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Cholette F, Périnet S, Neufeld B, Bryson M, Macri J, Sibley KM, Kim J, Driedger SM, Becker ML, Sandstrom P, Meyers AFA, Paquette D. Validity of dried blood spot testing for sexually transmitted and blood-borne infections: A narrative systematic review. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0003320. [PMID: 38875246 PMCID: PMC11178196 DOI: 10.1371/journal.pgph.0003320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Accepted: 05/15/2024] [Indexed: 06/16/2024]
Abstract
Testing for human immunodeficiency virus (HIV) and hepatitis C virus (HCV) using dried blood spot (DBS) specimens has been an integral part of bio-behavioural surveillance in Canada for almost two decades, though less is known regarding the use of DBS in surveillance of other sexually transmitted and blood-borne infections (STBBI). A systematic review was conducted using a peer-reviewed search strategy to assess the current evidence regarding the validity of STBBI testing using DBS specimens. Eligibility criteria included studies reporting use of DBS specimens for STBBI testing with either commercially available or "in-house" tests in populations 15 years of age or older. Studies reporting a measure of validity such as sensitivity, specificity, positive and negative predictive values were eligible for inclusion. Quality of studies and risk of bias were assessed using the QUADAS-2 tool. A total of 7,132 records were identified. Of these, 174 met the criteria for inclusion. Among the studies that reported validity measures, a substantial proportion demonstrated high sensitivity (≥90%) in 62.5% of cases (N = 334/534 sensitivity measurements), and high specificity (≥90%) was observed in 84.9% of instances (N = 383/451 specificity measurements). However, the quality of the studies varied greatly. Our findings support the validity of the use of DBS specimens in STBBI testing where sufficient evidence was available, but validity is highly dependent on thorough method development and validation.
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Affiliation(s)
- François Cholette
- National Sexually Transmitted and Blood Borne Infection Laboratory, National Microbiology Laboratory at the J. C. Wilt Infectious Diseases Research Centre, Public Health Agency of Canada, Winnipeg, Canada
- Department of Medical Microbiology and Infectious Diseases, University of Manitoba, Winnipeg, Canada
| | - Simone Périnet
- Sexually Transmitted and Blood Borne Infection Surveillance Division, Centre for Communicable Diseases and Infection Control, Public Health Agency of Canada, Ottawa, Canada
| | - Bronwyn Neufeld
- National Sexually Transmitted and Blood Borne Infection Laboratory, National Microbiology Laboratory at the J. C. Wilt Infectious Diseases Research Centre, Public Health Agency of Canada, Winnipeg, Canada
| | - Maggie Bryson
- Horizontal Surveillance Operations Division, Centre for Corporate Surveillance Coordination, Public Health Agency of Canada, Ottawa, Canada
| | - Jennifer Macri
- Public Health Data Science and Systems, Data Management, Innovation and Analytics, Public Health Agency of Canada, Ottawa, Canada
| | - Kathryn M Sibley
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Canada
- George & Fay Yee Centre for Healthcare Innovation, University of Manitoba, Winnipeg, Canada
| | - John Kim
- National Sexually Transmitted and Blood Borne Infection Laboratory, National Microbiology Laboratory at the J. C. Wilt Infectious Diseases Research Centre, Public Health Agency of Canada, Winnipeg, Canada
| | - S Michelle Driedger
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Marissa L Becker
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Paul Sandstrom
- National Sexually Transmitted and Blood Borne Infection Laboratory, National Microbiology Laboratory at the J. C. Wilt Infectious Diseases Research Centre, Public Health Agency of Canada, Winnipeg, Canada
- Department of Medical Microbiology and Infectious Diseases, University of Manitoba, Winnipeg, Canada
| | - Adrienne F A Meyers
- National Sexually Transmitted and Blood Borne Infection Laboratory, National Microbiology Laboratory at the J. C. Wilt Infectious Diseases Research Centre, Public Health Agency of Canada, Winnipeg, Canada
- Department of Medical Microbiology and Infectious Diseases, University of Manitoba, Winnipeg, Canada
- Office of Population and Public Health, Indigenous Services Canada, Ottawa, Canada
| | - Dana Paquette
