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Chavez JV, Ewart LD, Ilyas O, Ghanooni D, Diaz JE, Atkins L, Ramos R, Garayua AH, Stewart A, Horvath KJ, Hirshfield S, Carrico AW. I was like sh*t this is gonna hurt': Implementing Self-Sampling of Dried Blood Spots to Measure HIV Viral Load. RESEARCH SQUARE 2024:rs.3.rs-4132978. [PMID: 38645181 PMCID: PMC11030538 DOI: 10.21203/rs.3.rs-4132978/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/23/2024]
Abstract
Background Sexual minority men (SMM) with HIV who use stimulants may experience greater difficulties with antiretroviral therapy adherence which amplifies risk for unsuppressed HIV viral load (VL). Remote monitoring of VL could support efforts to rapidly respond to sub-optimal adherence. Methods This qualitative study enrolled 24 SMM with HIV who use stimulants to examine experiences with two different dried blood spots (DBS) self-sampling devices (i.e., Tasso-M20 vs. HemaSpot HD) to measure VL. Participants were asked to complete self-sampling of DBS using both devices, and then participated in a 45-minute semi-structured interview. Interviews focused on ease of use, device preference, experiences with receiving and mailing kits, and barriers to participating in research. A thematic analysis was conducted to analyze interviews transcripts. Results Twenty-two participants (92%) returned the Tasso-M20 and 21 (88%) returned the Hemaspot HD devices. Among the 22 participants that completed qualitative interviews, twenty-three codes were identified and collapsed within seven themes. Preferences for devices were based on convenience, pain and prior experiences with finger-pricking technology. Participants emphasized that clearer instructions with contingency plans for self-sampling of DBS would improve the user experience with self-sampling of DBS. Intersectional stigma (e.g., HIV, sexual minority status, and substance use) was noted as an important consideration in implementing self-sampling of DBS. Promoting decision making, or the option to choose sampling method based on personal preferences, may improve engagement and likelihood of DBS completion. Conclusions Findings will guide the broader implementation of self-sampling of DBS to optimize VL monitoring in SMM with HIV who use stimulants.
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Simushi P, Kalunga MN, Mwakyoma T, Mwewa M, Muchaili L, Hazeemba N, Mulenga C, Mwewa P, Chiyenu KOR, Kachimba J, Choonga P, Shibemba A, Hamooya BM, Zambwe M, Chipimo PJ, Kasonka L. Verification of dried blood spot as a sample type for HIV viral load and early infant diagnosis on Hologic Panther in Zambia. BMC Res Notes 2023; 16:75. [PMID: 37165436 PMCID: PMC10172060 DOI: 10.1186/s13104-023-06344-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2022] [Accepted: 04/28/2023] [Indexed: 05/12/2023] Open
Abstract
OBJECTIVE Zambia has embarked on improving the diagnostic capacity by setting up high throughput and accurate machines in the testing process and introduction of dried blood spot (DBS) as a sample type. This was a cross sectional study to verify dried blood spot as a sample type for HIV viral load and early infant diagnosis (EID) on Hologic Panther platform and Evaluate the analytical performance (precision, linearity and measurement of uncertainty) of the Hologic Panther. RESULTS The specificity and sensitivity of EID performance of Aptima Quant Dx assay on Hologic panther machine against the gold standard machine COBAS Taqman (CAP/CTM) was 100% with an overall agreement of 100%. The quantitative HIV Viral Load (VL) accuracy had a positive correlation of (0.96) obtained against the gold standard (plasma samples) run on COBAS4800 platform. Analytical performance of the Hologic panther machine was evaluated; Precision low positive repeatability 3.50154 and within lab 2.268915 at mean 2.88 concentration and precision high positive repeatability 1.116955 and within lab 2.010677 at mean 5.09 concentration were obtained confirming manufacturers claims. Uncertainty of measurement for this study was found to be ± 71 copies/ml. Linearity studies were determined and all points were within acceptable limits. We therefore recommend DBS as a sample type alternative to plasma for the estimation of HIV-1 viral load and EID diagnosis on the Hologic panther machine.
