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Implementation and Operational Research: Programmatic Feasibility of Dried Blood Spots for the Virological Follow-up of Patients on Antiretroviral Treatment in Nord Kivu, Democratic Republic of the Congo
As part of its policy to shift monitoring of antiretroviral therapy (ART) to primary health care (PHC) workers, the Ministry of Health of the Democratic Republic of Congo (DRC) tested the feasibility of using dried blood spots (DBS) for viral load (VL) quantification and genotypic drug resistance te...
Autores principales: | , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
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JAIDS Journal of Acquired Immune Deficiency Syndromes
2016
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4679362/ https://www.ncbi.nlm.nih.gov/pubmed/26413848 http://dx.doi.org/10.1097/QAI.0000000000000844 |
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author | Boillot, François Serrano, Laetitia Muwonga, Jeremie Kabuayi, Jean Pierre Kambale, Alain Mutaka, Fidèle Fujiwara, Paula I. Decosas, Josef Peeters, Martine Delaporte, Eric |
author_facet | Boillot, François Serrano, Laetitia Muwonga, Jeremie Kabuayi, Jean Pierre Kambale, Alain Mutaka, Fidèle Fujiwara, Paula I. Decosas, Josef Peeters, Martine Delaporte, Eric |
author_sort | Boillot, François |
collection | PubMed |
description | As part of its policy to shift monitoring of antiretroviral therapy (ART) to primary health care (PHC) workers, the Ministry of Health of the Democratic Republic of Congo (DRC) tested the feasibility of using dried blood spots (DBS) for viral load (VL) quantification and genotypic drug resistance testing in off-site high-throughput laboratories. METHODS: DBS samples from adults on ART were collected in 13 decentralized PHC facilities in the Nord-Kivu province and shipped during program quarterly supervision to a reference laboratory 2000 km away, where VL was quantified with a commercial assay (m2000rt, Abbott). A second DBS was sent to a World Health Organization (WHO)-accredited laboratory for repeat VL quantification on a subset of samples with a generic assay (Biocentric) and genotypic drug resistance testing when VL >1000 copies per milliliter. FINDINGS: Constraints arose because of an interruption in national laboratory funding rather than to technical or logistic problems. All samples were assessed by both VL assays to allow ART adjustment. Median DBS turnaround time was 37 days (interquartile range: 9–59). Assays performed unequally with DBS, impacting clinical decisions, quality assurance, and overall cost-effectiveness. Based on m2000rt or generic assay, 31.3% of patients were on virological failure (VF) and 14.8% presented resistance mutations versus 50.3% and 15.4%, respectively. CONCLUSION: This study confirms that current technologies involving DBS make virological monitoring of ART possible at PHC level, including in challenging environments, provided organizational issues are addressed. Adequate core funding of HIV laboratories and adapted choice of VL assays require urgent attention to control resistance to ART as coverage expands. |
format | Online Article Text |
id | pubmed-4679362 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2016 |
publisher | JAIDS Journal of Acquired Immune Deficiency Syndromes |
record_format | MEDLINE/PubMed |
spelling | pubmed-46793622015-12-21 Implementation and Operational Research: Programmatic Feasibility of Dried Blood Spots for the Virological Follow-up of Patients on Antiretroviral Treatment in Nord Kivu, Democratic Republic of the Congo Boillot, François Serrano, Laetitia Muwonga, Jeremie Kabuayi, Jean Pierre Kambale, Alain Mutaka, Fidèle Fujiwara, Paula I. Decosas, Josef Peeters, Martine Delaporte, Eric J Acquir Immune Defic Syndr Epidemiology and Prevention As part of its policy to shift monitoring of antiretroviral therapy (ART) to primary health care (PHC) workers, the Ministry of Health of the Democratic Republic of Congo (DRC) tested the feasibility of using dried blood spots (DBS) for viral load (VL) quantification and genotypic drug resistance testing in off-site high-throughput laboratories. METHODS: DBS samples from adults on ART were collected in 13 decentralized PHC facilities in the Nord-Kivu province and shipped during program quarterly supervision to a reference laboratory 2000 km away, where VL was quantified with a commercial assay (m2000rt, Abbott). A second DBS was sent to a World Health Organization (WHO)-accredited laboratory for repeat VL quantification on a subset of samples with a generic assay (Biocentric) and genotypic drug resistance testing when VL >1000 copies per milliliter. FINDINGS: Constraints arose because of an interruption in national laboratory funding rather than to technical or logistic problems. All samples were assessed by both VL assays to allow ART adjustment. Median DBS turnaround time was 37 days (interquartile range: 9–59). Assays performed unequally with DBS, impacting clinical decisions, quality assurance, and overall cost-effectiveness. Based on m2000rt or generic assay, 31.3% of patients were on virological failure (VF) and 14.8% presented resistance mutations versus 50.3% and 15.4%, respectively. CONCLUSION: This study confirms that current technologies involving DBS make virological monitoring of ART possible at PHC level, including in challenging environments, provided organizational issues are addressed. Adequate core funding of HIV laboratories and adapted choice of VL assays require urgent attention to control resistance to ART as coverage expands. JAIDS Journal of Acquired Immune Deficiency Syndromes 2016-01-01 2015-12-12 /pmc/articles/PMC4679362/ /pubmed/26413848 http://dx.doi.org/10.1097/QAI.0000000000000844 Text en Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved. This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives License 4.0 (CC BY-NC-ND) (http://creativecommons.org/licenses/by-nc-nd/4.0/) , which permits downloading and sharing the work provided it is properly cited. The work cannot be changed in any way or used commercially. |
spellingShingle | Epidemiology and Prevention Boillot, François Serrano, Laetitia Muwonga, Jeremie Kabuayi, Jean Pierre Kambale, Alain Mutaka, Fidèle Fujiwara, Paula I. Decosas, Josef Peeters, Martine Delaporte, Eric Implementation and Operational Research: Programmatic Feasibility of Dried Blood Spots for the Virological Follow-up of Patients on Antiretroviral Treatment in Nord Kivu, Democratic Republic of the Congo |
title | Implementation and Operational Research: Programmatic Feasibility of Dried Blood Spots for the Virological Follow-up of Patients on Antiretroviral Treatment in Nord Kivu, Democratic Republic of the Congo |
title_full | Implementation and Operational Research: Programmatic Feasibility of Dried Blood Spots for the Virological Follow-up of Patients on Antiretroviral Treatment in Nord Kivu, Democratic Republic of the Congo |
title_fullStr | Implementation and Operational Research: Programmatic Feasibility of Dried Blood Spots for the Virological Follow-up of Patients on Antiretroviral Treatment in Nord Kivu, Democratic Republic of the Congo |
title_full_unstemmed | Implementation and Operational Research: Programmatic Feasibility of Dried Blood Spots for the Virological Follow-up of Patients on Antiretroviral Treatment in Nord Kivu, Democratic Republic of the Congo |
title_short | Implementation and Operational Research: Programmatic Feasibility of Dried Blood Spots for the Virological Follow-up of Patients on Antiretroviral Treatment in Nord Kivu, Democratic Republic of the Congo |
title_sort | implementation and operational research: programmatic feasibility of dried blood spots for the virological follow-up of patients on antiretroviral treatment in nord kivu, democratic republic of the congo |
topic | Epidemiology and Prevention |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4679362/ https://www.ncbi.nlm.nih.gov/pubmed/26413848 http://dx.doi.org/10.1097/QAI.0000000000000844 |
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