- Horizontal Surveillance Operations Division, Centre for Corporate Surveillance Coordination, Public Health Agency of Canada, Ottawa, Canada
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Araujo Chaveron L, Pham TTP, Nguyen BT, Tran TH, Le NTH, Pham TH, Ngo KP, Tong HT, Phan HTT, Ait-Ahmed M, Nguyen TA, Taieb F, Madec Y. Injecting drug use increases the risk of death in HIV patients on antiretroviral therapy in Vietnam. AIDS Care 2024; 36:631-640. [PMID: 37339000 DOI: 10.1080/09540121.2023.2224549] [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: 10/12/2022] [Accepted: 06/07/2023] [Indexed: 06/22/2023]
Abstract
The Human Immunodeficiency Virus (HIV) epidemic remains a major public health issue worldwide. In Vietnam, the HIV epidemic is essentially driven by people who inject drugs (PWID). This study aims to compare mortality and loss to follow-up (LTFU) between PWID and other patients. From June 2017 to April 2018, HIV-infected adults were enrolled in a prospective cohort from time of ART initiation in six provinces of North Vietnam. The end date was July 2020. Mortality and LTFU were described using competing-risk survival models. Factors associated with mortality and with LTFU were identified using Cox models with a competing-risk approach. Of the 578 participants, 261 (45.2%) were PWID and almost exclusively male. 49 patients died, corresponding to a mortality rate (95% confidence interval (CI)) of 3.7 (2.8-4.9) per 100 person-months, and 79 were lost to follow-up, corresponding to a rate (95% CI) of 6.0 (4.8-7.4) per 100 person-months. PWID were at higher risk of death but not of LTFU. Overall, LTFU was high in both groups. Latecomers to clinical visits were more at risk of both death and LTFU. Therefore, this should be a warning to clinical teams and preventive actions taken in these patients.Trial registration: ClinicalTrials.gov identifier: NCT03249493..
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Affiliation(s)
- Lucia Araujo Chaveron
- EHESP French School of Public Health, Paris, France
- Institut Pasteur, Epidemiology of Emerging Diseases, Université de Paris, Paris, France
| | - Tram Thi Phuong Pham
- HIV Molecular Laboratory, National Institute of Hygiene and Epidemiology, Hanoi, Vietnam
| | - Binh Thanh Nguyen
- HIV Molecular Laboratory, National Institute of Hygiene and Epidemiology, Hanoi, Vietnam
| | - Tram Hong Tran
- HIV Molecular Laboratory, National Institute of Hygiene and Epidemiology, Hanoi, Vietnam
| | - Nhung Thi Hong Le
- HIV Molecular Laboratory, National Institute of Hygiene and Epidemiology, Hanoi, Vietnam
| | - Thang Hong Pham
- HIV Molecular Laboratory, National Institute of Hygiene and Epidemiology, Hanoi, Vietnam
| | - Khanh Phuong Ngo
- Training and Research Management Center, National Institute of Hygiene and Epidemiology, Hanoi, Vietnam
| | - Ha Thi Tong
- Training and Research Management Center, National Institute of Hygiene and Epidemiology, Hanoi, Vietnam
| | - Huong Thi Thu Phan
- Ministry of Health, Vietnam Administration of HIV/AIDS Control (VAAC), Hanoi, Vietnam
| | - Mohand Ait-Ahmed
- Institut Pasteur, Center for Translational Research, Université de Paris, Paris, France
| | - Tuan Anh Nguyen
- HIV and AIDS Department, National Institute of Hygiene and Epidemiology, Hanoi, Vietnam
| | - Fabien Taieb
- Institut Pasteur, Center for Translational Research, Université de Paris, Paris, France
- Institut Pasteur, Department of international affairs, Université de Paris, Paris, France
| | - Yoann Madec
- Institut Pasteur, Epidemiology of Emerging Diseases, Université de Paris, Paris, France
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Chandane Tak M, Vaidyanathan A, Mukherjee A. Revolutionizing HIV-1 Viral Load Monitoring in India: The Potential of Dried Blood Spot Analysis for Expanding Access and Improving Care. Healthcare (Basel) 2024; 12:413. [PMID: 38391789 PMCID: PMC10887712 DOI: 10.3390/healthcare12040413] [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: 12/11/2023] [Revised: 01/20/2024] [Accepted: 01/30/2024] [Indexed: 02/24/2024] Open
Abstract
