaccines and ImmunologyNational Institute for Communicable DiseasesJohannesburgSouth Africa
- Faculty of Health SciencesUniversity of WitwatersrandJohannesburgSouth Africa
| | - Lillian Makhathini
- Centre for Vaccines and ImmunologyNational Institute for Communicable DiseasesJohannesburgSouth Africa
| | - Jayendrie Thaver
- Centre for Vaccines and ImmunologyNational Institute for Communicable DiseasesJohannesburgSouth Africa
| | - Morubula Jack Manamela
- Centre for Vaccines and ImmunologyNational Institute for Communicable DiseasesJohannesburgSouth Africa
| | - Susan Malfeld
- Centre for Vaccines and ImmunologyNational Institute for Communicable DiseasesJohannesburgSouth Africa
| | - C. Wendy Spearman
- Division of Hepatology, Department of Medicine, Faculty of Health SciencesUniversity of Cape TownCape TownSouth Africa
| | - Mark Sonderup
- Division of Hepatology, Department of Medicine, Faculty of Health SciencesUniversity of Cape TownCape TownSouth Africa
| | - Andrew Scheibe
- TB HIV CareCape TownSouth Africa
- Department of Family MedicineUniversity of PretoriaPretoriaSouth Africa
| | | | | | - Adrian J. Puren
- Centre for Vaccines and ImmunologyNational Institute for Communicable DiseasesJohannesburgSouth Africa
- Faculty of Health SciencesUniversity of WitwatersrandJohannesburgSouth Africa
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19
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Tola M, Habib RO, Sylvia A, Crowell TA, Rebecca NG, Charurat ME, Dakum P, Ndembi N. Field evaluation of HIV-1 viral load monitoring in adults and children receiving antiretroviral treatment in Nigeria by dried blood spot testing with RealTime HIV-1 on m2000. J Clin Virol 2021; 135:104694. [PMID: 33476928 DOI: 10.1016/j.jcv.2020.104694] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 11/11/2020] [Accepted: 11/15/2020] [Indexed: 10/22/2022]
Abstract
In resource-limited settings, use of dried blood spots (DBS) could be a pragmatic alternative to plasma for VL monitoring in people living with HIV (PLWH). We compared results from DBS to standard plasma VL testing under field conditions in patients receiving antiretroviral therapy (ART). DBS cards were prepared from venous blood (V-DBS), finger-pricks using micro-capillary tubes (M-DBS), and direct spotting (D-DBS). DBS and matched EDTA plasma were tested on the Abbott m2000 platform using the appropriate RealTime HIV-1 quantitative CE protocol. Matched plasma samples were also tested on the Roche COBAS Ampliprep/COBAS TaqMan version 2.0. Diagnostic accuracy indicators (sensitivity, specificity, misclassification rate, and kappa coefficient) for viral failure (VF) based on different VL threshold levels and agreement of absolute VL were calculated. A total of 669 participants provided 2676 samples. V-DBS had a peak sensitivity for VF of 89.1 % [95 % CI: 85.5-92.7] at the 1000 copies/mL threshold and a peak specificity of 97.4 % [95 % CI: 95.9-99.0] at the 5000 copies/mL threshold. The lowest proportion of upward misclassification (patients classified with VF who actually had viral suppression) for V-DBS was 3.1 % [95 % CI: 1.4-4.8] at the 5000 copies/mL threshold, whereas the lowest proportion of downward misclassification (patients classified as undetectable who actually had VF) was 10.9 % [95 % CI: 7.2-14.5] at the 1000 copies/mL threshold. Abbott RealTime HIV-1 VL results from all 3 DBS types for adults and children showed strong correlation with the gold standard plasma-based assay. DBS could be useful for monitoring VL in resource limited settings such as Nigeria.
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Affiliation(s)
- Monday Tola
- Institute of Human Virology Nigeria, Abuja, Federal Capital Territory, Nigeria
| | - Ramadhani O Habib
- Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Adebajo Sylvia
- Maryland Global Initiatives Corporation, University of Maryland, Nigeria
| | - Trevor A Crowell
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, USA; U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, USA
| | - Nowak G Rebecca
- Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Manhattan E Charurat
- Institute of Human Virology Nigeria, Abuja, Federal Capital Territory, Nigeria; Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Patrick Dakum
- Institute of Human Virology Nigeria, Abuja, Federal Capital Territory, Nigeria; Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Nicaise Ndembi
- Institute of Human Virology Nigeria, Abuja, Federal Capital Territory, Nigeria; Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD, USA; Africa Centers for Disease Control and Prevention (Africa CDC), African Union Commission, Addis Ababa, Ethiopia; Kanazawa University, Graduate Medical Sciences, Kanazawa, Japan.
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20
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The Development of a Standardized Quality Assessment Material to Support Xpert ® HIV-1 Viral Load Testing for ART Monitoring in South Africa. Diagnostics (Basel) 2021; 11:diagnostics11020160. [PMID: 33499162 PMCID: PMC7911816 DOI: 10.3390/diagnostics11020160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 01/17/2021] [Accepted: 01/19/2021] [Indexed: 11/17/2022] Open
Abstract
The tiered laboratory framework for human immunodeficiency virus (HIV) viral load monitoring accommodates a range of HIV viral load testing platforms, with quality assessment critical to ensure quality patient testing. HIV plasma viral load testing is challenged by the instability of viral RNA. An approach using an RNA stabilizing buffer is described for the Xpert® HIV-1 Viral Load (Cepheid) assay and was tested in remote laboratories in South Africa. Plasma panels with known HIV viral titres were prepared in PrimeStore molecular transport medium for per-module verification and per-instrument external quality assessment. The panels were transported at ambient temperatures to 13 testing laboratories during 2017 and 2018, tested according to standard procedures and uploaded to a web portal for analysis. A total of 275 quality assessment specimens (57 verification panels and two EQA cycles) were tested. All participating laboratories met study verification criteria (n = 171 specimens) with an overall concordance correlation coefficient (ρc) of 0.997 (95% confidence interval (CI): 0.996 to 0.998) and a mean bias of −0.019 log copies per milliliter (cp/mL) (95% CI: −0.044 to 0.063). The overall EQA ρc (n = 104 specimens) was 0.999 (95% CI: 0.998 to 0.999), with a mean bias of 0.03 log cp/mL (95% CI: 0.02 to 0.05). These panels are suitable for use in quality monitoring of Xpert® HIV-1 VL and are applicable to laboratories in remote settings.
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21
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Weisser H, Steinhagen K, Höcker R, Borchardt-Lohölter V, Anvari Ö, Kern PM. Evaluation of dried blood spots as alternative sampling material for serological detection of anti-SARS-CoV-2 antibodies using established ELISAs. Clin Chem Lab Med 2021; 59:979-985. [PMID: 33554537 DOI: 10.1515/cclm-2020-1436] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Accepted: 12/10/2020] [Indexed: 12/22/2022]
Abstract
OBJECTIVES During the current pandemic, antibody testing based on venous serum helps to determine whether the tested person has been previously infected with SARS-CoV-2. Alternatively, capillary blood can be taken via a finger prick (dried blood spots, DBS). In this study, paired DBS and venipuncture samples were tested using two serological assays to evaluate the usability of DBS for the detection of anti-SARS-CoV-2 antibodies. METHODS Paired samples of DBS and venous serum were collected from 389 volunteers, of whom 75 had a recent PCR-confirmed SARS-CoV-2 infection, and tested for anti-SARS-CoV-2 IgG antibodies against both viral S1 and nucleocapsid protein (NCP) antigens using two ELISAs. Degree of agreement and correlation coefficients between ELISA results based on the two sampling methods were calculated. RESULTS Results of DBS showed almost perfect agreement and high correlations with results from corresponding serum samples in both the S1-based ELISA and the NCP-based ELISA. CONCLUSIONS ELISA results derived from DBS showed very high agreement to those obtained with serum, supposing adequate usability and robustness of DBS as sample material for detection of anti-SARS-CoV-2 antibodies. In the near future, large-scale epidemiological screening for antibodies against SARS-CoV-2 will be carried out. Since DBS reduce the strain on healthcare institutions regarding sample collection, they have a potential to facilitate efficient community- and population-based screening in the current SARS-CoV-2 pandemic.
