Dr. John Kim: Dried blood spot testing for HIV diagnosis in Canada

My name is Dr. John Kim, I’m with the
National HIV Labs, which is part of the National Microbiology Lab, which is part
of the Public Health Agency of Canada. Dried blood spot testing is a relatively
new method for testing, however it’s been with us for about 20 years. So
essentially what it is, it’s a novel way of collecting blood without having to
use venipuncture. And what venipuncture is, is everybody’s familiar with the use
of a needle and a tube. So one of the advantages of dried blood spot testing
is that you do not need to have a nurse or somebody trained in taking blood with
a needle. It’s essentially just picking the end of your finger and then dropping
it onto a special piece of paper which is known as the dried blood spot card. It
has its origins in the 1960s with newborn screening of pediatrics. It’s
only been within the last maybe 15-20 years where the use the dried blood
spot card collection for infectious diseases, with HIV being the ‘poster child’,
for lack of a better word, being the main infectious disease in which
dried blood spot testing is starting to gain prominence. One of the advantages, I can say,
within the interventions in which we’ve used dried blood spot
testing for diagnosis, is that the individuals – we’ve heard anecdotally – that
the reason it’s been more acceptable is because you do not get the test result
right away as you would in the case of rapid testing. It also has other
advantages, and as I said earlier, is because quite often these remote
communities don’t have persons who are able to take blood, you know, by the
needle. So as the reference lab for PHAC, we have used dried blood spot
collection – card testing and collection, for all of its epi
surveillance studies. So this is looking at HIV and hepatitis C in Indigenous
populations, men having sex with men, injection drug users and persons from
endemic countries. We’ve used it for the past 15-17 years, and to date we’ve
tested thousands if not tens of thousands. Recently, however, we have used
dried blood spot card collection and testing in applying it to diagnostic
testing within First Nations communities. The reason it hasn’t been broadly
implemented is, in fact, dried blood spot card collecting and testing, is it’s mainly
been a research tool. So, we have to perform validation on it. So it’s not
like an HIV test that you would use for serology detection or viral load
monitoring, where typically companies will actually validate that test,
have it approved by Medical Devices Bureau of
Health Canada. So it’s been mainly a research tool, it’s just that we’ve now
taken it out of the realm of research into diagnostics. But as long as one
shows proper validation, I can’t see why it can’t be used in a diagnostic
capacity. So it’s the beginning of a good thing and we hope at some point in the
future that companies who perform and sell these diagnostic tests, whether it
be for serology or for molecular, will now have protocols for dried
blood spot testing. We know it’s a step in
the right direction. We’ve had good response,
we’ve already shown good efficacy in the two First Nation
communities in which it’s been rolled out. We hope and suspect that as others
start to learn of this technique and some of the advantages associated with
dried blood spot testing versus the standard way of testing, which is either
the needle or rapid testing, that it will start to become part of the routine way
of testing for blood in addition to the, you know, the venipuncture – the needle
method – as well as rapid testing

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