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PLoS One. 2015 Apr 21;10(4):e0124748. doi: 10.1371/journal.pone.0124748. eCollection 2015.

Dried blood spots for viral load monitoring in Malawi: feasible and effective.

Author information

1
Department of Health Policy and Management, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States; Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States.
2
Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States; University of North Carolina Project, Lilongwe, Malawi.
3
University of North Carolina Project, Lilongwe, Malawi.
4
School of Public Health, Loma Linda University, Loma Linda, California, United States.
5
Department of Health Policy and Management, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States.
6
Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States; Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States.
7
Centers for Disease Control, Lilongwe, Malawi.
8
Ministry of Health, Lilongwe, Malawi.
9
College of Medicine, Blantyre, Malawi.
10
Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States.

Abstract

OBJECTIVES:

To evaluate the feasibility and effectiveness of dried blood spots (DBS) use for viral load (VL) monitoring, describing patient outcomes and programmatic challenges that are relevant for DBS implementation in sub-Saharan Africa.

METHODS:

We recruited adult antiretroviral therapy (ART) patients from five district hospitals in Malawi. Eligibility reflected anticipated Ministry of Health VL monitoring criteria. Testing was conducted at a central laboratory. Virological failure was defined as >5000 copies/ml. Primary outcomes were program feasibility (timely result availability and patient receipt) and effectiveness (second-line therapy initiation).

RESULTS:

We enrolled 1,498 participants; 5.9% were failing at baseline. Median time from enrollment to receipt of results was 42 days; 79.6% of participants received results within 3 months. Among participants with confirmed elevated VL, 92.6% initiated second-line therapy; 90.7% were switched within 365 days of VL testing. Nearly one-third (30.8%) of participants with elevated baseline VL had suppressed (<5,000 copies/ml) on confirmatory testing. Median period between enrollment and specimen testing was 23 days. Adjusting for relevant covariates, participants on ART >4 years were more likely to be failing than participants on therapy 1-4 years (RR 1.7, 95% CI 1.0-2.8); older participants were less likely to be failing (RR 0.95, 95% CI 0.92-0.98). There was no difference in likelihood of failure based on clinical symptoms (RR 1.17, 95% CI 0.65-2.11).

CONCLUSIONS:

DBS for VL monitoring is feasible and effective in real-world clinical settings. Centralized DBS testing may increase access to VL monitoring in remote settings. Programmatic outcomes are encouraging, especially proportion of eligible participants switched to second-line therapy.

PMID:
25898365
PMCID:
PMC4405546
DOI:
10.1371/journal.pone.0124748
[Indexed for MEDLINE]
Free PMC Article

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