Dried Blood Spots for Viral Load Monitoring in Malawi: Feasible and Effective

作者：Rutstein Sarah E^*; Hosseinipour Mina C; Kamwendo Deborah; Soko Alice; Mkandawire Memory; Biddle Andrea K; Miller William C; Weinberger Morris; Wheeler Stephanie B; Sarr Abdoulaye; Gupta Sundeep; Chimbwandira Frank; Mwenda Reuben; Kamiza Steve; Hoffman Irving; Mataya Ronald

来源：PLos One, 2015, 10(4): UNSP e0124748.

DOI：10.1371/journal.pone.0124748

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 secondline therapy.

• 出版日期2015-4-21