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Affiliation(s)
- Precious Simushi
- Livingstone University Teaching Hospital Laboratory, Livingstone, Zambia
| | | | - Tuku Mwakyoma
- Livingstone University Teaching Hospital Laboratory, Livingstone, Zambia
| | - Mulenga Mwewa
- Livingstone University Teaching Hospital Laboratory, Livingstone, Zambia
| | - Lweendo Muchaili
- Livingstone University Teaching Hospital Laboratory, Livingstone, Zambia
| | - Nchimunya Hazeemba
- Livingstone University Teaching Hospital Laboratory, Livingstone, Zambia
| | - Chileshe Mulenga
- Livingstone University Teaching Hospital Laboratory, Livingstone, Zambia
| | - Patience Mwewa
- Livingstone University Teaching Hospital Laboratory, Livingstone, Zambia
| | | | - John Kachimba
- Livingstone University Teaching Hospital Laboratory, Livingstone, Zambia
| | | | | | | | - Mowa Zambwe
- Benefits Department, Workers Compensation Fund Control Board, Lusaka, Zambia
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DeVos J, McCarthy K, Sewe V, Akinyi G, Junghae M, Opollo V, Nouhin J, Shafer R, Zeh C, Ramos A, Alexander H, Chang J. A Partially Multiplexed HIV Drug Resistance (HIVDR) Assay for Monitoring HIVDR Mutations of the Protease, Reverse-Transcriptase (PRRT), and Integrase (INT). Microbiol Spectr 2022; 10:e0177621. [PMID: 35510849 PMCID: PMC9241735 DOI: 10.1128/spectrum.01776-21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Accepted: 01/28/2022] [Indexed: 12/05/2022] Open
Abstract
As dolutegravir (DTG)-containing HIV regimens are scaled up globally, monitoring for HIV drug resistance (HIVDR) will become increasingly important. We designed a partially multiplexed HIVDR assay using Sanger sequencing technology to monitor HIVDR mutations in the protease, reverse-transcriptase (PRRT), and integrase (INT). A total of 213 clinical and analytical plasma and dried blood spot (DBS) samples were used in the evaluation. The assay detected a wide range of known HIV-1 subtypes and circulating recombinant forms (CRFs) of group M from 139 samples. INT accuracy showed that the average nucleotide (nt) sequence concordance was 99.8% for 75 plasma samples and 99.5% for 11 DBS samples compared with the reference sequences. The PRRT accuracy also demonstrated the average nucleotide sequence concordance was 99.5% for 57 plasma samples and 99.2% for 33 DBS samples. The major PRRT and INT DR mutations of all samples tested were concordant with those of the reference sequences using the Stanford HIV database (db). Amplification sensitivity of samples with viral load (VL) >5000 copies/mL showed plasma exceeded 95% of positivity, and DBS exceeded 90% for PRRT and INT. Samples with VL (1000 to 5000 copies/mL) showed plasma exceeded 90%, and DBS reached 88% positivity for PRRT and INT. Assay precision and reproducibility showed >99% nucleotide sequence concordance in each set of replicates for PRRT and INT. In conclusion, this HIVDR assay met WHO HIVDR assay performance criteria for surveillance, worked for plasma and DBS, used minimal sample volume, was sensitive, and was a potentially cost-effective tool to monitor HIVDR mutations in PRRT and INT. IMPORTANCE This HIVDR genotyping assay works for both plasma and DBS samples, requires low sample input, and is sensitive. This assay has the potential to be a user-friendly and cost-effective HIVDR assay because of its partially multiplexed design. Application of this genotyping assay will help HIVDR monitoring in HIV high-burdened countries using a DGT-based HIV drug regimen recommended by the U.S. President's Emergency Plan for AIDS Relief and the WHO.
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Affiliation(s)
- Joshua DeVos
- International Laboratory Branch, Division of Global HIV and Tuberculosis (TB), Center for Global Health, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, USA
| | | | - Victor Sewe
- HIV Research Laboratory, Kenya Medical Research Institute-Center for Global Health Research, Kisumu, Kenya
| | - Grace Akinyi
- HIV Research Laboratory, Kenya Medical Research Institute-Center for Global Health Research, Kisumu, Kenya
| | | | - Valarie Opollo
- HIV Research Laboratory, Kenya Medical Research Institute-Center for Global Health Research, Kisumu, Kenya
| | | | | | - Clement Zeh
- International Laboratory Branch, Division of Global HIV and Tuberculosis (TB), Center for Global Health, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, USA
| | - Artur Ramos
- International Laboratory Branch, Division of Global HIV and Tuberculosis (TB), Center for Global Health, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, USA
| | - Heather Alexander
- International Laboratory Branch, Division of Global HIV and Tuberculosis (TB), Center for Global Health, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, USA
| | - Joy Chang
- International Laboratory Branch, Division of Global HIV and Tuberculosis (TB), Center for Global Health, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, USA
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Omooja J, Bbosa N, Lule DB, Nannyonjo M, Lunkuse S, Nassolo F, Nabirye SE, Suubi HN, Kaleebu P, Ssemwanga D. HIV-1 drug resistance genotyping success rates and correlates of Dried-blood spots and plasma specimen genotyping failure in a resource-limited setting. BMC Infect Dis 2022; 22:474. [PMID: 35581555 PMCID: PMC9112432 DOI: 10.1186/s12879-022-07453-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 05/03/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND HIV-1 drug resistance genotyping is critical to the monitoring of antiretroviral treatment. Data on HIV-1 genotyping success rates of different laboratory specimen types from multiple sources is still scarce. METHODS In this cross-sectional study, we determined the laboratory genotyping success rates (GSR) and assessed the correlates of genotyping failure of 6837 unpaired dried blood spot (DBS) and plasma specimens. Specimens from multiple studies in a resource-constrained setting were analysed in our laboratory between 2016 and 2019. RESULTS We noted an overall GSR of 65.7% and specific overall GSR for DBS and plasma of 49.8% and 85.9% respectively. The correlates of genotyping failure were viral load (VL) < 10,000 copies/mL (aOR 0.3 95% CI: 0.24-0.38; p < 0.0001), lack of viral load testing prior to genotyping (OR 0.85 95% CI: 0.77-0.94; p = 0.002), use of DBS specimens (aOR 0.10 95% CI: 0.08-0.14; p < 0.0001) and specimens from routine clinical diagnosis (aOR 1.4 95% CI: 1.10-1.75; p = 0.005). CONCLUSIONS We report rapidly decreasing HIV-1 genotyping success rates between 2016 and 2019 with increased use of DBS specimens for genotyping and note decreasing median viral loads over the years. We recommend improvement in DBS handling, pre-genotyping viral load testing to screen samples to enhance genotyping success and the development of more sensitive assays with well-designed primers to genotype specimens with low or undetectable viral load, especially in this era where virological suppression rates are rising due to increased antiretroviral therapy roll-out.
