An investigation of fingerstick blood collection for point-of-care HIV-1 viral load monitoring in South Africa

Abstract

Background. Viral load (VL) quantification is an important tool in determining newly developed drug resistance or problems with adherence to antiretroviral therapy (ART) in HIV-positive patients. VL monitoring is becoming the standard of care in many resource-limited settings. Testing in resource-limited settings may require sampling by fingerstick because of general shortages of skilled phlebotomists and the expense of venepuncture supplies and problems with their distribution. Objective. To assess the feasibility and ease of collecting 150 µL capillary blood needed for the use of a novel collection device following a classic fingerstick puncture. Methods. Patients were recruited by the study nurse upon arrival for routine ART monitoring at the Themba Lethu Clinic in Johannesburg, South Africa. Each step of the fingerstick and blood collection protocol was observed, and their completion or omission was recorded. Results. One hundred and three patients consented to the study, of whom three were excluded owing to the presence of callouses. From a total of 100 patients who consented and were enrolled, 98% of collection attempts were successful and 86% of participants required only one fingerstick to successfully collect 150 µL capillary blood. Study nurse adherence to the fingerstick protocol revealed omissions in several steps that may lower the success rate of capillary blood collection and reduce the performance of a subsequent VL assay. Conclusion. The findings of this study support the feasibility of collecting 150 µL of capillary blood via fingerstick for point-of-care HIV-1 VL testing in a resource-limited setting.

The feasibility of fingerstick blood collection for point-of-care HIV-1 viral load monitoring in rural Zambia

“…Study staff observed blood collection and documented adherence of the counselors to standard practice (Maiers et al, 2015). After blood collection, a photograph was taken of the capillary tubes and the participant’s fingertips and the participant was again asked about their preference for blood collection methods.…”

“…In collaboration with Quidel Corporation (USA), the Northwestern Global Health Foundation (USA) is developing a point-of-care test that will require up to 200 μL (with a target blood volume of 165 μL) of capillary blood to reach a lower limit of detection of 1 000 copies/mL. Prior studies conducted in urban clinics in South Africa have demonstrated the feasibility of collecting 95 and 150 μL of capillary blood from study participants (Gous et al, 2013, Maiers et al, 2015). Little is known about the feasibility of collecting capillary blood from patients in rural areas, where they may be more likely to be engaged in subsistence farming, fishing, mining, and other labor-intensive activities.…”

Point-of-Care Cepheid Xpert HIV-1 Viral Load Test in Rural African Communities Is Feasible and Reliable

“…Despite the development of several POC viral load technologies over the last decade (14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24), there is a shortage of commercially available tests. In this study, we evaluated the performance of the POC Cepheid Xpert HIV-1 viral load test in rural communities in Botswana in order to provide additional data to policy makers regarding the use of this assay in decentralized HIV treatment programs.…”

Immiscible phase filter extraction and equivalent amplification of genotypes 1–6 of hepatitis C RNA: The building blocks for point-of-care diagnosis

“…However, the volume of blood that can be consistently obtained is limited compared to venipuncture. We recently reported that it is feasible to collect 150 μl of whole blood from a fingerstick [42], from which we estimate that 50 μl of plasma can be reliably collected even if the hematocrit is as high as 55%. Based upon the LOD of the HCV Quant Assay established by testing 200 μl plasma, the LOD from 50 μl plasma would be estimated to be 120 IU/ml, i.e.…”