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Affiliation(s)
- Heike Weisser
- Institute of Laboratory Medicine, University Medicine Marburg - Campus Fulda, Fulda, Germany
| | - Katja Steinhagen
- Institute for Experimental Immunology, affiliated to EUROIMMUN Medizinische Labordiagnostika AG, Lübeck, Germany
| | - Ralf Höcker
- Institute of Laboratory Medicine, University Medicine Marburg - Campus Fulda, Fulda, Germany
| | - Viola Borchardt-Lohölter
- Institute for Experimental Immunology, affiliated to EUROIMMUN Medizinische Labordiagnostika AG, Lübeck, Germany
| | | | - Peter M Kern
- Medical Clinic IV, University Medicine Marburg - Campus Fulda, Fulda, Germany
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22
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Milanzi E, Mwapasa V, Joseph J, Jousset A, Tchereni T, Gunda A, Phiri J, Reece JC. Receipt of infant HIV DNA PCR test results is associated with a reduction in retention of HIV-exposed infants in integrated HIV care and healthcare services: a quantitative sub-study nested within a cluster randomised trial in rural Malawi. BMC Public Health 2020; 20:1879. [PMID: 33287772 PMCID: PMC7720620 DOI: 10.1186/s12889-020-09973-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 11/25/2020] [Indexed: 11/29/2022] Open
Abstract
Background Retention of HIV-infected mothers in integrated HIV and healthcare facilities is effective at reducing mother-to-child-transmission (MTCT) of HIV. In the context of Option B+, we examined maternal and HIV-exposed infant retention across three study arms to 18 months postpartum: mother-and-infant clinics (MIP), MIP with short-messaging service (MIP + SMS) and standard of care (SOC). In particular, we focused on the impact of mothers receiving an infant’s HIV PCR test result on maternal and infant study retention. Methods A quantitative sub-study nested within a cluster randomised trial undertaken between May 2013 and August 2016 across 30 healthcare facilities in rural Malawi enrolling HIV-infected pregnant mothers and HIV-exposed infants on delivery, was performed. Survival probabilities of maternal and HIV-exposed infant study retention was estimated using Kaplan-Meier curves. Associations between mother’s receiving an infant’s HIV test result and in particular, an infant’s HIV-positive result on maternal and infant study retention were modelled using time-varying multivariate Cox regression. Results Four hundred sixty-one, 493, and 396 HIV-infected women and 386, 399, and 300 HIV-exposed infants were enrolled across study arms; MIP, MIP + SMS and SOC, respectively. A total of 47.5% of mothers received their infant’s HIV test results < 5 months postpartum. Receiving an infant’s HIV result by mothers was associated with a 70% increase in infant non-retention in the study compared with not receiving an infant’s result (HR = 1.70; P-value< 0.001). Receiving a HIV-positive result was associated with 3.12 times reduced infant retention compared with a HIV-negative result (P-value< 0.001). Of the infants with a HIV-negative test result, 87% were breastfed at their final study follow-up. Conclusions Receiving an infant’s HIV test result was a driving factor for reduced infant study retention, especially an infant’s HIV-positive test result. As most HIV-negative infants were still breastfed at their last follow-up, this indicates a large proportion of HIV-exposed infants were potentially at future risk of MTCT of HIV via breastfeeding but were unlikely to undergo follow-up HIV testing after breastfeeding cessation. Future studies to identify and address underlying factors associated with infant HIV testing and reduced infant retention could potentially improve infant retention in HIV/healthcare facilities. Trial registration Pan African Clinical Trial Registry: PACTR201312000678196. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-020-09973-y.
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Affiliation(s)
- Elasma Milanzi
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Carlton, Victoria, Australia.,Victorian Centre for Biostatistics, Melbourne, Victoria, Australia
| | - Victor Mwapasa
- College of Medicine, University of Malawi, Blantyre, Malawi
| | - Jessica Joseph
- Clinton Health Access Initiative (CHAI), MA, Boston, USA
| | | | | | - Andrews Gunda
- Clinton Health Access Initiative (CHAI), Lilongwe, Malawi
| | - Jennipher Phiri
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Carlton, Victoria, Australia
| | - Jeanette C Reece
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Carlton, Victoria, Australia. .,The University of Melbourne Centre for Cancer Research, The University of Melbourne, Parkville, Victoria, Australia.
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23
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Rich SN, Cook RL, Yaghjyan L, Francois K, Puttkammer N, Robin E, Bae J, Joseph N, Pessoa-Brandão L, Delcher C. Risk factors for delayed viral suppression on first-line antiretroviral therapy among persons living with HIV in Haiti, 2013-2017. PLoS One 2020; 15:e0240817. [PMID: 33119631 PMCID: PMC7595392 DOI: 10.1371/journal.pone.0240817] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Accepted: 10/02/2020] [Indexed: 12/29/2022] Open
Abstract
Studies of viral suppression on first-line antiretroviral therapy (ART) in persons living with human immunodeficiency virus (PLHIV) in Haiti are limited, particularly among PLHIV outside of the Ouest department, where the capital Port-au-Prince is located. This study described the prevalence and risk factors for delayed viral suppression among PLHIV in all geographic departments of Haiti between 2013 and 2017. Individuals who received viral load testing 3 to 12 months after ART initiation were included. Data on demographics and clinical care were obtained from the Haitian Active Longitudinal Tracking of HIV database. Multivariable logistic regression was performed to predict delayed viral suppression, defined as a viral load ≥1000 HIV-1 RNA copies/mL after at least 3 months on ART. Viral load test results were available for 3,368 PLHIV newly-initiated on ART. Prevalence of delayed viral suppression was 40%, which is slightly higher than previous estimates in Haiti. In the multivariable analysis, delayed viral suppression was significantly associated with younger age, receiving of care in the Ouest department, treatment with lamivudine (3TC), zidovudine (AZT), and nevirapine (NVP) combined ART regimen, and CD4 counts below 200 cells/mm3. In conclusion, this study was the first to describe and compare differences in delayed viral suppression among PLHIV by geographic department in Haiti. We identified populations to whom public health interventions, such as more frequent viral load testing, drug resistance testing, and ART adherence counseling should be targeted.
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Affiliation(s)
- Shannan N. Rich
- Department of Epidemiology, College of Public Health and Health Professions and College of Medicine, University of Florida, Gainesville, FL, United States of America
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, FL, United States of America
- * E-mail:
| | - Robert L. Cook
- Department of Epidemiology, College of Public Health and Health Professions and College of Medicine, University of Florida, Gainesville, FL, United States of America
| | - Lusine Yaghjyan
- Department of Epidemiology, College of Public Health and Health Professions and College of Medicine, University of Florida, Gainesville, FL, United States of America
| | - Kesner Francois
- Programme National de Lutte contre le SIDA, Ministère de la Santé Publique et de la Population, Port au Prince, Haïti
| | - Nancy Puttkammer
- Department of Global Health, International Training and Education Center for Health (I-TECH), University of Washington, Seattle, WA, United States of America
| | - Ermane Robin
- Programme National de Lutte contre le SIDA, Ministère de la Santé Publique et de la Population, Port au Prince, Haïti
| | - Jungjun Bae
- College of Pharmacy, Institute for Pharmaceutical Outcomes and Policy, University of Kentucky, Lexington, KY, United States of America
| | - Nadjy Joseph
- National Alliance of State and Territorial AIDS Directors, Port au Prince, Haiti
| | - Luisa Pessoa-Brandão
- National Alliance of State and Territorial AIDS Directors, Port au Prince, Haiti
| | - Chris Delcher
- College of Pharmacy, Institute for Pharmaceutical Outcomes and Policy, University of Kentucky, Lexington, KY, United States of America
- National Alliance of State and Territorial AIDS Directors, Port au Prince, Haiti
- Department of Pharmacy Practice and Science, College of Pharmacy, University of Kentucky, Lexington, KY, United States of America
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Amstutz A, Nsakala BL, Vanobberghen F, Muhairwe J, Glass TR, Namane T, Mpholo T, Battegay M, Klimkait T, Labhardt ND. Switch to second-line versus continued first-line antiretroviral therapy for patients with low-level HIV-1 viremia: An open-label randomized controlled trial in Lesotho. PLoS Med 2020; 17:e1003325. [PMID: 32936795 PMCID: PMC7494118 DOI: 10.1371/journal.pmed.1003325] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Accepted: 08/11/2020] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Current World Health Organization (WHO) antiretroviral therapy (ART) guidelines define virologic failure as two consecutive viral load (VL) measurements ≥1,000 copies/mL, triggering empiric switch to next-line ART. This trial assessed if patients with sustained low-level HIV-1 viremia on first-line ART benefit from a switch to second-line treatment. METHODS AND FINDINGS This multicenter, parallel-group, open-label, superiority, randomized controlled trial enrolled patients on first-line ART containing non-nucleoside reverse transcriptase inhibitors (NNRTI) with two consecutive VLs ≥100 copies/mL, with the second VL between 100-999 copies/mL, from eight clinics in Lesotho. Consenting participants were randomly assigned (1:1), stratified by facility, demographic group, and baseline VL, to either switch to second-line ART (switch group) or continued first-line ART (control group; WHO guidelines). The primary endpoint was viral suppression (<50 copies/mL) at 36 weeks. Analyses were by intention to treat, using logistic regression models, adjusted for demographic group and baseline VL. Between August 1, 2017, and August 7, 2019, 137 individuals were screened, of whom 80 were eligible and randomly assigned to switch (n = 40) or control group (n = 40). The majority of participants were female (54 [68%]) with a median age of 42 y (interquartile range [IQR] 35-51), taking tenofovir disoproxil fumarate/lamivudine/efavirenz (49 [61%]) and on ART for a median of 5.9 y (IQR 3.3-8.6). At 36 weeks, 22/40 (55%) participants in the switch versus 10/40 (25%) in the control group achieved viral suppression (adjusted difference 29%, 95% CI 8%-50%, p = 0.009). The switch group had significantly higher probability of viral suppression across different VL thresholds (<20, <100, <200, <400, and <600 copies/mL) but not for <1,000 copies/mL. Thirty-four (85%) participants in switch group and 21 (53%) in control group experienced at least one adverse event (AE) (p = 0.002). No hospitalization or death or other serious adverse events were observed. Study limitations include a follow-up period too short to observe differences in clinical outcomes, missing values in CD4 cell counts due to national stockout of reagents during the study, and limited generalizability of findings to other than NNRTI-based first-line ART regimens. CONCLUSIONS In this study, switching to second-line ART among patients with sustained low-level HIV-1 viremia resulted in a higher proportion of participants with viral suppression. These results endorse lowering the threshold for virologic failure in future WHO guidelines. TRIAL REGISTRATION The trial is registered at ClinicalTrials.gov, NCT03088241.
