Using Dried Blood Spots for Pediatric HIV Viral Loads in Uganda
July 2014 – Journal of Clinical Microbiology 52(7): 2665-2667

In resource-limited settings such as Uganda, robust methods to monitor viral load in children living with HIV remain challenging. This study investigated the use of dried blood spot (DBS) samples collected at the home-care department of St Raphael of St Francis Hospital, Kampala (via Nsambya Home Care) to evaluate how well DBS viral load results correlate with standard clinical and immunological criteria for treatment failure.

Key Findings

Among 104 HIV-1 infected children on combination antiretroviral therapy (cART), 12.5% experienced clinical or immunological failure.

Viral load (VL) measurements from DBS showed that 28.8% had <1,000 copies/ml, 44.2% had 1,000-5,000 copies/ml, and 26.9% had >5,000 copies/ml.

Clinical/immunological criteria for treatment failure performed poorly at predicting virological failure: for VL ≥1,000 or ≥5,000 copies/ml, the area under the ROC curve (AUC) was approximately 0.52 — essentially no better than chance.

The findings highlight that even when children appear clinically stable, significant virological failure can go undetected if relying only on clinical/immunological monitoring.

Among gender groups, the reduction in stigma was more pronounced among women (from 59% at baseline to 33% at end-line) than among men (41% to 39%). The difference is attributed to higher female participation in training and intervention activities.

Within internal stigma components (of which eight were tracked), self-blame emerged as the most frequent issue (19.7% of respondents). The broader internal stigma profile – shame, guilt, low self-esteem – also shifted positively over the project period.

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In a setting where plasma viral load testing is often unavailable, using DBS offers a practical step forward. Our work through Nsambya Home Care shows that children may look well clinically yet harbour virological failure — so expanding DBS viral load monitoring is essential to protect their long-term health.

Dr Maria Nannyonga Musoke

Implications for Practice

This study suggested that DBS-based viral load monitoring can offer a more reliable and operationally feasible alternative for routine virological monitoring of children on ART in low-resource settings. Given the low predictive value of clinical/immunological failure criteria, programmes should consider scaling up viral load monitoring — including DBS methods — to promptly identify children who need regimen changes or enhanced adherence support.

What Next?

Strengthen the capacity for DBS collection, transport and viral load testing in paediatric HIV care settings.

Integrate DBS viral load monitoring into routine follow-up for children on ART, especially in locations without easy access to plasma viral load testing.

Provide timely actionable results from viral load tests to guide treatment decisions, adherence counselling or regimen switches.

Advocate for policy and funding support to scale-up DBS-based viral load monitoring in Uganda and similar contexts.