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Affiliation(s)
- Jonah Omooja
- Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine, Uganda Research Unit, Entebbe, Uganda.
| | - Nicholas Bbosa
- Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine, Uganda Research Unit, Entebbe, Uganda
| | - Dan Bugembe Lule
- Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine, Uganda Research Unit, Entebbe, Uganda
| | - Maria Nannyonjo
- Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine, Uganda Research Unit, Entebbe, Uganda
| | - Sandra Lunkuse
- Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine, Uganda Research Unit, Entebbe, Uganda
| | - Faridah Nassolo
- Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine, Uganda Research Unit, Entebbe, Uganda
| | - Stella Esther Nabirye
- Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine, Uganda Research Unit, Entebbe, Uganda
| | - Hamidah Namagembe Suubi
- Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine, Uganda Research Unit, Entebbe, Uganda
| | - Pontiano Kaleebu
- Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine, Uganda Research Unit, Entebbe, Uganda
- Uganda Virus Research Institute, Entebbe, Uganda
- London School of Hygiene and Tropical Medicine, London, UK
| | - Deogratius Ssemwanga
- Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine, Uganda Research Unit, Entebbe, Uganda.
- Uganda Virus Research Institute, Entebbe, Uganda.
- London School of Hygiene and Tropical Medicine, London, UK.
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Real-Life Feasibility of HIV Drug Resistance Testing Using Dried Filter Analytes in Kenyan Children and Adolescents Living with HIV. Microbiol Spectr 2022; 10:e0267521. [PMID: 35389242 PMCID: PMC9045389 DOI: 10.1128/spectrum.02675-21] [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] [Indexed: 11/20/2022] Open
Abstract
HIV-1 drug resistance remains a global challenge, yet access to testing is limited, particularly in resource-limited settings. We examined feasibility and limitations of genotyping using dried filter analytes in treatment-experienced Kenyan youth with HIV. Youth infected with HIV perinatally were enrolled in 2016-2018 at the Academic Model Providing Access to Healthcare in Eldoret, western Kenya. Samples were shipped in real-time at ambient temperature to the US, and those with viral load (VL)>1,000 copies/mL were tested based on convenience. Dried blood spots genotyping was attempted when unsuccessful from Hemaspots. Multiple logistic regression was used to examine predictors of genotyping success. Samples from 49 participants (median age 15 years, 43% female, median CD4 496 cells/μL [18%], median 8 years on therapy, median VL 11,827 copies/mL) were shipped after median 7 days from collection, arrived in 20 shipments after median 5 days, and extracted after median 2 days (1 day for samples processed on arrival; and 42 days for frozen Hemaspots). Overall, 29/49 (59%) samples with VL > 1,000 copies/mL and 25/32 (78%) with VL > 5,000 copies/mL were genotyped by either Hemaspots or DBS. Successful genotyping was associated with higher Hemaspot volume and higher VL. Real-life HIV-1 drug resistance testing from dried filter analytes is feasible, even in settings with constrained resources. Findings, particularly relevant where resistance testing is limited for clinical care, raise awareness to implementation practicability of this guidelines-recommended test in care of more individuals and populations. Further optimization of filter analytes is needed to overcome related challenges. IMPORTANCE In this manuscript we use dried filter analytes shipped from Kenya to the US in real time, to demonstrate the real-life feasibility of conducting HIV drug resistance testing in a vulnerable population of young children and adolescents with HIV in a resource limited setting. Such testing, which is recommended in resource-rich settings, is unavailable in most resource limited settings for individual clinical care. We show that real-life HIV drug resistance testing from dried filter analytes is feasible, even in settings with constrained resources. These findings raise awareness to the importance of HIV drug resistance for individual care, even in such settings, and emphasize the implementation practicability of this guidelines-recommended test.
