Abstract

BackgroundSuboptimal antiretroviral therapy (ART) adherence and disengagement in care present significant public health challenges because of the increased probability of HIV transmission. In the United States, men who have sex with men (MSM) continue to be disproportionately affected by HIV, highlighting a critical need to engage high-risk MSM living with HIV who are not engaged or retained in care.ObjectiveThe aim of the study was to assess the feasibility of at-home blood self-collection and laboratory quantification of HIV-1 RNA viral load (VL) to report laboratory-based VL outcomes and compare self-reported and laboratory-reported VLMethodsBetween 2016 and 2017, 766 US HIV-positive MSM enrolled in a Web-based behavioral intervention were invited to participate in an at-home dried blood spot (DBS) collection study using HemaSpot-HF kits (Spot On Sciences, Inc, Austin, TX) for laboratory-quantified VL.ResultsOf those invited to participate, 72.3% (554/766) enrolled in the DBS study. Most (79.2%, 439/554) men enrolled reported attempting to collect their blood, 75.5% (418/554) of participants mailed a DBS specimen to the research laboratory, and 60.8% (337/554) had an adequate blood sample for VL testing. Of the 337 specimens tested for VL by the laboratory, 52.5% (177/337) had detectable VL (median: 3508 copies/mL; range: 851-1,202,265 copies/mL). Most men (83.9%, 135/161) who returned a DBS specimen with laboratory-quantified detectable VL self-reported an undetectable VL during their last clinical visit.ConclusionsHome collection of DBS samples from HIV-positive MSM is feasible and has the potential to support clinical VL monitoring. Discrepant laboratory HIV-1 RNA values and self-reported VL indicate a need to address perceived VL status, especially in the era of treatment as prevention. Most participants were willing to use an at-home DBS kit in the future, signaling an opportunity to engage high-risk MSM in long-term HIV care activities.

Highlights

  • BackgroundSuboptimal antiretroviral therapy (ART) adherence and intermittent engagement in care present significant public health challenges because of the increased probability of HIV transmission resulting from high HIV-1 RNA viral load (VL) [1,2,3,4,5]

  • The Mailed-Spot (M-Spot) study assessed the feasibility of home self-collection of dried blood spot (DBS) specimens for laboratory quantification of VL among US white, black, and Hispanic men who have sex with men (MSM) living with HIV who participated in a Web-based behavioral intervention [14]

  • Of the 337 specimens tested for VL by the laboratory, over half (52.5%, 177/337) had detectable VL, whereas 47.5% (160/337) of participants returned a sample with no detectable HIV-1 RNA (Figure 2)

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Summary

Introduction

Suboptimal antiretroviral therapy (ART) adherence and intermittent engagement in care present significant public health challenges because of the increased probability of HIV transmission resulting from high HIV-1 RNA viral load (VL) [1,2,3,4,5]. In the United States, men who have sex with men (MSM) continue to be disproportionately affected by HIV; in 2016, MSM accounted for 66.79% (26,570/39,782) of all HIV diagnoses and 82.69% (26,570/32,131) of diagnoses among men [1]. Suboptimal antiretroviral therapy (ART) adherence and disengagement in care present significant public health challenges because of the increased probability of HIV transmission. In the United States, men who have sex with men (MSM) continue to be disproportionately affected by HIV, highlighting a critical need to engage high-risk MSM living with HIV who are not engaged or retained in care

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