India continues to grapple with a significant burden of HIV infections. Despite notable progress in prevention and treatment efforts, multiple challenges, such as high-risk populations, inadequate testing facilities, and limited access to healthcare in remote areas, persist. Though the Government of India offers HIV-1 plasma viral load testing at various medical centers, aiding treatment decisions and monitoring antiretroviral therapy effectiveness, enhancing care for individuals living with HIV under the National AIDS Control Program (NACP), the nation's large population and diverse demographics further complicate its outreach and response. Hence, strategic interventions and alternative methods of testing remain crucial to curbing HIV transmission and improving the quality of life for those affected. Dried blood spot (DBS) sampling has emerged as a convenient and cost-effective alternative for HIV-1 viral load testing, revolutionizing the landscape of diagnostic and monitoring strategies for HIV infection. Though the plasma-based viral load remains the gold standard for monitoring HIV-1, DBS-based HIV-1 viral load testing holds immense promise for improving access to care, particularly in resource-limited settings where traditional plasma-based methods may be logistically challenging. DBS entails the collection of a small volume of blood onto filter paper, followed by drying and storage. This approach offers numerous advantages, including simplified sample collection, transportation, and storage, reducing the need for cold-chain logistics. Recent studies have demonstrated the feasibility and accuracy of DBS-based HIV-1 viral load testing, revealing a strong correlation between DBS and plasma measurements. Its implementation can enhance the early detection of treatment failure, guide therapeutic decisions, and ultimately contribute to better clinical outcomes for HIV-infected individuals. Hence, this review explores the principles, advancements, feasibility, and implications of DBS-based HIV-1 viral load testing.
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Affiliation(s)
- Madhuri Chandane Tak
- Division of Virology, ICMR-National AIDS Research Institute, Pune 411026, MH, India
| | | | - Anupam Mukherjee
- Division of Virology, ICMR-National AIDS Research Institute, Pune 411026, MH, India
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Lefrancois LH, Nguyen BT, Pham TTP, Le NTH, Dao HTT, Tran TH, Ngo KP, Tong HT, Phan HTT, Ait-Ahmed M, Pham TH, Nguyen TA, Taieb F, Madec Y. Assessment of HIV viral load monitoring in remote settings in Vietnam - comparing people who inject drugs to the other patients. PLoS One 2023; 18:e0281857. [PMID: 36802388 PMCID: PMC9942987 DOI: 10.1371/journal.pone.0281857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 02/02/2023] [Indexed: 02/23/2023] Open
Abstract
INTRODUCTION Increasing access to viral load (VL) monitoring is essential to fight HIV epidemics. In remote settings in Vietnam, using dried blood spot (DBS) sampling for specimen collection could improve the situation. Here, people who inject drugs (PWID) represent many newly antiretroviral therapy (ART)-initiated patients. The goals of this evaluation were to evaluate if access to VL monitoring and the rate of virological failure differed between PWID and non-PWID. METHODS Prospective cohort study of patients newly initiated on ART in remote settings in Vietnam. DBS coverage at 6, 12 and 24 months of ART was investigated. Factors associated with DBS coverage were identified through logistic regression, as were factors associated with virological failure (VL ≥1,000 copies/mL) at 6, 12 and 24 months of ART. RESULTS Overall 578 patients were enrolled in the cohort, of whom 261 (45%) were PWID. DBS coverage improved from 74.7% to 82.9% between 6 and 24 months of ART (p = 0.001). PWID status was not associated with DBS coverage (p = 0.74), but DBS coverage was lower in patients who were late to clinical visits and in those in WHO stage 4 (p = 0.023 and p = 0.001, respectively). The virological failure rate decreased from 15.8% to 6.6% between 6 and 24 months of ART (p<0.001). In multivariate analysis, PWID were more at risk of failure (p = 0.001), as were patients who were late to clinical visits (p<0.001) and not fully adherent (p<0.001). CONCLUSIONS Despite training and simple procedures, DBS coverage was not perfect. DBS coverage was not associated with PWID status. Close management is required for effective routine HIV VL monitoring. PWID were more at risk of failure, as were patients who were not fully adherent and patients who were late to clinical visits. Specific interventions targeting these patients are needed to improve their outcomes. Overall, efforts in coordination and communication are essential to improve global HIV care. TRIAL REGISTRATION Clinical Trial Number: NCT03249493.
