Abstract
Early infant diagnosis (EID) of HIV provides an opportunity for early HIV detection and access to appropriate Antiretroviral treatment (ART). Dried Blood Spot (DBS) samples are used for EID of exposed infants, born to HIV-positive mothers. However, DBS rejection rates in Zimbabwe have been exceeding the target of less than 2% per month set by the National Microbiology Reference Laboratory (NMRL), in Harare. The aim of this study was to determine the DBS sample rejection rate, the reasons for rejection and the possible associations between rejection and level of health facility where the samples were collected. This is an analytical cross-sectional study using routine DBS sample data from the NMRL in Harare, Zimbabwe, between January and December 2017.A total of 34 950 DBS samples were received at the NMRL. Of these, 1291(4%) were rejected. Reasons for rejection were insufficient specimen volume (72%), missing request form (11%), missing sample (6%), cross-contamination (6%), mismatch of information (4%) and clotted sample (1%). Samples collected from clinics/rural health facilities were five times more likely to be rejected compared to those from a central hospital. Rejection rates were above the set target of <2%. The reasons for rejection were ‘pre-analytical’ errors including labelling errors, missing or inconsistent data, and insufficient blood collected. Samples collected at primary healthcare facilities had higher rejection rates.
Highlights
Prevention of mother-to-child transmission (PMTCT) of HIV is one of the most important challenges in the global elimination of paediatric HIV infection [1, 2]
Dried Blood Spot (DBS) samples are collected by pricking the heel of the infant using a blood lancet, dripping the blood onto the five circles of a DBS card, and leave to dry for two to four hours on a dry and dust-free surface before packaging and sending it by courier to the National Microbiology Reference Laboratory (NMRL) in Harare
DBS samples collected from all facilities in 5provinces of Zimbabwe and sent to NMRL were logged into Early infant diagnosis (EID)-laboratory information management system (LIMS)
Summary
Prevention of mother-to-child transmission (PMTCT) of HIV is one of the most important challenges in the global elimination of paediatric HIV infection [1, 2]. WHO recommends EID to be performed as part of the PMTCT cascade on HIV-exposed infants within four to six weeks of age [1]. In February 2013, Zimbabwe’s Ministry of Health and Child Care (MoHCC) adopted Option B+, the implementation of lifelong ART for all pregnant and breastfeeding HIV-positive mothers, regardless of CD4 count and clinical stage [3]. Dried Blood Spot (DBS) samples are preferred to EDTA anticoagulated whole blood samples for EID-testing because they permit infant HIV-testing even in areas with limited resources for collection, storage and transportation of blood samples. DBS samples are collected by pricking the heel of the infant using a blood lancet, dripping the blood onto the five circles of a DBS card (see Fig 1), and leave to dry for two to four hours on a dry and dust-free surface before packaging and sending it by courier to the National Microbiology Reference Laboratory (NMRL) in Harare
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