Challenges Related To Dbs Testing
DBS has been the standard of care for neonatal screening for a variety of diseases, including PKU, sickle cell, hypothyroidism, and HIV infection.
However, the utilization of DBS beyond neonatal screening was limited for many years due to a variety of technical issues. First and foremost, the quantity of blood collected with each sample is small . Therefore, successful analysis is dependent on highly sensitive and reliable analytic techniques.
Other contributing factors that make consistent DBS sampling a challenge include the following:
- cumbersome drying procedures
- differences in blood sample viscosity
- distribution on the filter paper
- stability of the sample during transport and storage
Mother To Child Transmission
Having HIV does not mean a woman cant have a healthy baby. The key is to work with a doctor to take all the necessary precautions.
Aside from blood and sexual secretions, HIV can also be transmitted during pregnancy or through breast milk while breastfeeding. Mother to child transmissions can also occur at any point during pregnancy, as well as during delivery.
All pregnant women should be screened for HIV. Antiretroviral therapy is strongly recommended for pregnant women with HIV to achieve viral suppression. This will subsequently reduce the risk of transmitting HIV to the baby during pregnancy and labor. Sometimes a caesarean delivery is recommended to reduce transmission during delivery if the infection is not suppressed.
Its also important to protect the baby after birth. Breastfeeding might not be recommended in some cases, though consistent viral suppression may reduce the transmission of HIV through breast milk. A doctor may also recommend that the baby take antiretroviral therapy for up to six weeks after birth.
Overall, great strides have been made in decreasing HIV transmission between mothers and infants due to improved screening and use of anti-HIV drugs during pregnancy.
In the United States, the
Demographics Of The Participants Who Mailed Back Dbs Cards
eSTAMP participants were recruited from across the US and most were between 18 and 34years old. Participants were mostly non-Hispanic white followed by 19.6% Hispanic, 7.4% black, and 5.1% Asian.
AMIS study participants were from across the US as well and 74.4% were non-Hispanic white, 12.8% Hispanic, 7.7% black, and 5.1% others or multiple races. The majority of AMIS participants were over 50years old.
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Early Infant Diagnosis Through Dried Blood Spot Collection
Several countries are at different stages of scaling up HIV viral load testing and uptake of results for patient management. Viral load testing is the gold standard and the most effective method for monitoring of people on antiretroviral therapy living with HIV. For countries to achieve the UNAIDS target of 90% viral suppression of patients on ART, increased access to viral load testing and utilization of results for patient management with adherence counselling would be critical for monitoring patients. Several barriers to access and uptake of HIV viral load results have been identified within the pre-analytical, analytical and post analytical phase of the viral load cascade and include weaknesses in demand creation, sample referral systems, procurement, optimization of testing capacity, return and uptake of results, and monitoring and evaluation of the cascade for improvements.
Recognizing these barriers to viral load scale up, a group of partners and stakeholders convened, identified and developed tools that would assist programs in scaling up viral load testing and uptake of results.
Storing Serum And Plasma Collected By Venepuncture
To store serum and plasma, consider the following: ,
- Make sure the cap is tight on the labelled cryovial or plastic tube. Place the cryovials in a cardboard freezer box with a partitioned insert.
- If the specimens are to be transported to the testing laboratory, store the specimens at 48 °C for up to a maximum of 1 week. For longer-term storage, the specimens should be frozen at 20 °C or below.
- Pack the specimens upright in a cooler containing cold packs for transport to the testing facility.
- Limit the number of freeze/thaw cycles because it may impact the HIV test results and subsequent additional testing.
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Hiv Diagnostic Tests Available
HIV Ag/Ab Testing: BVL uses an FDA-approved chemiluminescent microparticle immunoassay that detects HIV-1 p24 antigen and IgM/IgG antibodies to HIV-1 and HIV-2 in human serum and plasma. A reactive result does not distinguish between the detection of HIV-1 p24 antigen, HIV-1 antibody, or HIV-2 antibody. As with all immunoassays, there may be nonspecific reactions due to a variety of causes. A repeatedly reactive result is considered preliminary and supplemental testing of the specimen is required to produce a final interpretation. This test is for plasma and serum only.
HIV-1/2 Supplemental Antibody Testing: The BVL performs supplemental testing to confirm the presence of HIV-1 and HIV-2 antibodies in plasma and serum using an FDA-approved single-use, immunochromatographic assay. The BVL has also validated and received NYSDOH Clinical Laboratory Evaluation Program approval to conduct this supplemental HIV-1/2 antibody test on dried blood spots using a modified protocol. Supplemental HIV-1/2 antibody testing is intended only for specimens that are reactive on an HIV screening assay.