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Affiliation(s)
- Alain Amstutz
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
- Department of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, Basel, Switzerland
| | | | - Fiona Vanobberghen
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | | | - Tracy Renée Glass
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Tilo Namane
- Motebang Government Hospital, Leribe, Lesotho
| | | | - Manuel Battegay
- University of Basel, Basel, Switzerland
- Department of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, Basel, Switzerland
| | - Thomas Klimkait
- Molecular Virology, Department of Biomedicine, University of Basel, Basel, Switzerland
| | - Niklaus Daniel Labhardt
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
- Department of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, Basel, Switzerland
- * E-mail:
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25
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Preiser W, van Zyl GU. Pooled testing: A tool to increase efficiency of infant HIV diagnosis and virological monitoring. Afr J Lab Med 2020; 9:1035. [PMID: 32934914 PMCID: PMC7479369 DOI: 10.4102/ajlm.v9i2.1035] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Accepted: 04/15/2020] [Indexed: 01/04/2023] Open
Abstract
Background Pooled testing, or pooling, has been used for decades to efficiently diagnose relatively rare conditions, such as infection in blood donors. Programmes for the prevention of mother-to-child transmission of HIV and for antiretroviral therapy (ART) are being rolled out in much of Africa and are largely successful. This increases the need for early infant diagnosis (EID) of HIV using qualitative nucleic acid testing and for virological monitoring of patients on ART using viral load testing. While numbers of patients needing testing are increasing, infant HIV infections and ART failures are becoming rarer, opening an opportunity for pooled testing approaches. Aim This review highlights the need for universal EID and viral load coverage as well as the challenges faced. We introduce the concept of pooled testing and highlight some important considerations before giving an overview of studies exploring pooled testing for EID and virological monitoring. Results For ART monitoring, pooling has been shown to be accurate and efficient; for EID it has not been tried although modelling shows it to be promising. The final part attempts to place pooling into the context of current mother-to-child transmission of HIV and ART programmes and their expected trajectories over the next years. Conclusion Several points warrant consideration: pre-selection to exclude samples with an elevated pre-test probability of positivity from pooled testing, the use of dried blood or plasma spots, and choosing a pooling strategy that is both practically feasible and economical. Finally, novel ideas are suggested to make pooling even more attractive.
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Affiliation(s)
- Wolfgang Preiser
- Division of Medical Virology, Department of Pathology, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.,National Health Laboratory Service (NHLS) Tygerberg, Cape Town, South Africa
| | - Gert U van Zyl
- Division of Medical Virology, Department of Pathology, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.,National Health Laboratory Service (NHLS) Tygerberg, Cape Town, South Africa
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26
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Yacouba A, Congo M, Dioma GK, Somlare H, Coulidiaty D, Ouattara K, Sangare L. Whatman FTA cards versus plasma specimens for the quantitation of HIV-1 RNA using two real-time PCR assays. Access Microbiol 2020; 2:acmi000138. [PMID: 32974600 PMCID: PMC7497827 DOI: 10.1099/acmi.0.000138] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Accepted: 02/17/2020] [Indexed: 11/24/2022] Open
Abstract
Background Several studies have compared the use of dried blot spot (DBS) as an alternative to plasma specimens, mainly using Whatman 903 cards as filter paper. The aim of this study was to evaluate the use of Whatman FTA card (FTA card) specimens for HIV-1 viral load testing compared to plasma specimens using two real-time PCR assays manufactured by Roche and Abbott. Methodology A cross-sectional study was conducted between April 2017 and September 2017 on HIV-1 patients admitted to Yalgado Ouédraogo Teaching Hospital. Paired FTA cards and plasma specimens were collected and analysed using the Abbott Real-Time HIV-1 assay (Abbott) and COBAS AmpliPrep/COBAS TaqMan v2.0 (Roche). Results In total, 107 patients were included. No statistical differences (P>0.05) were observed between the mean viral loads obtained from the FTA cards and those of the plasma specimens using the Roche and Abbott assays. In total, 29 samples with Roche and 15 samples with Abbott assay showed discrepant results. At viral loads of ≤1000 copies ml−1, the sensitivity and specificity of the FTA cards were 78.6 and 100% with Roche, and 92.3 and 95.9% with Abbott, respectively. Both the Roche and Abbott assays showed good correlation and agreement between the FTA cards and plasma values. Conclusion Our study demonstrates the feasibility of using FTA card filter paper for HIV-1 viral load testing. However, further studies will be required for the validation of the use of FTA card filter paper in HIV-1 treatment monitoring.
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Affiliation(s)
- Abdourahamane Yacouba
- Laboratoire National de Référence du VIH/Sida et des Infections Sexuellement Transmissibles, Centre Hospitalier Universitaire Yalgado Ouédraogo, 03 B.P. 7022 Ouaga 03, Ouagadougou, Burkina Faso
| | - Malika Congo
- Laboratoire National de Référence du VIH/Sida et des Infections Sexuellement Transmissibles, Centre Hospitalier Universitaire Yalgado Ouédraogo, 03 B.P. 7022 Ouaga 03, Ouagadougou, Burkina Faso
| | - Gérard Komonsira Dioma
- Laboratoire National de Référence du VIH/Sida et des Infections Sexuellement Transmissibles, Centre Hospitalier Universitaire Yalgado Ouédraogo, 03 B.P. 7022 Ouaga 03, Ouagadougou, Burkina Faso
| | - Hermann Somlare
- Laboratoire National de Référence du VIH/Sida et des Infections Sexuellement Transmissibles, Centre Hospitalier Universitaire Yalgado Ouédraogo, 03 B.P. 7022 Ouaga 03, Ouagadougou, Burkina Faso
| | - David Coulidiaty
- Laboratoire National de Référence du VIH/Sida et des Infections Sexuellement Transmissibles, Centre Hospitalier Universitaire Yalgado Ouédraogo, 03 B.P. 7022 Ouaga 03, Ouagadougou, Burkina Faso
| | - Kalifa Ouattara
- Laboratoire National de Référence du VIH/Sida et des Infections Sexuellement Transmissibles, Centre Hospitalier Universitaire Yalgado Ouédraogo, 03 B.P. 7022 Ouaga 03, Ouagadougou, Burkina Faso
| | - Lassana Sangare
- Unité de Formation et des Recherches en Sciences de la Santé, Université Ouaga I Pr Joseph KI-ZERBO, 03 B.P. 7021 Ouaga 03, Ouagadougou, Burkina Faso
- Laboratoire National de Référence du VIH/Sida et des Infections Sexuellement Transmissibles, Centre Hospitalier Universitaire Yalgado Ouédraogo, 03 B.P. 7022 Ouaga 03, Ouagadougou, Burkina Faso
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Comparison of Alere q whole blood viral load with DBS and plasma viral load in the classification of HIV virological failure. PLoS One 2020; 15:e0232345. [PMID: 32469947 PMCID: PMC7259604 DOI: 10.1371/journal.pone.0232345] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Accepted: 04/14/2020] [Indexed: 11/19/2022] Open
Abstract
Background In remote settings, timely plasma separation and transportation to testing laboratories is an impediment to the access of HIV viral load (VL) testing. Potential solutions are whole blood testing through point of care (POC) assays or dried blood spots (DBS). Methods We evaluated the performance of a prototype Alere q whole blood VL protocol and compared it against plasma (Abbott RealTime HIV-1) and DBS VL (Abbott RealTime HIV-1 DBS revised prototype protocol and Roche CAP/CTM HIV-1 v2.0 DBS free virus elution protocol). Virological failure (VF) was defined at >1000 copies/ml. Results Of 299 samples, Alere q correctly classified VF in 61% versus 87% by Abbott DBS and 76% by Roche FVE. Performance varied across plasma VL categories. Alere q showed 100% sensitivity. Below 1000 copies/ml of plasma, Alere q demonstrated over-quantification, with 19% specificity. Abbott DBS had 91% sensitivity and the best overall correlation with plasma (r2 = 0.72). Roche FVE had the best specificity of 99% but reduced sensitivity of 52%, especially between 1000–10,000 copies/ml of plasma. Correlation was best for all assays at >10,000 copies/ml. Conclusion Variability was prominent between the assays. Each method requires optimization to facilitate the implementation of a cut-off with optimal sensitivity and specificity for VF. Although Alere q whole blood assay exhibited excellent sensitivity, the poor specificity of only 19% would lead to unnecessary switching of regimens. Thus any VF detected would need to be confirmed by a more specific assay. Both the Abbott DBS and Roche FVE protocols showed good specificity, however sensitivity was reduced when the plasma VL was 1000–10,000 copies/ml. This could result in delays in detecting VF and accumulation of drug resistance. Field evaluation in settings that have adopted these DBS protocols are necessary.
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Use of an Indeterminate Range in HIV Early Infant Diagnosis: A Systematic Review and Meta-Analysis. J Acquir Immune Defic Syndr 2020; 82:281-286. [PMID: 31609927 DOI: 10.1097/qai.0000000000002104] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND Expanded access to HIV antiretrovirals has dramatically reduced mother-to-child transmission of HIV. However, there is increasing concern around false-positive HIV test results in perinatally HIV-exposed infants but few insights into the use of indeterminate range to improve infant HIV diagnosis. METHODS A systematic review and meta-analysis was conducted to evaluate the use of an indeterminate range for HIV early infant diagnosis. Published and unpublished studies from 2000 to 2018 were included. Study quality was evaluated using GRADE and QUADAS-2 criteria. A random-effects model compared various indeterminate ranges for identifying true and false positives. RESULTS The review identified 32 studies with data from over 1.3 million infants across 14 countries published from 2000 to 2018. Indeterminate results accounted for 16.5% of initial non-negative test results, and 76% of indeterminate results were negative on repeat testing. Most results were from Roche tests. In the random-effects model, an indeterminate range using a polymerase chain reaction cycle threshold value of ≥33 captured over 93% of false positives while classifying fewer than 9% of true positives as indeterminate. CONCLUSIONS Without the use of an indeterminate range, over 10% of infants could be incorrectly diagnosed as HIV positive if their initial test results are not confirmed. Use of an indeterminate range appears to lead to substantial improvements in the accuracy of early infant diagnosis testing and supports current recommendations to confirm all initial positive tests.