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Khan M, Rosadas C, Katsanovskaja K, Weber ID, Shute J, Ijaz S, Marchesin F, McClure E, Elias S, Flower B, Gao H, Quinlan R, Short C, Rosa A, Roustan C, Moshe M, Taylor GP, Elliott P, Cooke GS, Cherepanov P, Parker E, McClure MO, Tedder RS. Simple, sensitive, specific self-sampling assay secures SARS-CoV-2 antibody signals in sero-prevalence and post-vaccine studies. Sci Rep 2022; 12:1885. [PMID: 35115570 PMCID: PMC8814240 DOI: 10.1038/s41598-022-05640-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Accepted: 01/10/2022] [Indexed: 12/20/2022] Open
Abstract
At-home sampling is key to large scale seroprevalence studies. Dried blood spot (DBS) self-sampling removes the need for medical personnel for specimen collection but facilitates specimen referral to an appropriately accredited laboratory for accurate sample analysis. To establish a highly sensitive and specific antibody assay that would facilitate self-sampling for prevalence and vaccine-response studies. Paired sera and DBS eluates collected from 439 sero-positive, 382 sero-negative individuals and DBS from 34 vaccine recipients were assayed by capture ELISAs for IgG and IgM antibody to SARS-CoV-2. IgG and IgM combined on DBS eluates achieved a diagnostic sensitivity of 97.9% (95%CI 96.6 to 99.3) and a specificity of 99.2% (95% CI 98.4 to 100) compared to serum, displaying limits of detection equivalent to 23 and 10 WHO IU/ml, respectively. A strong correlation (r = 0.81) was observed between serum and DBS reactivities. Reactivity remained stable with samples deliberately rendered inadequate, (p = 0.234) and when samples were accidentally damaged or 'invalid'. All vaccine recipients were sero-positive. This assay provides a secure method for self-sampling by DBS with a sensitivity comparable to serum. The feasibility of DBS testing in sero-prevalence studies and in monitoring post-vaccine responses was confirmed, offering a robust and reliable tool for serological monitoring at a population level.
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Affiliation(s)
- Maryam Khan
- Department of Infectious Disease, Faculty of Medicine, Imperial College London, St Mary's Campus, Praed Street, London, W2 1NY, UK
| | - Carolina Rosadas
- Department of Infectious Disease, Faculty of Medicine, Imperial College London, St Mary's Campus, Praed Street, London, W2 1NY, UK
| | - Ksenia Katsanovskaja
- Department of Infectious Disease, Faculty of Medicine, Imperial College London, St Mary's Campus, Praed Street, London, W2 1NY, UK
| | - Isaac D Weber
- Department of Infectious Disease, Faculty of Medicine, Imperial College London, St Mary's Campus, Praed Street, London, W2 1NY, UK
| | - Justin Shute
- Public Health England, 61 Colindale Ave, London, NW9 5EQ, UK
| | - Samreen Ijaz
- Public Health England, 61 Colindale Ave, London, NW9 5EQ, UK
| | - Federica Marchesin
- Department of Infectious Disease, Faculty of Medicine, Imperial College London, St Mary's Campus, Praed Street, London, W2 1NY, UK
| | - Eleanor McClure
- Department of Infectious Disease, Faculty of Medicine, Imperial College London, St Mary's Campus, Praed Street, London, W2 1NY, UK
| | - Salem Elias
- Department of Infectious Disease, Faculty of Medicine, Imperial College London, St Mary's Campus, Praed Street, London, W2 1NY, UK
| | - Barnaby Flower
- Department of Infectious Disease, Faculty of Medicine, Imperial College London, St Mary's Campus, Praed Street, London, W2 1NY, UK
| | - He Gao
- Department of Infectious Disease, Faculty of Medicine, Imperial College London, St Mary's Campus, Praed Street, London, W2 1NY, UK
| | - Rachael Quinlan
- Department of Infectious Disease, Faculty of Medicine, Imperial College London, St Mary's Campus, Praed Street, London, W2 1NY, UK
| | - Charlotte Short
- Department of Infectious Disease, Faculty of Medicine, Imperial College London, St Mary's Campus, Praed Street, London, W2 1NY, UK
| | - Annachiara Rosa
- Francis Crick Institute, 1 Midland Rd, Somers Town, London, NW1 1AT, UK
| | - Chloe Roustan
- Francis Crick Institute, 1 Midland Rd, Somers Town, London, NW1 1AT, UK
| | - Maya Moshe
- Department of Infectious Disease, Faculty of Medicine, Imperial College London, St Mary's Campus, Praed Street, London, W2 1NY, UK
| | - Graham P Taylor
- Department of Infectious Disease, Faculty of Medicine, Imperial College London, St Mary's Campus, Praed Street, London, W2 1NY, UK
- Imperial College Healthcare NHS Trust, St Mary's Hospital, Praed St, Paddington, London, W2 1NY, UK
| | - Paul Elliott
- Imperial College Healthcare NHS Trust, St Mary's Hospital, Praed St, Paddington, London, W2 1NY, UK
- Department of Epidemiology and Biostatistics, School of Public Health, MRC Centre for Environment and Health, Imperial College London, London, UK
- NIHR Imperial Biomedical Research Centre, Imperial College London, Exhibition Rd, London, SW7 2AZ, UK
| | - Graham S Cooke
- Department of Infectious Disease, Faculty of Medicine, Imperial College London, St Mary's Campus, Praed Street, London, W2 1NY, UK
- Imperial College Healthcare NHS Trust, St Mary's Hospital, Praed St, Paddington, London, W2 1NY, UK
| | - Peter Cherepanov
- Francis Crick Institute, 1 Midland Rd, Somers Town, London, NW1 1AT, UK
| | - Eleanor Parker
- Department of Infectious Disease, Faculty of Medicine, Imperial College London, St Mary's Campus, Praed Street, London, W2 1NY, UK
| | - Myra O McClure
- Department of Infectious Disease, Faculty of Medicine, Imperial College London, St Mary's Campus, Praed Street, London, W2 1NY, UK
| | - Richard S Tedder
- Department of Infectious Disease, Faculty of Medicine, Imperial College London, St Mary's Campus, Praed Street, London, W2 1NY, UK.