HIV-2 Nucleic Acid Testing: The BVL uses a NYSDOH CLEP-approved real-time PCR assay to detect and quantify HIV-2 RNA.
Preparing And Storing A Dried Blood Spot For An Hiv Test
Blood from a finger- or ear-lobe stick can be used to make DBS. Although finger-stick is the most typical method, DBS can also be obtained by using blood collected in a tube with an anticoagulant. DBS have the advantage of being easy to transport, without the need for a cold chain.
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Advantages And Disadvantages Of Oral Fluid
Other specimens besides blood and blood products can be used for HIV testing. For linked testing, where must be obtained, oral fluid may be used.
- Does not require a trained laboratory technician for specimen collection and processing, can be collected by a trained health worker
- Does not require contact with possibly contaminated laboratory materials, e.g. used needles or lancets that need biohazard waste facilities for sharps disposal
- Can be collected in a variety of field settings, including non-clinical settings
- Collection of oral fluid may be more acceptable to hard-to-reach populations than specimen collection requiring venepuncture or finger-stick. Therefore, a greater percentage of the target population may agree to be tested.
- May require special collection devices
- Currently available testing technologies used for oral fluid specimens are limited but additional new tests are being validated.
- Cannot be used to perform additional testing for special studies
- Same specimen cannot be used to confirm initial reactivity with a second test therefore, a second specimen must be taken, i.e. whole blood, serum, plasma for further testing
- Should not be used for confidential linked testing
Cfir Construct: Inner Setting
Inner setting factors such as training, biweekly operation meetings, and available resources were highlighted as key factors that affected the implementation of DBS testing. CBRC provided in-person training for site coordinators across the country to carry out DBS testing. Site coordinators generally expressed positive feedback regarding this training, but when it came time for them to train their local DBS volunteer collectors, one CBRC staff noted that incorrect information was sometimes communicated . While CBRC staff were present at each collection event to ensure protocol fidelity, it was again noted that having more than one person responsible for this task would be ideal.
To help keep the various implementation sites communicating and aligned, CBRC held biweekly operation meetings leading up to Pride events and throughout the recruitment period. As Pride festivals across Canada are staggered throughout the summer months, this allowed subsequent sites to learn and adapt from previous sites successes and challenges CBRC also centrally coordinated most of the resources that each community partner organization required to carry out DBS collection, and each community partner organization assigned site coordinators to oversee implementation. As one interviewee described, in practice this sometimes meant an increased workload for existing staff at partner organizations . CBRC did not dictate how funds provided to a local site had to be spent.
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Raye St Denis Executive Director
Shining Mountains Living Community Services
Why was dried blood spot testing implemented in your community? What needs were you trying to fill and what benefits did it offer?
Shining Mountains Living Community Services partnered with the Public Health Agency of Canadas National Laboratory for HIV Reference Services in 2019 to take part in a research project to bring dried blood spot testing to the community of Métis people we serve. Launched as part of the Drum & Sash project, our pilot aimed to better understand how Métis people living in Alberta would respond to and access alternative methods of testing. We wanted to use this information to improve the delivery of testing and care models for HIV and sexually transmitted and blood-borne infections across a wide range of city and rural settings.
Can you describe your program? What strategies did you use to deliver dried blood spot testing in a way that met the needs of your community and encouraged people to take part?
Shining Mountains has been operating in Red Deer, Alberta, for over 20 years and provides services to people experiencing or at risk for HIV, hepatitis C, domestic or intimate partner violence, and addictions. We prioritize the physical, mental, emotional and spiritual health of Aboriginal people in a wide range of environments in Central Alberta . A strength of Shining Mountains is that it is owned, operated and staffed by Aboriginal people.
How To Avoid Getting Hiv
Abstinence, or not having sex, is the only type of protection that works every time. But if you are having sex, you can lower your risk if you:
- Use a condom every time you have sex
- Get tested for HIV and STDs
- Limit the number of people you have sex with
- DonÃ¢t inject yourself with drugs
Talk to your doctor right away if you think youÃ¢ve been exposed to the virus. They can help you figure out next steps.