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Vubil A, Zicai AF, Sitoe N, Nhachigule C, Meggi B, Loquiha O, Viegas S, Mabunda N, Scott L, Jani I. Accurate HIV viral load measurement in primary health care settings using the cobas® plasma separation card. PLoS One 2020; 15:e0232122. [PMID: 32374748 PMCID: PMC7202605 DOI: 10.1371/journal.pone.0232122] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2019] [Accepted: 04/07/2020] [Indexed: 11/19/2022] Open
Abstract
Introduction Plasma is considered the gold standard for HIV viral load (VL) testing, however its use is challenging due to the need for phlebotomy and centrifugation services, as well as cold chain for transporting to laboratories for testing. The use of Dried Blood Spot (DBS) specimen has allowed a rapid expansion of antiretroviral therapy (ART) monitoring in remote areas in many African countries, however, the VL in DBS may overestimate the copies of viral RNA result at the clinically relevant range of 1000 copies/ml, due to proviral DNA and intracellular RNA. The characteristics of the cobas® Plasma Separation Card (PSC) specimen are similar to fresh plasma (gold standard), so a better performance of HIV VL is expetected in PSC specimen and can be an alternative to DBS. This study aims to evaluate the performance of cobas® PSC for VL testing at primary health care facilities in Mozambique. Methodology HIV-1 infected adults on ART were enrolled consecutively in two health facilities in Mozambique, between August 2018 and October 2018. Capillary and venous cobas® PSC, DBS and fresh plasma specimens were collected from each patient. All specimens were tested for VL using CAP/CTM v2.0. Sensitivity and specificity of viral load using DBS, capillary and venous PSC specimens were estimated. Viral load obtained in fresh plasma specimen was used as reference and a threshold of 1000 copies/ml was considered for the analyses. Results From the total 613 patients included for the study, 2444 specimens including DBS (613), plasma (613), venous cobas® PSC (609) and capillary cobas® PSC (609) were collected and 2407 results were obtained. Sensitivity and specificity of the VL using venous cobas®PSC specimen at 1000 copies/ml threshold were 99.8% and 98.1% respectively, whereas for capillary cobas® PSC sensitivity was 99.6% and specificity was 97.2%. For DBS VL, sensitivity was 96.9% and specificity was 81.8%. Misclassification rate was more prominent in DBS specimens (5.9%), but lower in venous and capillary cobas®PSC with a rate of 0.3% and 0.7% respectively. Conclusion The cobas® PSC specimen has improved performance over DBS for more accurate VL testing aligned with plasma testing. The use of this specimen type can increase the rates of reliable VL results and this will improve the quality of VL monitoring of HIV-positive patients in low-income settings.
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Affiliation(s)
- Adolfo Vubil
- Instituto Nacional de Saúde, Marracuene, Mozambique
- * E-mail:
| | | | - Nádia Sitoe
- Instituto Nacional de Saúde, Marracuene, Mozambique
| | | | | | | | - Sofia Viegas
- Instituto Nacional de Saúde, Marracuene, Mozambique
| | | | - Lesley Scott
- Department of Molecular Medicine and Haematology, School of Pathology, Faulty of Health Science, University of the Witwatersrand, Johannesburg, South Africa
| | - Ilesh Jani
- Instituto Nacional de Saúde, Marracuene, Mozambique
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30
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Field Suitability and Diagnostic Accuracy of the Biocentric Open Real-Time PCR Platform for Dried Blood Spot-Based HIV Viral Load Quantification in Eswatini. J Acquir Immune Defic Syndr 2020; 82:96-104. [PMID: 31408452 PMCID: PMC6727953 DOI: 10.1097/qai.0000000000002101] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Supplemental Digital Content is Available in the Text. Background: To assess the performance and suitability of dried blood spot (DBS) sampling using filter paper to collect blood for viral load (VL) quantification under routine conditions. Methods: We compared performance of DBS VL quantification using the Biocentric method with plasma VL quantification using Roche and Biocentric as reference methods. Adults (≥18 years) were enrolled at 2 health facilities in Eswatini from October 12, 2016 to March 1, 2017. DBS samples were prepared through finger-prick by a phlebotomist (DBS-1), and through the pipetting of whole venous blood by a phlebotomist (DBS-2) and by a laboratory technologist (DBS-3). We calculated the VL-testing completion rate, correlation, and agreement, as well as diagnostic accuracy estimates at the clinical threshold of 1000 copies/mL. Results: Of 362 patients enrolled, 1066 DBS cards (DBS-1: 347; DBS-2: 359; DBS-3: 360) were tested. Overall, test characteristics were comparable between DBS-sampling methods, irrespective of the reference method. The Pearson correlation coefficients ranged from 0.67 to 0.82 (P < 0.001) for different types of DBS sampling using both reference methods, and the Bland–Altman difference ranged from 0.15 to 0.30 log10 copies/mL. Sensitivity estimates were from 85.3% to 89.2% and specificity estimates were from 94.5% to 98.6%. The positive predictive values were between 87.0% and 96.5% at a prevalence of 30% VL elevations, and negative predictive values were between 93.7% and 95.4%. Conclusions: DBS VL quantification using the newly configured Biocentric method can be part of contextualized VL-testing strategies, particularly for remote settings and populations with higher viral failure rates.
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Tuaillon E, Kania D, Pisoni A, Bollore K, Taieb F, Ontsira Ngoyi EN, Schaub R, Plantier JC, Makinson A, Van de Perre P. Dried Blood Spot Tests for the Diagnosis and Therapeutic Monitoring of HIV and Viral Hepatitis B and C. Front Microbiol 2020; 11:373. [PMID: 32210946 PMCID: PMC7075356 DOI: 10.3389/fmicb.2020.00373] [Citation(s) in RCA: 53] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Accepted: 02/19/2020] [Indexed: 12/20/2022] Open
Abstract
Blood collected and dried on a paper card – dried blood spot (DBS) – knows a growing interest as a sampling method that can be performed outside care facilities by capillary puncture, and transported in a simple and safe manner by mail. The benefits of this method for blood collection and transport has recently led the World Health Organization to recommend DBS for HIV and hepatitis B and C diagnosis. The clinical utility of DBS sampling to improve diagnostics and care of HIV and hepatitis B and C infection in hard to reach populations, key populations and people living in low-income settings was highlighted. Literature about usefulness of DBS specimens in the therapeutic cascade of care – screening, confirmation, quantification of nucleic acids, and resistance genotyping -, was reviewed. DBS samples are suitable for testing antibodies, antigens, or nucleic acids using most laboratory methods. Good sensibility and specificity have been reported for infant HIV diagnosis and diagnosis of hepatitis B and C. The performance of HIV RNA testing on DBS to identified virological failure on antiretroviral therapy is also high but not optimal because of the dilution of dried blood in the elution buffer, reducing the analytical sensitivity, and because of the contamination by intracellular HIV DNA. Standardized protocols are needed for inter-laboratory comparisons, and manufacturers should pursue regulatory approval for in vitro diagnostics using DBS specimens. Despite these limitations, DBS sampling is a clinically relevant tool to improve access to infectious disease diagnosis worldwide.
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Affiliation(s)
- Edouard Tuaillon
- Pathogenèse et Contrôle des Infections Chroniques, INSERM U1058, Centre Hospitalier Universitaire de Montpellier, Montpellier, France
| | | | - Amandine Pisoni
- Pathogenèse et Contrôle des Infections Chroniques, INSERM U1058, Centre Hospitalier Universitaire de Montpellier, Montpellier, France
| | - Karine Bollore
- Pathogenèse et Contrôle des Infections Chroniques, INSERM U1058, Centre Hospitalier Universitaire de Montpellier, Montpellier, France
| | - Fabien Taieb
- Emerging Diseases Epidemiology Unit, Center for Translational Science, Institut Pasteur, Paris, France
| | - Esther Nina Ontsira Ngoyi
- Pathogenèse et Contrôle des Infections Chroniques, INSERM U1058, Centre Hospitalier Universitaire de Montpellier, Montpellier, France
| | - Roxane Schaub
- CIC AG/INSERM 1424, Centre Hospitalier de Cayenne, Cayenne, France
| | | | - Alain Makinson
- INSERM U1175/IRD UMI 233, IRD, CHU de Montpellier, Montpellier, France
| | - Philippe Van de Perre
- Pathogenèse et Contrôle des Infections Chroniques, INSERM U1058, Centre Hospitalier Universitaire de Montpellier, Montpellier, France
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Khamduang W, Kaewbundit A, Duangmano A, Hongjaisee S, Klinbuayaem V, Halue G, Chutanunta A, Sirirungsi W, Jourdain G, Ngo-Giang-Huong N. HIV RNA measurement in dried blood spots of HIV-infected patients in Thailand using Abbott m2000 system. PLoS One 2020; 15:e0227929. [PMID: 31978113 PMCID: PMC6980635 DOI: 10.1371/journal.pone.0227929] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Accepted: 01/02/2020] [Indexed: 11/18/2022] Open
Abstract
World Health Organization recommends using dried blood spots (DBS) for HIV RNA viral load (VL) measurement whenever plasma processing is not convenient or feasible. DBS collected from 80 treatment-naïve HIV-infected patients presenting in three hospitals of two different regions of Thailand were shipped to a central laboratory along with corresponding plasma specimens. Viral load was measured in both DBS and plasma using the Abbott m2000 system. HIV RNA levels were strongly correlated (r = 0.94) with a mean of differences of 0.23 log10 copies/mL. Using the 1,000 copies/mL cut-off, the sensitivity of DBS was 97% (95%CI, 91–100%) and specificity was 75% (95%CI, 19–99%). DBS are useful to scale-up HIV RNA VL testing in settings with limited access to VL testing.