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Resource and infrastructure challenges on the RESIST-2 Trial: an implementation study of drug resistance genotype-based algorithmic ART switches in HIV-2-infected adults in Senegal. Trials 2021; 22:931. [PMID: 34922614 PMCID: PMC8683814 DOI: 10.1186/s13063-021-05902-5] [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: 02/01/2021] [Accepted: 12/01/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Second-line treatment of HIV-2 in resource-limited settings (RLS) is complicated by a lack of controlled trial data, limited availability of HIV-2-active antiretroviral drugs, and inadequate access to drug resistance testing. We conducted an implementation trial of a dried blood spot- (DBS) based, drug resistance genotype-informed antiretroviral therapy (ART) switching algorithm for HIV-2-infected patients in Senegal. METHODS HIV-2-infected adults initiating or receiving ART through the Senegalese national AIDS program were invited to participate in this single-arm trial. DBS from participants with virologic failure (defined as viral load (VL) > 250 copies/mL after > 6 months on the current ART regimen) were shipped to Seattle for genotypic drug resistance testing. Participants with evidence of drug resistance in protease or reverse transcriptase were switched to new regimens according to a pre-specified algorithm. Participant clinical and immuno-virologic outcomes were assessed, as were implementation challenges. RESULTS We enrolled 152 participants. Ten were initiating ART. The remainder were ART-experienced, with 91.0% virologically suppressed (< 50 copies/mL). Problems with viral load testing capability resulted in obtaining VL results for only 227 of 613 (37.0%) participant-visits. Six of 115 participants (5.2%) with VL available after > 6 months on current ART regimen experienced virologic failure, with per-protocol genotypic testing attempted. One additional test was performed for a participant with a VL of 222 copies/mL. Genotypes from three participants showed no evidence of major drug resistance mutations, two showed nucleoside reverse transcriptase inhibitor (NRTI) resistance, one showed both NRTI and protease inhibitor resistance, and one test failed. No integrase inhibitor resistance was observed. Five of six successfully-tested participants switched to the correct regimen or received additional adherence counseling according to the algorithm; the sixth was lost to follow-up. Follow-up VL testing was available for two participants; both of these were virally suppressed (< 10 copies/mL). The trial was terminated early due to the COVID-19 pandemic (which prevented further VL and genotypic testing), planned rollout of dolutegravir-based 1st-line ART, and funding. CONCLUSIONS The RESIST-2 trial demonstrated that a DBS-based genotypic test can be used to help inform second-line ART decisions as part of a programmatic algorithm in RLS, albeit with significant implementation challenges. TRIAL REGISTRATION ClinicalTrials.gov NCT03394196 . Registered on January 9, 2018.