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Affiliation(s)
- Louise H. Lefrancois
- Epidemiology of Emerging Diseases, Institut Pasteur, Université de Paris, Paris, France
| | - Binh Thanh Nguyen
- National Reference Laboratory of HIV Molecular Biology, National Institute of Hygiene and Epidemiology, Hanoi, Vietnam
| | - Tram Thi Phuong Pham
- National Reference Laboratory of HIV Molecular Biology, National Institute of Hygiene and Epidemiology, Hanoi, Vietnam
| | - Nhung Thi Hong Le
- National Reference Laboratory of HIV Molecular Biology, National Institute of Hygiene and Epidemiology, Hanoi, Vietnam
| | - Huyen Thi Thanh Dao
- National Reference Laboratory of HIV Molecular Biology, National Institute of Hygiene and Epidemiology, Hanoi, Vietnam
| | - Tram Hong Tran
- National Reference Laboratory of HIV Molecular Biology, National Institute of Hygiene and Epidemiology, Hanoi, Vietnam
| | - Khanh Phuong Ngo
- Training and Research Management Center, National Institute of Hygiene and Epidemiology, Hanoi, Vietnam
| | - Ha Thi Tong
- Training and Research Management Center, National Institute of Hygiene and Epidemiology, Hanoi, Vietnam
| | - Huong Thi Thu Phan
- Vietnam Administration of HIV/AIDS Control, Ministry of Health, Hanoi, Vietnam
| | - Mohand Ait-Ahmed
- Center for Translational Research, Institut Pasteur, Université de Paris, Paris, France
| | - Thang Hong Pham
- National Reference Laboratory of HIV Molecular Biology, National Institute of Hygiene and Epidemiology, Hanoi, Vietnam
- HIV/AIDS Department, National Institute of Hygiene and Epidemiology, Hanoi, Vietnam
| | - Tuan Anh Nguyen
- HIV/AIDS Department, National Institute of Hygiene and Epidemiology, Hanoi, Vietnam
| | - Fabien Taieb
- Center for Translational Research, Institut Pasteur, Université de Paris, Paris, France
- Department of International Affairs, Institut Pasteur, Université de Paris, Paris, France
| | - Yoann Madec
- Epidemiology of Emerging Diseases, Institut Pasteur, Université de Paris, Paris, France
- * E-mail:
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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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Nanyeenya N, Kiwanuka N, Nakanjako D, Nakigozi G, Kibira SP, Nabadda S, Kiyaga C, Sewanyana I, Nasuuna E, Makumbi F. Low-level viraemia: An emerging concern among people living with HIV in Uganda and across sub-Saharan Africa. Afr J Lab Med 2022; 11:1899. [PMID: 36353193 PMCID: PMC9639359 DOI: 10.4102/ajlm.v11i1.1899] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 06/29/2022] [Indexed: 11/04/2023] Open
Abstract
Attaining viral load (VL) suppression for over 95% of the people living with HIV on antiretroviral therapy is a fundamental step in enabling Uganda and other sub-Saharan African countries to achieve global Sustainable Development Goal targets to end the HIV/AIDS epidemic by 2030. In line with the 2013 World Health Organization recommendations, several sub-Saharan African countries, including Uganda, use a threshold of 1000 HIV viral RNA copies/mL to determine HIV viral non-suppression. The United States Centers for Disease Control and Prevention and the International Association of Providers of AIDS Care deem this threshold very high, and hence recommend using 200 copies/mL to determine viral non-suppression. Using 1000 copies/mL as a threshold ignores people living with HIV who have low-level viraemia (LLV; HIV VL of at least 50 copies/mL but less than 1000 copies/mL). Despite the 2021 World Health Organization recommendations of using intensive adherence counselling for people living with HIV with LLV, several sub-Saharan African countries have no interventions to address LLV. However, recent studies have associated LLV with increased risks of HIV drug resistance, virologic failure and transmission. The purpose of this narrative review is to provide insights on the emerging concern of LLV among people living with HIV receiving antiretroviral therapy in sub-Saharan Africa. The review also provides guidance for Uganda and other sub-Saharan African countries to implement immediate appropriate interventions like intensive adherence counselling, reducing VL thresholds for non-suppression and conducting more research to manage LLV which threatens progress towards ending HIV by 2030.