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Affiliation(s)
- Woottichai Khamduang
- Department of Medical Technology, Faculty of Associated Medical Sciences, Chiang Mai University, Chiangmai, Thailand.,Infectious Diseases Research Unit, Division of Clinical Microbiology, Department of Medical Technology, Faculty of Associated Medical Sciences, Chiang Mai University, Chiangmai, Thailand.,Institut de Recherche pour le Développement (IRD), Chiangmai, Thailand
| | - Ampika Kaewbundit
- Institut de Recherche pour le Développement (IRD), Chiangmai, Thailand
| | - Amonrat Duangmano
- Institut de Recherche pour le Développement (IRD), Chiangmai, Thailand
| | - Sayamon Hongjaisee
- Research Institute for Health Sciences, Chiang Mai University, Chiangmai, Thailand
| | | | | | | | - Wasna Sirirungsi
- Department of Medical Technology, Faculty of Associated Medical Sciences, Chiang Mai University, Chiangmai, Thailand
| | - Gonzague Jourdain
- Department of Medical Technology, Faculty of Associated Medical Sciences, Chiang Mai University, Chiangmai, Thailand.,Institut de Recherche pour le Développement (IRD), Chiangmai, Thailand.,Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, Boston, MA, United States of America
| | - Nicole Ngo-Giang-Huong
- Department of Medical Technology, Faculty of Associated Medical Sciences, Chiang Mai University, Chiangmai, Thailand.,Institut de Recherche pour le Développement (IRD), Chiangmai, Thailand.,Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, Boston, MA, United States of America
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33
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Screening for Human Immunodeficiency Virus Infection by Use of a Fourth-Generation Antigen/Antibody Assay and Dried Blood Spots: In-Depth Analysis of Sensitivity and Performance Assessment in a Cross-Sectional Study. J Clin Microbiol 2019; 58:JCM.01645-19. [PMID: 31666365 DOI: 10.1128/jcm.01645-19] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Accepted: 10/24/2019] [Indexed: 12/29/2022] Open
Abstract
We evaluated the performance of a fourth-generation antigen/antibody (Ag/Ab) assay for detecting HIV-1 infection on dried blood spots (DBS) both in a conventional laboratory environment and in an epidemiological survey corresponding to a real-life situation. Although a 2-log loss of sensitivity compared to that with plasma was observed when using DBS in an analytical analysis, the median delay of positivity between DBS and crude serum during the early phase postacute infection was 7 days. The performance of the fourth-generation assay on DBS was approximately similar to that of a third-generation (antibody only) assay using crude serum samples. Among 2,646 participants of a cross-sectional study in a population of men having sex with men, 428 DBS were found reactive, but negative results were obtained from 5 DBS collected from individuals who self-reported a positive HIV status, confirmed by detection of antiretroviral (ARV) drugs in their DBS. The data generated allowed us to estimate a sensitivity of 98.8% of the fourth-generation assay/DBS strategy in a high-risk population, even including a broad majority of individuals on ARV treatment among those HIV positive. Our study brings additional proofs that DBS testing using a fourth-generation immunoassay is a reliable strategy able to provide alternative approaches for both individual HIV testing and surveillance of various populations.
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Luo R, Markby J, Sacks J, Vojnov L. Systematic review of the accuracy of plasma preparation tubes for HIV viral load testing. PLoS One 2019; 14:e0225393. [PMID: 31751392 PMCID: PMC6874077 DOI: 10.1371/journal.pone.0225393] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Accepted: 11/03/2019] [Indexed: 01/28/2023] Open
Abstract
Expanding access to HIV viral load testing is essential to improving the care and treatment of people living with HIV/AIDS and ending the AIDS epidemic. Though significant investments have been made in the past five years, many high burden, low resource countries continue to have viral load access rates below 50%. Plasma preparation tubes (PPTs) can simplify storage, transport, and preparation of plasma used for viral load testing. A systematic review was conducted to evaluate the accuracy of plasma preparation tubes for HIV viral load testing. Study results regarding the accuracy of PPT viral load measurements across various storage and transportation conditions were examined. The quality of evidence was evaluated using GRADE and QUADAS-2 criteria. The review identified 16 studies using PPTs with data from 6,141 individuals from 1995 to 2014. Overall the quality of evidence was rated as moderate, with unclear applicability for studies evaluating viral load assays that are no longer commercially available. Significantly elevated viral load results (>0.3 log copies/ml difference) have been observed with PPTs; however, when manufacturer handling instructions are followed, when plasma is aliquoted into a secondary tube, or when PPTs are centrifuged prior to testing, PPT results only differed from standard EDTA plasma testing using commercially available viral load assays by a range on average of -0.03 to +0.08 log copies/ml across studies. Although spuriously elevated viral load results have been observed with PPTs, following proper sample handing techniques have been shown to provide accurate results. PPTs, therefore, provide a high quality alternative specimen type for countries seeking solutions to infrastructure and specimen transportation challenges in an effort to scale-up viral load testing and achieve 90-90-90 targets.
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Affiliation(s)
- Robert Luo
- World Health Organization, Geneva, Switzerland
- * E-mail:
| | - Jessica Markby
- Clinton Health Access Initiative, Boston, Massachusetts, United States of America
| | - Jilian Sacks
- Clinton Health Access Initiative, Boston, Massachusetts, United States of America
| | - Lara Vojnov
- World Health Organization, Geneva, Switzerland
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Dubé K, Auerbach JD, Stirratt MJ, Gaist P. Applying the Behavioural and Social Sciences Research (BSSR) Functional Framework to HIV Cure Research. J Int AIDS Soc 2019; 22:e25404. [PMID: 31665568 PMCID: PMC6820877 DOI: 10.1002/jia2.25404] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Revised: 08/30/2019] [Accepted: 09/25/2019] [Indexed: 12/15/2022] Open
Abstract
INTRODUCTION The search for an HIV cure involves important behavioural and social processes that complement the domains of biomedicine. However, the field has yet to tap into the full potential of behavioural and social sciences research (BSSR). In this article, we apply Gaist and Stirratt's BSSR Functional Framework to the field of HIV cure research. DISCUSSION The BSSR Functional Framework describes four key research domains: (1) basic BSSR (understanding basic behavioural and social factors), (2) elemental BSSR (advancing behavioural and social interventions), (3) supportive BSSR (strengthening biomedically focused clinical trials), and (4) integrative BSSR (building multi-disciplinary combination approaches for real-world implementation). In revisiting and applying the BSSR Functional Framework, we clarify the importance of BSSR in HIV cure research by drawing attention to such things as: how language and communication affect the meaning of "cure" to people living with HIV (PLHIV) and broader communities; how cure affects the identity and social position of PLHIV; counselling and support interventions to address the psychosocial needs and concerns of study participants related to analytical treatment interruptions (ATIs); risk reduction in the course of ATI study participation; motivation, acceptability, and decision-making processes of potential study participants related to different cure strategies; HIV care providers' perceptions and attitudes about their patients' participation in cure research; potential social harms or adverse social events associated with cure research participation; and the scalability of a proven cure strategy in the context of further advances in HIV prevention and treatment. We also discuss the BSSR Functional Framework in the context of ATIs, which involve processes at the confluence of the BSSR domains. CONCLUSIONS To move HIV cure regimens through the translational research pathway, attention will need to be paid to both biomedical and socio-behavioural elements. BSSR can contribute an improved understanding of the human and social dimensions related to HIV cure research and the eventual application of HIV cure regimens. The BSSR Functional Framework provides a way to identify advances, gaps and opportunities to craft an integrated, multi-disciplinary approach at all stages of cure research to ensure the real-world applicability of any strategy that shows promise.
