@article{fdi:010066012,
  title = {{P}rogrammatic feasibility of dried blood spots for the virological follow-up of patients on antiretroviral treatment in {N}ord {K}ivu, {D}emocratic {R}epublic of the {C}ongo},
  author = {{B}oillot, {F}. and {S}errano, {L}. and {M}uwonga, {J}. and {K}abuayi, {J}. {P}. and {K}ambale, {A}. and {M}utaka, {F}. and {F}ujiwara, {P}. {I}. and {D}ecosas, {J}. and {P}eeters, {M}artine and {D}elaporte, {E}ric},
  editor = {},
  language = {{ENG}},
  abstract = {{B}ackground:{A}s part of its policy to shift monitoring of antiretroviral therapy ({ART}) to primary health care ({PHC}) workers, the {M}inistry of {H}ealth of the {D}emocratic {R}epublic of {C}ongo ({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.{M}ethods:{DBS} samples from adults on {ART} were collected in 13 decentralized {PHC} facilities in the {N}ord-{K}ivu province and shipped during program quarterly supervision to a reference laboratory 2000 km away, where {VL} was quantified with a commercial assay (m2000rt, {A}bbott). {A} second {DBS} was sent to a {W}orld {H}ealth {O}rganization ({WHO})-accredited laboratory for repeat {VL} quantification on a subset of samples with a generic assay ({B}iocentric) and genotypic drug resistance testing when {VL} >1000 copies per milliliter.{F}indings:{C}onstraints arose because of an interruption in national laboratory funding rather than to technical or logistic problems. {A}ll samples were assessed by both {VL} assays to allow {ART} adjustment. {M}edian {DBS} turnaround time was 37 days (interquartile range: 9-59). {A}ssays performed unequally with {DBS}, impacting clinical decisions, quality assurance, and overall cost-effectiveness. {B}ased 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.{C}onclusion:{T}his 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. {A}dequate core funding of {HIV} laboratories and adapted choice of {VL} assays require urgent attention to control resistance to {ART} as coverage expands.},
  keywords = {{HIV} ; {ART} monitoring ; {D}emocratic {R}epublic of {C}ongo ; dried blood spots ; viral load assay ; programmatic context ; {REPUBLIQUE} {DEMOCRATIQUE} {DU} {CONGO}},
  booktitle = {},
  journal = {{J}aids-{J}ournal of {A}cquired {I}mmune {D}eficiency {S}yndromes},
  volume = {71},
  numero = {1},
  pages = {{E}9--{E}15},
  ISSN = {1525-4135},
  year = {2016},
  DOI = {10.1097/qai.0000000000000844},
  URL = {https://www.documentation.ird.fr/hor/fdi:010066012},
}