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Shrivastava R, Poxon R, Rottinghaus E, Essop L, Sanon V, Chipeta Z, van-Schalkwyk E, Sekwadi P, Murangandi P, Nguyen S, Devos J, Nesby-Odell S, Stevens T, Umaru F, Cox A, Kim A, Yang C, Parsons LM, Malope-Kgokong B, Nkengasong JN. Leveraging gains from African Center for Integrated Laboratory Training to combat HIV epidemic in sub-Saharan Africa. BMC Health Serv Res 2021; 21:22. [PMID: 33407442 PMCID: PMC7787229 DOI: 10.1186/s12913-020-06005-8] [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: 07/14/2020] [Accepted: 12/08/2020] [Indexed: 11/24/2022] Open
Abstract
Background In sub-Saharan Africa, there is dearth of trained laboratorians and strengthened laboratory systems to provide adequate and quality laboratory services for enhanced HIV control. In response to this challenge, in 2007, the African Centre for Integrated Laboratory Training (ACILT) was established in South Africa with a mission to train staffs from countries with high burdens of diseases in skills needed to strengthen sustainable laboratory systems. This study was undertaken to assess the transference of newly gained knowledge and skills to other laboratory staff, and to identify enabling and obstructive factors to their implementation. Methods We used Kirkpatrick model to determine training effectiveness by assessing the transference of newly gained knowledge and skills to participant’s work environment, along with measuring enabling and obstructive factors. In addition to regular course evaluations at ACILT (pre and post training), in 2015 we sent e-questionnaires to 867 participants in 43 countries for course participation between 2008 and 2014. Diagnostics courses included Viral Load, and systems strengthening included strategic planning and Biosafety and Biosecurity. SAS v9.44 and Excel were used to analyze retrospective de-identified data collected at six months pre and post-training. Results Of the 867 participants, 203 (23.4%) responded and reported average improvements in accuracy and timeliness in Viral Load programs and to systems strengthening. For Viral Load testing, frequency of corrective action for unsatisfactory proficiency scores improved from 57 to 91%, testing error rates reduced from 12.9% to 4.9%; 88% responders contributed to the first national strategic plan development and 91% developed strategies to mitigate biosafety risks in their institutions. Key enabling factors were team and management support, and key obstructive factors included insufficient resources and staff’s resistance to change. Conclusions Training at ACILT had a documented positive impact on strengthening the laboratory capacity and laboratory workforce and substantial cost savings. ACILT’s investment produced a multiplier effect whereby national laboratory systems, personnel and leadership reaped training benefits. This laboratory training centre with a global clientele contributed to improve existing laboratory services, systems and networks for the HIV epidemic and is now being leveraged for COVID-19 testing that has infected 41,332,899 people globally. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-020-06005-8.
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Affiliation(s)
- Ritu Shrivastava
- International Laboratory Branch (ILB), Division of Global HIV and TB (DGHT), Centres for Disease Control and Prevention (CDC), 1600 Clifton Road NE, Atlanta, GA, 30333, USA.
| | - Richard Poxon
- African Center for Integrated Laboratory Training at National Health Laboratory Service, Johannesburg, South Africa
| | - Erin Rottinghaus
- International Laboratory Branch (ILB), Division of Global HIV and TB (DGHT), Centres for Disease Control and Prevention (CDC), 1600 Clifton Road NE, Atlanta, GA, 30333, USA
| | - Leyya Essop
- African Center for Integrated Laboratory Training at National Health Laboratory Service, Johannesburg, South Africa
| | - Victoria Sanon
- Georgia State University, intern at ILB, DGHT, CDC, Atlanta, USA
| | | | - Elsie van-Schalkwyk
- African Center for Integrated Laboratory Training at National Health Laboratory Service, Johannesburg, South Africa
| | - Phuti Sekwadi
- African Center for Integrated Laboratory Training at National Health Laboratory Service, Johannesburg, South Africa
| | - Pelagia Murangandi
- African Center for Integrated Laboratory Training at National Health Laboratory Service, Johannesburg, South Africa
| | - Shon Nguyen
- International Laboratory Branch (ILB), Division of Global HIV and TB (DGHT), Centres for Disease Control and Prevention (CDC), 1600 Clifton Road NE, Atlanta, GA, 30333, USA
| | - Josh Devos
- International Laboratory Branch (ILB), Division of Global HIV and TB (DGHT), Centres for Disease Control and Prevention (CDC), 1600 Clifton Road NE, Atlanta, GA, 30333, USA
| | - Shanna Nesby-Odell
- International Laboratory Branch (ILB), Division of Global HIV and TB (DGHT), Centres for Disease Control and Prevention (CDC), 1600 Clifton Road NE, Atlanta, GA, 30333, USA
| | - Thomas Stevens
- International Laboratory Branch (ILB), Division of Global HIV and TB (DGHT), Centres for Disease Control and Prevention (CDC), 1600 Clifton Road NE, Atlanta, GA, 30333, USA
| | - Farouk Umaru
- Supply Chain Management System, United States Agency for Internationl Development, Atlanta, USA
| | | | | | - Chunfu Yang
- International Laboratory Branch (ILB), Division of Global HIV and TB (DGHT), Centres for Disease Control and Prevention (CDC), 1600 Clifton Road NE, Atlanta, GA, 30333, USA
| | - Linda M Parsons
- International Laboratory Branch (ILB), Division of Global HIV and TB (DGHT), Centres for Disease Control and Prevention (CDC), 1600 Clifton Road NE, Atlanta, GA, 30333, USA
| | - Babatyi Malope-Kgokong
- African Center for Integrated Laboratory Training at National Health Laboratory Service, Johannesburg, South Africa
| | - John N Nkengasong
- International Laboratory Branch (ILB), Division of Global HIV and TB (DGHT), Centres for Disease Control and Prevention (CDC), 1600 Clifton Road NE, Atlanta, GA, 30333, USA
