Dried Blood Spots Improve Access to HIV Diagnosis and Care for Infants in Low-Resource Settings

Department of Molecular Medicine and Haematology, National Health Laboratory Service and University of the Witwatersrand, Johannesburg, South Africa.
JAIDS Journal of Acquired Immune Deficiency Syndromes (Impact Factor: 4.56). 05/2005; 38(5):615-7. DOI: 10.1097/01.qai.0000143604.71857.5d
Source: PubMed


Effective health care delivery to the majority of perinatally exposed infants worldwide, including those enrolled in prevention of mother-to-child transmission programs, is hampered by lack of access to an HIV diagnosis in infancy. Dried blood spot collection from young infants for centralized HIV polymerase chain reaction (PCR) testing is attainable in low-resource settings, provided PCR methodology suitable for routine laboratory service is available. The accuracy of the Roche Amplicor HIV-1 DNA test version 1.5 (Branchburg, NJ) performed on dried blood spots collected prospectively on ordinary Whatman filter paper from a cohort of 300 6-week-old infants born to HIV-infected women in Johannesburg, South Africa, was assessed. Anonymous analysis of the blood spots using a unique DNA extraction procedure was performed in a routine diagnostic laboratory and the results compared with HIV DNA and RNA PCR liquid blood tests at age 6 weeks, and the HIV status of the infant. Dried blood spots were available for 288 infants (96%) of whom 25 (8.7%) were HIV infected. The Roche Amplicor assay yielded a sensitivity of 100% and a specificity of 99.6%. HIV DNA PCR tests on dried blood spots have the potential to improve health care delivery to HIV-affected children in low-resource settings right now.

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    • "Definitive diagnosis of HIV-infection at any age requires diagnostic testing that confirms the presence of the virus. Two types of tests are in use: serological tests which detect antibodies to HIV proteins in blood and other body fluids and virologic tests which detect actual viral particles (Sherman et al., 2005). In 2007, Zimbabwe introduced virological testing which detects a component of the HIV deoxyribonucleic acid (DNA) through the use of a polymerase chain reaction (DNA-PCR) from 6 weeks of age in HIV-exposed infants. "
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    ABSTRACT: Zimbabwe introduced the early infant diagnosis (EID) for human immunodeficiency virus (HIV) exposed infants in 2007. Data captured through this initiative has never been analysed in detail. A detailed EID data analysis was carried out to evaluate the effectiveness of the prevention of mother to child transmission (PMTCT) of HIV in reducing HIV transmission. A retrospective record review of the national EID dataset for the period of January, 2007 to August, 2011 was conducted. Secondary data analysis was done to calculate EID population coverage and HIV positivity amongst samples tested, to compare effectiveness of PMTCT regimens among tested children, and to determine the correlation between mode of delivery and infant outcomes. EID population coverage increased from 1% in January, 2007 to 38% by August, 2011, far below universal access target of 80%. Of the samples tested, HIV positivity showed an apparent decline from 38% in 2007 to 11% in 2011. HIV positivity in infants born vaginally was comparable to those delivered by caesarean section for the years 2010 (p-trend 0.427) and 2011 (p-trend 0.99). Both maternal and infant antiretroviral (ARV) prophylactic regimens were found to reduce HIV positivity significantly (p-trend < 0.001). The national EID database is an important and readily available tool for monitoring and evaluating the PMTCT program and paediatric HIV trends. The Ministry of Health through its PMTCT programme should regularly use this data to inform prioritization of PMTCT interventions. Increased access to both maternal and infant ARV prophylactic drug regimens is critical, if the target of eliminating paediatric HIV by 2015 is to be met in Zimbabwe.
    Full-text · Article · Jul 2015
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    • "However, the lack of access to virologic testing remains a challenge. The use of dried blood spots (DBS) has facilitated detection of HIV in settings with limited resources (Sherman et al., 2005). The test most widely used in the public health sector is the Roche Amplicor HIV-1 DNA Test, version 1.5, a manual DNA PCR test (Nelson et al., 2011). "
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    ABSTRACT: Timely diagnosis and treatment of infants infected with HIV are critical for reducing infant mortality. High-throughput automated diagnostic tests like Roche COBAS AmpliPrep/COBAS TaqMan HIV-1 Qual Test (Roche CAPCTM Qual) and the Abbott Real Time HIV-1 Qualitative (Abbott Qualitative) can be used to rapidly expand early infant diagnosis testing services. In this study, the performance characteristics of the Abbott Qualitative were evaluated using two hundred dried blood spots (DBS) samples (100 HIV-1 positive and 100 HIV-1 negative) collected from infants attending the antenatal facilities in Kisumu, Kenya. The Abbott Qualitative results were compared to the diagnostic testing completed using the Roche CAPCTM Qual in Kenya. The sensitivity and specificity of the Abbott Qualitative were 99.0% (95% CI: 95.0-100.0) and 100.0% (95% CI: 96.0-100.0), respectively, and the overall reproducibility was 98.0% (95%CI: 86.0-100.0). The limits of detection for the Abbott Qualitative and Roche CAPCTM Qual were 56.5 and 6.9 copies/mL at 95% CIs (p=0.005), respectively. The study findings demonstrate that the Abbott Qualitative test is a practical option for timely diagnosis of HIV in infants.
    Full-text · Article · Apr 2014 · Journal of virological methods
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    • "In 2006, the Uganda EID program adopted simplified dried blood spot (DBS) technology which made testing of infants in rural settings feasible through improved sample management and transport [6]. DBS samples can be transported at room temperature days after initial sample collection, unlike whole blood samples which must be tested on the day of collection [5], [6]. "
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    ABSTRACT: Uganda scaled-up Early HIV Infant Diagnosis (EID) when simplified methods for testing of infants using dried blood spots (DBS) were adopted in 2006 and sample transport and management was therefore made feasible in rural settings. Before this time only 35% of the facilities that were providing EID services were reached through the national postal courier system, Posta Uganda. The transportation of samples during this scale-up, therefore, quickly became a challenge and varied from facility to facility as different methods were used to transport the samples. This study evaluates a novel specimen transport network system for EID testing. A retrospective study was done in mid-2012 on 19 pilot hubs serving 616 health facilities in Uganda. The effect on sample-result turnaround time (TAT) and the cost of DBS sample transport on 876 sample-results was analyzed. The HUB network system provided increased access to EID services ranging from 36% to 51%, drastically reduced transportation costs by 62%, reduced turn-around times by 46.9% and by a further 46.2% through introduction of SMS printers. The HUB model provides a functional, reliable and efficient national referral network against which other health system strengthening initiatives can be built to increase access to critical diagnostic and treatment monitoring services, improve the quality of laboratory and diagnostic services, with reduced turn-around times and improved quality of prevention and treatment programs thereby reducing long-term costs.
    Full-text · Article · Nov 2013 · PLoS ONE
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