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Affiliation(s)
- Nicholus Nanyeenya
- Department of Epidemiology and Biostatistics, School of Public Health, Makerere University College of Health Sciences, Kampala, Uganda
- Ministry of Health Central Public Health Laboratories, Kampala, Uganda
| | - Noah Kiwanuka
- Department of Epidemiology and Biostatistics, School of Public Health, Makerere University College of Health Sciences, Kampala, Uganda
| | - Damalie Nakanjako
- Department of Medicine, School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | | | - Simon P.S. Kibira
- Department of Community Health and Behavioral Sciences, School of Public Health, Makerere University College of Health Sciences, Kampala, Uganda
| | - Susan Nabadda
- Ministry of Health Central Public Health Laboratories, Kampala, Uganda
| | - Charles Kiyaga
- Ministry of Health Central Public Health Laboratories, Kampala, Uganda
| | - Isaac Sewanyana
- Ministry of Health Central Public Health Laboratories, Kampala, Uganda
| | - Esther Nasuuna
- Infectious Diseases Institute, Makerere University College of Health Sciences, Kampala, Uganda
| | - Fredrick Makumbi
- Department of Epidemiology and Biostatistics, School of Public Health, Makerere University College of Health Sciences, Kampala, Uganda
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McCune JM, Turner EH, Jiang A, Doehle BP. Bringing Gene Therapies for HIV Disease to Resource-Limited Parts of the World. Hum Gene Ther 2020; 32:21-30. [PMID: 32998595 PMCID: PMC10112459 DOI: 10.1089/hum.2020.252] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Affiliation(s)
- Joseph M McCune
- HIV Frontiers, Global Health Innovative Technology Solutions, Bill & Melinda Gates Foundation, Seattle, Washington, USA
| | - Emily H Turner
- HIV Frontiers, Global Health Innovative Technology Solutions, Bill & Melinda Gates Foundation, Seattle, Washington, USA
| | - Adam Jiang
- HIV Frontiers, Global Health Innovative Technology Solutions, Bill & Melinda Gates Foundation, Seattle, Washington, USA
| | - Brian P Doehle
- HIV Frontiers, Global Health Innovative Technology Solutions, Bill & Melinda Gates Foundation, Seattle, Washington, USA
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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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Feasibility of dried blood spots for HIV viral load monitoring in decentralized area in North Vietnam in a test-and-treat era, the MOVIDA project. PLoS One 2020; 15:e0230968. [PMID: 32271796 PMCID: PMC7145146 DOI: 10.1371/journal.pone.0230968] [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: 10/22/2019] [Accepted: 03/12/2020] [Indexed: 11/30/2022] Open
Abstract
Background Access to HIV viral load is crucial to efficiently monitor patients on antiretroviral treatment (ART) and prevent HIV drug resistance acquisition. However, in some remote settings, access to viral load monitoring is still complex due to logistical and financial constraints. Use of dried blood spots (DBS) for blood collection could overcome these difficulties. This study aims to describe feasibility and operability of DBS use for routine viral load monitoring. Methods From June 2017 to April 2018, HIV-infected adults who initiated ART were enrolled in a prospective cohort in 43 clinical sites across 6 provinces in North Vietnam. Following national guidelines, the first viral load monitoring was planned 6 months after ART initiation. DBS were collected at the clinical site and sent by post to a central laboratory in Hanoi for viral load measurement. Results Of the 578 patients enrolled, 537 were still followed 6 months after ART initiation, of which DBS was collected for 397 (73.9%). The median (inter quartile range) delay between DBS collection at site level and reception at the central laboratory was 8 (6–19) days and for 70.0% viral load was measured ≤30 days after blood collection. The proportion of patients with viral load ≥1000 copies/mL at the 6 month evaluation was 15.9% (n = 59). Of these, a DBS was collected again to confirm virological failure in 15 (24.4%) of which virological failure was confirmed in 11 (73.3%). Conclusion Delay of DBS transfer to the central laboratory was acceptable and most viral loads were measured in ≤30 days, in-line with routine follow-up. However, the level of DBS coverage and the proportion of patients in failure for whom a confirmatory viral load was available were suboptimal, indicating that integration of viral load monitoring in the field requires, among other things, careful training and strong involvement of the local teams. The proportion of patients experiencing virological failure was in line with other reports; interestingly those who reported being non-adherent and those with a low BMI were more at risk of failure.