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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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Lippman SA, Mooney AC, Puren A, Hunt G, Grignon JS, Prach LM, Gilmore HJ, Truong HHM, Barnhart S, Liegler T. The role of drug resistance in poor viral suppression in rural South Africa: findings from a population-based study. BMC Infect Dis 2020; 20:248. [PMID: 32216752 PMCID: PMC7099808 DOI: 10.1186/s12879-020-4933-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Accepted: 02/28/2020] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Understanding factors driving virological failure, including the contribution of HIV drug resistance mutations (DRM), is critical to ensuring HIV treatment remains effective. We examine the contribution of drug resistance mutations for low viral suppression in HIV-positive participants in a population-based sero-prevalence survey in rural South Africa. METHODS We conducted HIV drug resistance genotyping and ART analyte testing on dried blood spots (DBS) from HIV-positive adults participating in a 2014 survey in North West Province. Among those with virologic failure (> 5000 copies/mL), we describe frequency of DRM to protease inhibitors (PI), nucleoside reverse transcriptase inhibitors (NRTI), and non-nucleoside reverse transcriptase inhibitors (NNRTI), report association of resistance with antiretroviral therapy (ART) status, and assess resistance to first and second line therapy. Analyses are weighted to account for sampling design. RESULTS Overall 170 DBS samples were assayed for viral load and ART analytes; 78.4% of men and 50.0% of women had evidence of virologic failure and were assessed for drug resistance, with successful sequencing of 76/107 samples. We found ≥1 DRM in 22% of participants; 47% were from samples with detectable analyte (efavirenz, nevirapine or lopinavir). Of those with DRM and detectable analyte, 60% showed high-level resistance and reduced predicted virologic response to ≥1 NRTI/NNRTI typically used in first and second-line regimens. CONCLUSIONS DRM and predicted reduced susceptibility to first and second-line regimens were common among adults with ART exposure in a rural South African population-based sample. Results underscore the importance of ongoing virologic monitoring, regimen optimization and adherence counseling to optimize durable virologic suppression.
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Affiliation(s)
- Sheri A Lippman
- Division of Prevention Science, Department of Medicine, University of California San Francisco, 550 16th Street, 3rd Floor, San Francisco, CA, 94158-2549, USA.
| | - Alyssa C Mooney
- Department of Epidemiology, University of California San Francisco, San Francisco, USA
| | - Adrian Puren
- National Institute for Communicable Diseases/NHLS, Johannesburg, South Africa
- Division of Virology, School of Pathology, University of the Witwatersrand, Johannesburg, South Africa
| | - Gillian Hunt
- National Institute for Communicable Diseases/NHLS, Johannesburg, South Africa
- Division of Virology, School of Pathology, University of the Witwatersrand, Johannesburg, South Africa
| | - Jessica S Grignon
- Department of Global Health, University of Washington, Seattle, USA
- International Training and Education Center for Health (I-TECH) South Africa, Pretoria, Republic of South Africa
| | - Lisa M Prach
- Division of Prevention Science, Department of Medicine, University of California San Francisco, 550 16th Street, 3rd Floor, San Francisco, CA, 94158-2549, USA
| | - Hailey J Gilmore
- Division of Prevention Science, Department of Medicine, University of California San Francisco, 550 16th Street, 3rd Floor, San Francisco, CA, 94158-2549, USA
| | - Hong-Ha M Truong
- Division of Prevention Science, Department of Medicine, University of California San Francisco, 550 16th Street, 3rd Floor, San Francisco, CA, 94158-2549, USA
| | - Scott Barnhart
- Department of Global Health, University of Washington, Seattle, USA
- International Training and Education Center for Health (I-TECH) South Africa, Pretoria, Republic of South Africa
| | - Teri Liegler
- Department of Medicine, University of California San Francisco, San Francisco, USA
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Facente SN, Busch MP, Grebe E, Pilcher CD, Welte A, Rice B, Murphy G. Challenges to the performance of current HIV diagnostic assays and the need for centralized specimen archives: a review of the Consortium for the Evaluation and Performance of HIV Incidence Assays (CEPHIA) repository. Gates Open Res 2019; 3:1511. [PMID: 31460496 PMCID: PMC6706958 DOI: 10.12688/gatesopenres.13048.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/17/2019] [Indexed: 11/20/2022] Open
Abstract
Background: New challenges for diagnosis of HIV infection abound, including the impact on key viral and immunological markers of HIV vaccine studies, pre-exposure prophylaxis usage and breakthrough infections, and very early initiation of anti-retroviral treatment. These challenges impact the performance of current diagnostic assays, and require suitable specimens for development and evaluation. In this article we review and describe an archive developed by the Consortium for the Evaluation and Performance of HIV Incidence Assays (CEPHIA), in order to identify the critical features required to create a centralized specimen archive to support these current and future developments. Review and Findings: We review and describe the CEPHIA repository, a large, consolidated repository comprised of over 31,000 highly-selected plasma samples and other body fluid specimen types, with over 50 purposely designed specimen panels distributed to 19 groups since 2012. The CEPHIA repository provided financial return on investment, supported the standardization of HIV incidence assays, and informed guidance and standards set by the World Health Organization and UNAIDS. Unified data from extensively characterized specimens has allowed this resource to support biomarker discovery, assay optimization, and development of new strategies for estimating duration of HIV infection. Critical features of a high-value repository include 1) extensively-characterized samples, 2) high-quality clinical background data, 3) multiple collaborations facilitating ongoing sample replenishment, and 4) sustained history of high-level specimen utilization. Conclusion: With strong governance and leadership, a large consolidated archive of samples from multiple studies provides investigators and assay developers with easy access to diverse samples designed to address challenges associated with HIV diagnosis, helping to enable improvements to HIV diagnostic assays and ultimately elimination of HIV. Its creation and ongoing utilization should compel funders, institutions and researchers to address and improve upon current approaches to sharing specimens.