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Affiliation(s)
- Karine Dubé
- UNC Gillings School of Global Public HealthUniversity of North CarolinaChapel HillNCUSA
| | - Judith D Auerbach
- School of MedicineUniversity of California San FranciscoSan FranciscoCAUSA
| | - Michael J Stirratt
- Division of AIDS Research (DAR)National Institute of Mental HealthNational Institutes of HealthBethesdaMDUSA
| | - Paul Gaist
- Office of AIDS ResearchDivision of Program Coordination, Planning, and Strategic InitiativesOffice of the DirectorNational Institutes of HealthBethesdaMDUSA
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Biondi MJ, van Tilborg M, Smookler D, Heymann G, Aquino A, Perusini S, Mandel E, Kozak RA, Cherepanov V, Kowgier M, Hansen B, Goneau LW, Janssen HLA, Mazzulli T, Cloherty G, de Knegt RJ, Feld JJ. Hepatitis C Core-Antigen Testing from Dried Blood Spots. Viruses 2019; 11:v11090830. [PMID: 31489933 PMCID: PMC6784259 DOI: 10.3390/v11090830] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2019] [Revised: 08/31/2019] [Accepted: 09/05/2019] [Indexed: 12/12/2022] Open
Abstract
In order to expand hepatitis C virus (HCV) screening, a change in the diagnostic paradigm is warranted to improve accessibility and decrease costs, such as utilizing dried blood spot (DBS) collection. In our study, blood from 68 patients with chronic HCV infection was spotted onto DBS cards and stored at the following temperatures for one week: −80 °C, 4 °C, 21 °C, 37 °C, and alternating 37 °C and 4 °C; to assess whether temperature change during transportation would affect sensitivity. Sample was eluted from the DBS cards and tested for HCV antibodies (HCV-Ab) and HCV core antigen (core-Ag). HCV-Abs were detected from 68/68 DBS samples at −80 °C, 4 °C, 21 °C, and 67/68 at 37 °C and alternating 37 °C and 4 °C. Sensitivity of core-Ag was as follows: 94% (−80 °C), 94% (4 °C), 91% (21 °C), 93% (37 °C), and 93% (37 °C/4 °C). Not only did temperature not greatly affect sensitivity, but sensitivities are higher than previously reported, and support the use of this assay as an alternative to HCV RNA. We then completed a head-to-head comparison (n = 49) of venous versus capillary samples, and one versus two DBS. No difference in core-Ag sensitivity was observed by sample type, but there was an improvement when using two spots. We conclude that HCV-Abs and core-Ag testing from DBS cards has high diagnostic accuracy and could be considered as an alternative to HCV RNA in certain settings.
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Affiliation(s)
- Mia J Biondi
- Toronto Centre for Liver Disease, Toronto General Hospital, University Health Network, University of Toronto, Toronto, ON M5G 2C4, Canada.
- Viral Hepatitis Care Network (VIRCAN) Study Group, Toronto Centre for Liver Disease, Toronto, ON M5G 2C4 Canada.
- Arthur Labatt Family School of Nursing, Western University, London, ON N6A 3K7, Canada.
| | - Marjolein van Tilborg
- Toronto Centre for Liver Disease, Toronto General Hospital, University Health Network, University of Toronto, Toronto, ON M5G 2C4, Canada.
- Gastroenterology and Hepatology, Erasmus MC University Medical Center Rotterdam, Rotterdam 3015 GD, The Netherlands.
| | - David Smookler
- Toronto Centre for Liver Disease, Toronto General Hospital, University Health Network, University of Toronto, Toronto, ON M5G 2C4, Canada.
- Viral Hepatitis Care Network (VIRCAN) Study Group, Toronto Centre for Liver Disease, Toronto, ON M5G 2C4 Canada.
| | - Gregory Heymann
- Toronto Centre for Liver Disease, Toronto General Hospital, University Health Network, University of Toronto, Toronto, ON M5G 2C4, Canada.
| | | | - Stephen Perusini
- Public Health Ontario Laboratories, Toronto, ON M5G 1M1, Canada.
| | - Erin Mandel
- Toronto Centre for Liver Disease, Toronto General Hospital, University Health Network, University of Toronto, Toronto, ON M5G 2C4, Canada.
- Viral Hepatitis Care Network (VIRCAN) Study Group, Toronto Centre for Liver Disease, Toronto, ON M5G 2C4 Canada.
| | - Robert A Kozak
- Department of Microbiology, Sunnybrook Health Sciences, Toronto, ON M4N 3M5, Canada.
| | - Vera Cherepanov
- Toronto Centre for Liver Disease, Toronto General Hospital, University Health Network, University of Toronto, Toronto, ON M5G 2C4, Canada.
| | - Matthew Kowgier
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON M5T 3M7, Canada.
| | - Bettina Hansen
- Toronto Centre for Liver Disease, Toronto General Hospital, University Health Network, University of Toronto, Toronto, ON M5G 2C4, Canada.
- Viral Hepatitis Care Network (VIRCAN) Study Group, Toronto Centre for Liver Disease, Toronto, ON M5G 2C4 Canada.
| | - Lee W Goneau
- Public Health Ontario Laboratories, Toronto, ON M5G 1M1, Canada.
| | - Harry L A Janssen
- Toronto Centre for Liver Disease, Toronto General Hospital, University Health Network, University of Toronto, Toronto, ON M5G 2C4, Canada
- Viral Hepatitis Care Network (VIRCAN) Study Group, Toronto Centre for Liver Disease, Toronto, ON M5G 2C4 Canada
| | - Tony Mazzulli
- Mount Sinai Hospital, Toronto, ON M5G 1X5, Canada.
- Public Health Ontario Laboratories, Toronto, ON M5G 1M1, Canada.
| | | | - Robert J de Knegt
- Gastroenterology and Hepatology, Erasmus MC University Medical Center Rotterdam, Rotterdam 3015 GD, The Netherlands.
| | - Jordan J Feld
- Toronto Centre for Liver Disease, Toronto General Hospital, University Health Network, University of Toronto, Toronto, ON M5G 2C4, Canada.
- Viral Hepatitis Care Network (VIRCAN) Study Group, Toronto Centre for Liver Disease, Toronto, ON M5G 2C4 Canada.
- Institute of Medical Sciences, University of Toronto, Toronto, ON M5S 1A8, Canada.
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Serial hyphenation of dried spot, reversed phase liquid chromatography, hydrophilic interaction liquid chromatography, and tandem mass spectrometry towards direct chemical profiling of herbal medicine-derived liquid matrices, an application in Cistanche sinensis. J Pharm Biomed Anal 2019; 174:34-42. [DOI: 10.1016/j.jpba.2019.05.048] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Revised: 04/25/2019] [Accepted: 05/21/2019] [Indexed: 02/06/2023]
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Chiku C, Zolfo M, Senkoro M, Mabhala M, Tweya H, Musasa P, Shukusho FD, Mazarura E, Mushavi A, Mangwanya D. Common causes of EID sample rejection in Zimbabwe and how to mitigate them. PLoS One 2019; 14:e0210136. [PMID: 31393883 PMCID: PMC6687112 DOI: 10.1371/journal.pone.0210136] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Accepted: 07/21/2019] [Indexed: 02/05/2023] Open
Abstract
Early infant diagnosis (EID) of HIV provides an opportunity for early HIV detection and access to appropriate Antiretroviral treatment (ART). Dried Blood Spot (DBS) samples are used for EID of exposed infants, born to HIV-positive mothers. However, DBS rejection rates in Zimbabwe have been exceeding the target of less than 2% per month set by the National Microbiology Reference Laboratory (NMRL), in Harare. The aim of this study was to determine the DBS sample rejection rate, the reasons for rejection and the possible associations between rejection and level of health facility where the samples were collected. This is an analytical cross-sectional study using routine DBS sample data from the NMRL in Harare, Zimbabwe, between January and December 2017.A total of 34 950 DBS samples were received at the NMRL. Of these, 1291(4%) were rejected. Reasons for rejection were insufficient specimen volume (72%), missing request form (11%), missing sample (6%), cross-contamination (6%), mismatch of information (4%) and clotted sample (1%). Samples collected from clinics/rural health facilities were five times more likely to be rejected compared to those from a central hospital. Rejection rates were above the set target of <2%. The reasons for rejection were ‘pre-analytical’ errors including labelling errors, missing or inconsistent data, and insufficient blood collected. Samples collected at primary healthcare facilities had higher rejection rates.
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Affiliation(s)
- Charles Chiku
- National Microbiology Reference Laboratory, Harare, Zimbabwe
- * E-mail:
| | - Maria Zolfo
- Institute of Tropical Medicine, Antwerp, Belgium
| | - Mbazi Senkoro
- National Institute for Medical Research, Muhimbili, Tanzania
| | | | | | - Patience Musasa
- National Microbiology Reference Laboratory, Harare, Zimbabwe
| | | | | | - Angela Mushavi
- Prevention of Mother to Child Transmission of HIV, Harare, Zimbabwe
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HIV Viral Load Estimation Using Hematocrit Corrected Dried Blood Spot Results on a BioMerieux NucliSENS ® Platform. Diagnostics (Basel) 2019; 9:diagnostics9030086. [PMID: 31366024 PMCID: PMC6787611 DOI: 10.3390/diagnostics9030086] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Revised: 07/17/2019] [Accepted: 07/26/2019] [Indexed: 11/25/2022] Open
Abstract
While reporting human immunodeficiency virus (HIV) viral load (VL) using dried blood spot (DBS) in the BioMerieux NucliSENS platform, application of the hematocrit correction factor has been suggested. In this cross-sectional study from the National Microbiology Reference Laboratory of Zimbabwe, we assessed whether hematocrit correction (individual and/or mean) in DBS results improved the correlation with plasma VL and prediction of VL non-suppression (≥1000 copies per ml in plasma). Of 517 specimens during August–December 2018, 65(12.6%) had non-suppressed plasma VL results. The hematocrit correction factor ranged from 1.3 to 2.0 with a mean of 1.6, standard deviation (SD: 1.5, 1.7). The intraclass correlation (ICC) for mean (0.859, 95% CI: 0.834, 0.880) and individual (0.809, 95% CI: 0.777, 0.837) hematocrit corrected DBS results were not significantly different. The uncorrected DBS results had a significantly lower ICC (0.640, 95% CI: 0.586, 0.688) when compared to corrected DBS results. There were no significant differences in validity, predictive values, and areas under the receiver operating characteristics curves for all three DBS results when predicting VL non-suppression. To conclude, hematocrit correction of DBS VL results improved agreement with the plasma results but did not improve prediction of VL non-suppression. The results were not significantly different for individual and mean corrected results.