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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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12
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Thepbundit V, Ngo-Giang-Huong N, Salvadori N, Laolue A, Kunyanone N, Sata-Un J, Jourdain G, Sirirungsi W, Khamduang W. Feasibility of using dried blood spots for HIV viral load testing among HIV-infected individuals in Thailand using QIAGEN QIAsymphony-artus HIV-1 platform. J Med Virol 2019; 91:1652-1659. [PMID: 31095748 DOI: 10.1002/jmv.25506] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2019] [Revised: 04/25/2019] [Accepted: 05/14/2019] [Indexed: 01/08/2023]
Abstract
In settings where plasma preparation and sample centralization are not feasible or inconvenient, dried blood spots (DBS) could be used as an alternative specimen to plasma to assess antiretroviral treatment response among HIV-infected individuals. This study was aimed to (1) validate the recent QIAsymphony-artus assay for DBS HIV viral load (VL) and (2) assess the feasibility of measuring HIV VL on DBS using this assay in Thailand. Ethylenediaminetetraacetic acid-blood samples from 99 HIV-infected individuals were used to prepare paired DBS and plasma. Also, DBS samples were shipped to three distant hospitals in the northern region. After short-term storage, DBS were returned by regular post to the AMS laboratory and were re-tested for HIV VL using the same platform. HIV VL results were compared using Pearson's correlation and Bland-Altman analysis. DBS HIV VL fairly correlated to plasma HIV VL (R = 0.62) with a mean difference of 0.02 log10 IU/mL (SD = 1.06). A high correlation (R = 0.79) was observed between HIV VL in DBS before and after shipping (mean difference = 0.14 log10 IU/mL, SD = 0.74), indicating good stability of HIV RNA in DBS. DBS can be used as an alternative specimen for HIV VL monitoring in Thailand. However, measurement of HIV VL with the QIAGEN QIAsymphony-artus assay should be improved, especially the DBS pre-extraction process.
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Affiliation(s)
- Viraporn Thepbundit
- Department of Medical Technology, Faculty of Associated Medical Sciences (AMS), Chiang Mai University, Chiangmai, Thailand
| | - Nicole Ngo-Giang-Huong
- Department of Medical Technology, Faculty of Associated Medical Sciences (AMS), Chiang Mai University, Chiangmai, Thailand.,Unité Internationale174-PHPT, Health and Societies Department, Institut de Recherche pour Développement (IRD), Chiangmai, Thailand.,Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Nicolas Salvadori
- Department of Medical Technology, Faculty of Associated Medical Sciences (AMS), Chiang Mai University, Chiangmai, Thailand.,Unité Internationale174-PHPT, Health and Societies Department, Institut de Recherche pour Développement (IRD), Chiangmai, Thailand
| | - Auswin Laolue
- Department of Medical Laboratory, Wiangsa Hospital, Nan, Thailand
| | - Naowarat Kunyanone
- Department of Medical Laboratory, Chiangrai Prachanukroh Hospital, Chiangrai, Thailand
| | - Jaggrit Sata-Un
- Department of Medical Laboratory, Thoeng Hospital, Chiangrai, Thailand
| | - Gonzague Jourdain
- Department of Medical Technology, Faculty of Associated Medical Sciences (AMS), Chiang Mai University, Chiangmai, Thailand.,Unité Internationale174-PHPT, Health and Societies Department, Institut de Recherche pour Développement (IRD), Chiangmai, Thailand.,Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Wasna Sirirungsi
- Department of Medical Technology, Faculty of Associated Medical Sciences (AMS), Chiang Mai University, Chiangmai, Thailand
| | - Woottichai Khamduang
- Department of Medical Technology, Faculty of Associated Medical Sciences (AMS), Chiang Mai University, Chiangmai, Thailand.,Infectious Diseases Research Unit, Department of Medical Technology, Faculty of Associated Medical Sciences, Chiang Mai University, Chiangmai, Thailand
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