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Affiliation(s)
- Shelley N. Facente
- University of California, San Francisco, San Francisco, CA, 94110, USA
- Vitalant Research Institute (formerly Blood Systems Research Institute), San Francisco, CA, 94118, USA
- Facente Consulting, Richmond, CA, 94804, USA
| | - Michael P. Busch
- University of California, San Francisco, San Francisco, CA, 94110, USA
- Vitalant Research Institute (formerly Blood Systems Research Institute), San Francisco, CA, 94118, USA
| | - Eduard Grebe
- University of California, San Francisco, San Francisco, CA, 94110, USA
- Vitalant Research Institute (formerly Blood Systems Research Institute), San Francisco, CA, 94118, USA
- The South African DST-NRF Centre of Excellence in Epidemiological Modelling and Analysis (SACEMA), Stellenbosch University, Stellenbosch, South Africa
| | | | - Alex Welte
- The South African DST-NRF Centre of Excellence in Epidemiological Modelling and Analysis (SACEMA), Stellenbosch University, Stellenbosch, South Africa
| | - Brian Rice
- London School of Hygiene and Tropical Medicine, London, UK
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Louis FJ, Segaren N, Desinor O, Beard RS, Jean-Louis R, Chang J, Boisson S, Hulland EN, Wagar N, DeVos J, François K, Buteau J, Boncy J, Marston BJ, Domerçant JW, Yang C, Charles M. High Levels of HIV-1 Drug Resistance in Children Who Acquired HIV Infection Through Mother to Child Transmission in the Era of Option B+, Haiti, 2013 to 2014. Pediatr Infect Dis J 2019; 38:503-507. [PMID: 30640198 PMCID: PMC6785839 DOI: 10.1097/inf.0000000000002270] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The main objective of this study was to determine the frequency and patterns of HIV drug resistance-associated mutations among children under 18 months of age born to HIV-1-positive mothers enrolled in the prevention of mother-to-child transmission services in Haiti. METHODS Between January 1, 2013 and December 31, 2014, HIV-positive remnant dried blood spots collected from children under 18 months of age for Early Infant Diagnosis at the National Public Health Laboratory were used for HIV-1 genotyping. HIV drug resistance mutations were analyzed using the Stanford Drug Resistance HIVdb program. RESULTS Of the 3555 dried blood spots collected for Early Infant Diagnosis, 360 (10.1%) were HIV-positive and 355 were available for genotyping. Of these, 304 (85.6%) were successfully genotyped and 217 (71.4%) had ≥1 drug resistance mutation. Mutations conferring resistance to nucleoside reverse transcriptase inhibitor (NRTIs) and non-NRTIs were present in 40.5% (123) and 69.1% (210), respectively. The most frequent mutations were K103N/S (48.0%), M184V (37.5%), G190A/S (15.1%), and Y181C/G/V (14.1%). Predicted drug resistance analysis revealed that 68.8% of the children had high-level resistance to non-NRTIs and 11.5% had intermediate to high-level resistance to abacavir. CONCLUSIONS This study showed high rates of resistance to NRTIs and non-NRTIs among newly HIV-diagnosed children in Haiti, suggesting that in the era of "Option B+" (initiation of lifelong combination antiretroviral therapy to pregnant women with HIV), the majority of children who acquire HIV infection through mother-to-child transmission of HIV have resistant HIV. These results have led the National HIV Program to revise the pediatric guidelines to include protease inhibitors in first-line regimens for all HIV-positive newborns.
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Affiliation(s)
| | | | - Olbeg Desinor
- United States Agency for International Development, Port-au-Prince, Haiti
| | | | | | - Joy Chang
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | - Erin N. Hulland
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Nick Wagar
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Joshua DeVos
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Kesner François
- Programme National de Lutte contre le VIH/SIDA, Ministère de la Santé Publique et de la Population, Port-au-Prince, Haiti
| | - Josiane Buteau
- Laboratoire National de Santé Publique, Ministère de la Santé Publique et de la Population, Port-au-Prince, Haiti
| | - Jacques Boncy
- Laboratoire National de Santé Publique, Ministère de la Santé Publique et de la Population, Port-au-Prince, Haiti
| | | | | | - Chunfu Yang
- Centers for Disease Control and Prevention, Atlanta, GA, USA
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