Accurate dried blood spots collection in the community using non-medically trained personnel could support scaling up routine viral load testing in resource limited settings

Autoři: Kombatende Sikombe aff001;  Cardinal Hantuba aff001;  Kalo Musukuma aff001;  Anjali Sharma aff001;  Nancy Padian aff002;  Charles Holmes aff003;  Nancy Czaicki aff001;  Sandra Simbeza aff001;  Paul Somwe aff001;  Carolyn Bolton-Moore aff001;  Izukanji Sikazwe aff001;  Elvin Geng aff005
Působiště autorů: Centre for Infectious Diseases Research in Zambia, Lusaka, Zambia aff001;  Division of Epidemiology, University of California, Berkeley, Berkeley, California, United States of America aff002;  Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America aff003;  Center for Global Health and Quality, Georgetown University, Washington, District of Columbia, United States of America aff004;  Division of HIV, Infectious Diseases and Global Medicine, University of California, San Francisco, Zuckerberg San Francisco General Hospital, San Francisco, California, United States of America aff005;  Division of Infectious Diseases, University of Alabama, Birmingham, Alabama, United States of America aff006
Vyšlo v časopise: PLoS ONE 14(10)
Kategorie: Research Article
doi: 10.1371/journal.pone.0223573


Regular plasma HIV-RNA testing for persons living with HIV on antiretroviral therapy (ART) is now the global standard, but as many as 60% of persons in Africa today on ART do not have access to standard laboratory HIV-RNA assays. As a result, patients in Zambia often receive treatment without any means of determining true virologic failure, which poses a risk of premature switch of ART regimens and widespread HIV drug resistance. Dry blood spots (DBS) on the other hand require unskilled personnel and less complex storage supply chain so are ideal to capture viral-load results from HIV patients outside clinic settings. We assess collection of DBS in the community using non-medically trained personnel (NMP) and documented challenges. We trained 23 NMP to collect DBS from lost to follow-up (LTFU) patients in 4 rural and urban Zambian districts. We developed a phlebotomy box to transport DBS without contamination at ambient temperature and concomitant training and standard operating procedures. We evaluated this through field observations, bi-weekly meetings, reports, and staff meetings. The laboratory assessed DBS quality for testing validity. We attempted to collect DBS from 357 participants in the community. Though individual reasons for refusal from the remaining 37% were not collected, NMPs reported privacy concerns, awkward box-size which drew attention in the community and fears of undisclosed uses of samples related to witchcraft and circulating narratives about past research. Successful DBS collection was not associated with patient gender, age, time on ART, enrolment CD4, facility. DBS viral-load collection by NMP is feasible in Zambia. Our training approach and assessments of NMP not part of the health system can be extended to patients by giving them more responsibility to manage their own differentiated care groups. Concerted efforts that compare collection of DBS by NMP to those collected by skilled-medical personnel are needed.

Klíčová slova:

Antiretroviral therapy – Blood – Blood plasma – HIV – Transportation – Viral load – Zambia – Phlebotomy


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2019 Číslo 10