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Zyl G, Maritz J, Newman H, Preiser W. Lessons in diagnostic virology: expected and unexpected sources of error. Rev Med Virol 2019; 29:e2052. [DOI: 10.1002/rmv.2052] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Revised: 04/05/2019] [Accepted: 04/14/2019] [Indexed: 11/07/2022]
Affiliation(s)
- Gert Zyl
- Division of Medical Virology, Department PathologyStellenbosch University, Faculty of Medicine and Health Sciences Parow South Africa
- National Health Laboratory Service South Africa
| | - Jean Maritz
- Division of Medical Virology, Department PathologyStellenbosch University, Faculty of Medicine and Health Sciences Parow South Africa
- PathCare Reference Laboratory Cape Town South Africa
| | - Howard Newman
- Division of Medical Virology, Department PathologyStellenbosch University, Faculty of Medicine and Health Sciences Parow South Africa
- National Health Laboratory Service South Africa
| | - Wolfgang Preiser
- Division of Medical Virology, Department PathologyStellenbosch University, Faculty of Medicine and Health Sciences Parow South Africa
- National Health Laboratory Service South Africa
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Point-of-Care HIV Viral Load Testing: an Essential Tool for a Sustainable Global HIV/AIDS Response. Clin Microbiol Rev 2019; 32:32/3/e00097-18. [PMID: 31092508 DOI: 10.1128/cmr.00097-18] [Citation(s) in RCA: 61] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
The global public health community has set ambitious treatment targets to end the HIV/AIDS pandemic. With the notable absence of a cure, the goal of HIV treatment is to achieve sustained suppression of an HIV viral load, which allows for immunological recovery and reduces the risk of onward HIV transmission. Monitoring HIV viral load in people living with HIV is therefore central to maintaining effective individual antiretroviral therapy as well as monitoring progress toward achieving population targets for viral suppression. The capacity for laboratory-based HIV viral load testing has increased rapidly in low- and middle-income countries, but implementation of universal viral load monitoring is still hindered by several barriers and delays. New devices for point-of-care HIV viral load testing may be used near patients to improve HIV management by reducing the turnaround time for clinical test results. The implementation of near-patient testing using these new and emerging technologies may be an essential tool for ensuring a sustainable response that will ultimately enable an end to the HIV/AIDS pandemic. In this report, we review the current and emerging technology, the evidence for decentralized viral load monitoring by non-laboratory health care workers, and the additional considerations for expanding point-of-care HIV viral load testing.
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Separation of Plasma from Whole Blood by Use of the cobas Plasma Separation Card: a Compelling Alternative to Dried Blood Spots for Quantification of HIV-1 Viral Load. J Clin Microbiol 2019; 57:JCM.01336-18. [PMID: 30728197 PMCID: PMC6440768 DOI: 10.1128/jcm.01336-18] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2018] [Accepted: 01/23/2019] [Indexed: 12/21/2022] Open
Abstract
Plasma HIV viral load testing is the preferred means of monitoring antiretroviral treatment response. Dried blood spots (DBSs) hold considerable logistical advantages over EDTA samples, but they more frequently misclassify virological failure and have higher limits of detection (LoD). Plasma separation cards (PSCs) may overcome these limitations. Health workers collected EDTA whole blood by venipuncture and 140 μl of finger-prick blood by capillary tube from 53 HIV-infected adults. Capillary blood was immediately transferred to PSCs. Additionally, 432 EDTA samples from HIV-infected adults were spotted onto PSCs and analyzed together with the finger-prick samples. Specificity and sensitivity of PSC with paired EDTA-PSC samples tested on a cobas 6800/8800 system with the cobas HIV-1 test (cobas HIV) was determined. LoD (3rd HIV-1 WHO International Standard) and stability at a range of temperatures and storage durations was determined using cobas HIV and cobas AmpliPrep/cobas TaqMan HIV-1 test v2.0 (CAP/CTM). Of 132 specimens with quantitative values for paired EDTA-PSC samples, the mean log10 difference between samples was 0.05 copies/ml (95% confidence interval [CI], -0.01 to 0.11). The LoD for cobas HIV was 790.2 copies/ml and for CAP/CTM was 737.9 copies/ml. At 1,000 copies/ml, PSC sensitivity was 97.0% (128/132) and specificity was 97.2% (343/353). Results correlated well with those from EDTA samples (Deming R 2 = 0.90). PSC results were unaffected by temperature and storage conditions. PSC samples correlate well with plasma viral load and have adequate sensitivity and specificity. The improved performance may be as a result of a reduction in contribution from cell-associated viral nucleic acids. The card provides an alternative sample collection technology to DBSs.
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Feld JJ. Hepatitis C Virus Diagnostics: The Road to Simplification. Clin Liver Dis (Hoboken) 2018; 12:125-129. [PMID: 30988927 PMCID: PMC6385922 DOI: 10.1002/cld.760] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2018] [Accepted: 09/08/2018] [Indexed: 02/04/2023] Open
Affiliation(s)
- Jordan J. Feld
- Toronto Centre for Liver Disease, Sandra Rotman Centre for Global HealthUniversity of TorontoTorontoOntarioCanada
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Abstract
HIV diagnostics have played a central role in the remarkable progress in identifying, staging, initiating, and monitoring infected individuals on life-saving antiretroviral therapy. They are also useful in surveillance and outbreak responses, allowing for assessment of disease burden and identification of vulnerable populations and transmission "hot spots," thus enabling planning, appropriate interventions, and allocation of appropriate funding. HIV diagnostics are critical in achieving epidemic control and require a hybrid of conventional laboratory-based diagnostic tests and new technologies, including point-of-care (POC) testing, to expand coverage, increase access, and positively impact patient management. In this review, we provide (i) a historical perspective on the evolution of HIV diagnostics (serologic and molecular) and their interplay with WHO normative guidelines, (ii) a description of the role of conventional and POC testing within the tiered laboratory diagnostic network, (iii) information on the evaluations and selection of appropriate diagnostics, (iv) a description of the quality management systems needed to ensure reliability of testing, and (v) strategies to increase access while reducing the time to return results to patients. Maintaining the central role of HIV diagnostics in programs requires periodic monitoring and optimization with quality assurance in order to inform adjustments or alignment to achieve epidemic control.
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Thulin Hedberg S, Eriksson L, Demontis MA, Mölling P, Sundqvist M, Taylor G, Malm K, Andersson S. Droplet digital PCR for absolute quantification of proviral load of human T-cell lymphotropic virus (HTLV) types 1 and 2. J Virol Methods 2018; 260:70-74. [DOI: 10.1016/j.jviromet.2018.07.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Revised: 06/07/2018] [Accepted: 07/06/2018] [Indexed: 11/15/2022]
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Lim MD. Dried Blood Spots for Global Health Diagnostics and Surveillance: Opportunities and Challenges. Am J Trop Med Hyg 2018; 99:256-265. [PMID: 29968557 PMCID: PMC6090344 DOI: 10.4269/ajtmh.17-0889] [Citation(s) in RCA: 106] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2017] [Accepted: 05/02/2018] [Indexed: 12/28/2022] Open
Abstract
There is increasing interest in using dried blood spot (DBS) cards to extend the reach of global health and disease surveillance programs to hard-to-reach populations. Conceptually, DBS offers a cost-effective solution for multiple use cases by simplifying logistics for collecting, preserving, and transporting blood specimens in settings with minimal infrastructure. This review describes methods to determine both the reliability of DBS-based bioanalysis for a defined use case and the optimal conditions that minimize pre-analytical sources of data variability. Examples by the newborn screening, drug development, and global health communities are provided in this review of published literature. Sources of variability are linked in most cases, emphasizing the importance of field-to-laboratory standard operating procedures that are evidence based and consider both stability and efficiency of recovery for a specified analyte in defining the type of DBS card, accessories, handling procedures, and storage conditions. Also included in this review are reports where DBS was determined to not be feasible because of technology limitations or physiological properties of a targeted analyte.
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Affiliation(s)
- Mark D. Lim
- Global Health Division, Bill & Melinda Gates Foundation, Seattle, Washington
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Pallas SW, Courey M, Hy C, Killam WP, Warren D, Moore B. Cost Analysis of Tuberculosis Diagnosis in Cambodia with and without Xpert ® MTB/RIF for People Living with HIV/AIDS and People with Presumptive Multidrug-resistant Tuberculosis. APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2018; 16:537-548. [PMID: 29862440 PMCID: PMC6050005 DOI: 10.1007/s40258-018-0397-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Abstract
BACKGROUND The Xpert® MTB/RIF (Xpert) test has been shown to be effective and cost-effective for diagnosing tuberculosis (TB) under conditions with high HIV prevalence and HIV-TB co-infection but less is known about Xpert's cost in low HIV prevalence settings. Cambodia, a country with low HIV prevalence (0.7%), high TB burden, and low multidrug-resistant (MDR) TB burden (1.4% of new TB cases, 11% of retreatment cases) introduced Xpert into its TB diagnostic algorithms for people living with HIV (PLHIV) and people with presumptive MDR TB in 2012. The study objective was to estimate these algorithms' costs pre- and post-Xpert introduction in four provinces of Cambodia. METHODS Using a retrospective, ingredients-based microcosting approach, primary cost data on personnel, equipment, maintenance, supplies, and specimen transport were collected at four sites through observation, records review, and key informant consultations. RESULTS Across the sample facilities, the cost per Xpert test was US$33.88-US$37.11, clinical exam cost US$1.22-US$1.84, chest X-ray cost US$2.02-US$2.14, fluorescent microscopy (FM) smear cost US$1.56-US$1.93, Ziehl-Neelsen (ZN) smear cost US$1.26, liquid culture test cost US$11.63-US$22.83, follow-on work-up for positive culture results and Mycobacterium tuberculosis complex (MTB) identification cost US$11.50-US$14.72, and drug susceptibility testing (DST) cost US$44.26. Specimen transport added US$1.39-US$5.21 per sample. Assuming clinician adherence to the algorithms and perfect test accuracy, the normative cost per patient correctly diagnosed under the post-Xpert algorithms would be US$25-US$29 more per PLHIV and US$34-US$37 more per person with presumptive MDR TB (US$41 more per PLHIV when accounting for variable test sensitivity and specificity). CONCLUSIONS Xpert test unit costs could be reduced through lower cartridge prices, longer usable life of GeneXpert® (Cepheid, USA) instruments, and increased test volumes; however, epidemiological and test eligibility conditions in Cambodia limit the number of specimens received at laboratories, leading to sub-optimal utilization of current instruments. Improvements to patient referral and specimen transport could increase test volumes and reduce Xpert test unit costs in this setting.