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Dried Blood Spot Collection For Hepatitis C And Hiv Testing In Canada
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Dried blood spot collection is a promising approach to hepatitis C and HIV testing that can reach people who might not access traditional health services. Using this method, a sample of blood droplets is collected on a filter paper and then dried for transportation to a laboratory where standard hepatitis C and/or HIV testing is performed. The ease of sample collection and the stability of the collected sample make DBS collection a useful tool. This approach is not yet widely used in Canada for hepatitis C and HIV testing, but it may become more widely available in the coming years as it has the potential to complement existing testing options. This article will explore what DBS testing is, the advantages of DBS testing and its use in Canada.
Processing Blood Collected By Venepuncture
To collect blood by venepuncture, follow local clinical or laboratory procedures. See the and for information on safety procedures.
The following steps are recommended for processing blood collected by venepuncture: Collect up to 10 ml of blood from the patients vein into a sterile 10 ml tube.
- For serum, blood is collected in a red-top tube .
- For plasma, blood is collected in a purple-top tube .
- For safety reasons, the use of an evacuated blood collection system is recommended.
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Dbs For Hiv And Viral Hepatitis Molecular Testing To Detect Viral Replication Therapeutic Response And Virologic Theray Failure
The detection of nucleic acids on DBS also finds a strong clinical indication in the diagnosis of infections transmitted from mother to child. Regarding HIV diagnosis, the presence of maternal antibodies in infants makes serological tests ineffective until at least 1 year of age. Molecular diagnosis of HIV infection on DBS has been shown to be effective and is routinely used in clinical practice for this indication. DBS sampling is finally useful for specialized tests such as HIV resistance genotyping, and antiretroviral dosages . It should be noted that although the clinical relevance of HIV resistance genotyping on DBS is indisputable, it nevertheless faces the difficulty of molecular genotyping on DBS, at the threshold defining the therapeutic failure .
Dbs For Screening And Serologic Confirmation Of Hiv And Viral Hepatitis
Dried blood spot can be used in the initial serological screening step as an alternative to conventional assays based on venipuncture and RDT. DBS can be decentralized such as RDT, but requires a return visit for post-counseling. This second visit leads to a risk of loss to follow up . The lower rate of retention in care using DBS is one of the limitations of DBS testing compared to RDT. Nevertheless, questioning health care workers about their perception of DBS testing highlights some advantages related to a diagnostic strategy requiring a second visit: unlike for RDT, the person who performed the DBS does not bear the responsibility of performing the assay and of immediately notifying the diagnosis to the screened subject in the event of a positive test, the medical team can anticipate and better organize the post-test counseling in an approach of risk-reduction, the time between screening and the result announcement may be perceived as beneficial to raising awareness.
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The Potential To Increase Testing
Given the unique advantages that DBS testing offers, such as the fact that DBS samples can be transported over long distances and remain stable and the fact that samples can be collected for multiple tests simultaneously, it has the potential to increase testing in certain populations.
Because DBS testing is currently limited in Canada, there has been limited research to date examining the impact of its use in communities. One small pilot program in Alberta used DBS testing for hepatitis B and C, HIV and syphilis at two Métis community events21 and provided evidence that this testing method was able to reach people who had previously not tested. Among 26 participants, 50% reported this was their first time getting tested for HIV, and 46% reported it was their first time getting tested for hepatitis C.
Dried Blood Spot Testing: Innovations And Applications
By Robert Lerman, M.D. | Published 2/9/2020 0
During the first ten days of December 2019, two very different headlines highlighted news reports that seemingly had nothing in common. But in actuality, they did. They both illustrated the potential new benefits from a well-established, but previously limited, clinical laboratory technique called Dried Blood Spot Testing or DBS.
Here are the stories:
- On December 1, World AIDS Day was commemorated. It provided an opportunity for people around the globe to unite in the fight against HIV. It reminded us to support the 36.7 million people living with the virus. And, to remember those who died from AIDS-related illness.
- Eight days later, the World Anti-Doping Agency issued a four-year penalty against the Russian national athletics team, banning them from all international sporting competitions, including the Olympics,. The ban was because of their continued participation in the years-long doping scandal.
Heres a closer look at the role of DBS in those stories:
In October of 2019, the WADA announced a collaboration with seven Anti-Doping Organizations The collaboration centered on the development and implementation of DBS for drug testing in sports in time for the 2022 Winter Olympic and Paralympic Games in Beijing, China.
Want to read more about doping in sports? Check out this book: Doping in Sports: Winning at Any Cost?
Ninety percent of all people:
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