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Affiliation(s)
- Sarah Wood Pallas
- Division of Global HIV/AIDS, Center for Global Health, US Centers for Disease Control and Prevention (CDC), 1600 Clifton Road NE, MS A-04, Atlanta, GA, 30329-4027, USA.
| | - Marissa Courey
- Division of Global HIV/AIDS, Center for Global Health, US Centers for Disease Control and Prevention (CDC), 1600 Clifton Road NE, MS A-04, Atlanta, GA, 30329-4027, USA
| | - Chhaily Hy
- Division of Global HIV/AIDS, Center for Global Health, US Centers for Disease Control and Prevention (CDC), National Institute of Public Health, #80, 289 Samdach Penn Nouth St. (289), Phnom Penh, Cambodia
| | - Wm Perry Killam
- Division of Global HIV/AIDS, Center for Global Health, US Centers for Disease Control and Prevention (CDC), National Institute of Public Health, #80, 289 Samdach Penn Nouth St. (289), Phnom Penh, Cambodia
| | - Dora Warren
- Division of Global HIV/AIDS, Center for Global Health, US Centers for Disease Control and Prevention (CDC), National Institute of Public Health, #80, 289 Samdach Penn Nouth St. (289), Phnom Penh, Cambodia
| | - Brittany Moore
- Division of Tuberculosis Elimination, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, US Centers for Disease Control and Prevention (CDC), 1600 Clifton Road NE, Atlanta, GA, 30329-4027, USA
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Early Infant Diagnosis Sample Management in Mashonaland West Province, Zimbabwe, 2017. AIDS Res Treat 2018; 2018:4234256. [PMID: 30147951 PMCID: PMC6083648 DOI: 10.1155/2018/4234256] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Revised: 07/02/2018] [Accepted: 07/19/2018] [Indexed: 01/22/2023] Open
Abstract
Background In 2016, Mashonaland West Province had 7.4% (520) dried blood spot (DBS) samples for early infant diagnosis (EID) rejected by the Zimbabwe National Microbiology Reference Laboratory (NMRL). The samples were suboptimal, delaying treatment initiation for HIV-infected children. EID is the entry point to HIV treatment services in exposed infants. We determined reasons for DBS sample rejections and suggested solutions. Methods A cause-effect analysis, modelled on Ishikawa, was used to identify factors impacting DBS sample quality. Interviewer-administered questionnaires and evaluation of sample collection process, using Standard Operating Procedure (SOP) was conducted. Rejected samples were reviewed. Epi Info™ was used to analyze findings. Results Eleven (73.3%) facilities did not adhere to SOP and (86.7%) did not evaluate DBS sample quality before sending for testing. Delayed feedback (up to 4 weeks) from NMRL extended EID delay for 14 (93.3%) of the facilities. Of the 53 participants, 62% knew valid sample identification. Insufficient samples resulted in most rejections (77.9%). Lack of training (94.3%) and ineffective supervision (69.8%) were also cited. Conclusion Sample rejections could have been averted through SOP adherence. Ineffective supervision, exacerbated by delayed communication of rejections, extended EID delay, disadvantaging potential ART beneficiaries. Following this study, enhanced quality control through perstage evaluations was recommended to enhance DBS sample quality.
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Dowling W, Veldsman K, Grace Katusiime M, Maritz J, Bock P, Meehan SA, Van Schalkwyk M, Cotton MF, Preiser W, Van Zyl GU. HIV-1 RNA testing of pooled dried blood spots is feasible to diagnose acute HIV infection in resource limited settings. S Afr J Infect Dis 2018. [DOI: 10.1080/23120053.2017.1393247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Affiliation(s)
- Wentzel Dowling
- Division of Medical Virology, Stellenbosch University, Cape Town, South Africa
- National Health Laboratory Service, Tygerberg Business Unit, Cape Town, South Africa
| | - Kirsten Veldsman
- Division of Medical Virology, Stellenbosch University, Cape Town, South Africa
| | | | - Jean Maritz
- Division of Medical Virology, Stellenbosch University, Cape Town, South Africa
- National Health Laboratory Service, Tygerberg Business Unit, Cape Town, South Africa
| | - Peter Bock
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Stellenbosch University, Cape Town, South Africa
| | - Sue-Ann Meehan
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Stellenbosch University, Cape Town, South Africa
| | - Marije Van Schalkwyk
- Division of Infectious Diseases, Department of Medicine, Stellenbosch University and Tygerberg Academic Hospital, Cape Town, South Africa
- Family Clinical Research Unit, Stellenbosch University, Cape Town, South Africa
| | - Mark F Cotton
- Department of Paediatrics and Child Health, Stellenbosch University and Tygerberg Children’s Hospital, Cape Town, South Africa
- Family Clinical Research Unit, Stellenbosch University, Cape Town, South Africa
| | - Wolfgang Preiser
- Division of Medical Virology, Stellenbosch University, Cape Town, South Africa
- National Health Laboratory Service, Tygerberg Business Unit, Cape Town, South Africa
| | - Gert U Van Zyl
- Division of Medical Virology, Stellenbosch University, Cape Town, South Africa
- National Health Laboratory Service, Tygerberg Business Unit, Cape Town, South Africa
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Pollack TM, Duong HT, Truong PT, Pham TT, Do CD, Colby D. Sensitivity and specificity of two dried blood spot methods for HIV-1 viral load monitoring among patients in Hanoi, Vietnam. PLoS One 2018; 13:e0191411. [PMID: 29346431 PMCID: PMC5773210 DOI: 10.1371/journal.pone.0191411] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Accepted: 12/18/2017] [Indexed: 11/23/2022] Open
Abstract
The use of dried blood spot (DBS) specimens for HIV viral load (VL) monitoring is recommended to support the roll-out of routine VL monitoring in low and middle income countries (LMICs). To better understand the use of DBS for VL monitoring, we evaluated two DBS testing methods, Roche TaqMan® Free Virus Evolution protocol (DBS-FVE) and Roche TaqMan® SPEX protocol (DBS-SPEX)) in patients receiving ART at an HIV clinic in Hanoi, Vietnam. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated for each DBS testing method at the thresholds of 1000 and 5000 copies/ml compared to plasma VL. At a threshold of 1000 copies/ml, sensitivity, specificity, PPV and NPV of the DBS-SPEX method were 98.8% (95% CI: 93.3%-100%), 74.3% (95% CI: 70.8%-77.5%), 31.5% (95% CI: 25.8%-37.6%), and 99.8% (95% CI: 98.9%-100%), respectively. Increasing the VL threshold value to 5000 copies/ml improved specificity (97.9% CI: 96.6%-98.9%) and PPV (83.9% CI: 74.5%-90.9%). Using the DBS-FVE method, at the threshold of 1000 copies/ml and with a correction factor of +0.3 log copies/ml, sensitivity was 95.1% (87.8%-98.6%) and specificity was 98.8% (97.7%-99.5%). Sensitivity decreased at the threshold of 5000 copies/ml (65.8%, 95% CI: 54.3%-76.1%). With a correction factor of +0.7 log copies/ml, the sensitivity was 96.3% (89.6%-99.2%) and specificity was 98.2% (96.9%-99.1%) at the threshold of 1000 copies/ml. We found that the Roche DBS-FVE method, with a +0.7 log copies/ml correction factor, performed well with sensitivity and specificity greater than 96% at a VL threshold of 1000 copies/m. These findings add to the growing body of evidence supporting the use of DBS VL testing for ART monitoring. Future research should evaluate the association between VL results by DBS and clinical outcome measures such as HIV drug resistance, morbidity, and mortality.
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Affiliation(s)
- Todd M. Pollack
- The Partnership for Health Advancement in Vietnam, Beth Israel Deaconess Medical Center, Hanoi, Vietnam
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States of America
- * E-mail:
| | - Hao T. Duong
- The Partnership for Health Advancement in Vietnam, Beth Israel Deaconess Medical Center, Hanoi, Vietnam
| | | | - Thuy T. Pham
- The Partnership for Health Advancement in Vietnam, Beth Israel Deaconess Medical Center, Hanoi, Vietnam
- Department of Infectious Diseases, Bach Mai Hospital, Hanoi, Vietnam
| | - Cuong D. Do
- Department of Infectious Diseases, Bach Mai Hospital, Hanoi, Vietnam
| | - Donn Colby
- Center for Applied Research on Men and Community Health, Ho Chi Minh City, Vietnam
- SEARCH, Thai Red Cross AIDS Research Centre, Bangkok, Thailand
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