Validity of Dried Blood Spot Testing for Sexually Transmitted and Blood-Borne Infections: A Narrative Systematic Review

Objective Testing for human immunodeficiency virus (HIV) and hepatitis C virus (HCV) using dried blood spot (DBS) specimens has been an integral part of bio-behavioural surveillance in Canada for almost two decades. A systematic review was conducted to assess the current evidence regarding the validity of sexually transmitted and blood-borne infection (STBBI) testing using DBS specimens. Methods A literature search was conducted using a peer-reviewed search strategy. Eligibility criteria included studies reporting use of DBS specimens for STBBI testing in populations 15 years of age or older. The intervention of interest was either commercially available or “in-house” tests used to detect STBBI from DBS specimens. Studies that reported a measure of validity such as sensitivity, specificity, positive and negative predictive values were eligible for inclusion. Quality of studies and risk of bias were assessed using the QUADAS-2 tool. Results A total of 6,706 records were identified. Of these records, 169 full-text articles met the criteria for inclusion. The STBBI with the most articles reporting a measure of validity for testing on DBS was HIV ( n =73), followed by HCV ( n =63), HBV ( n =33), syphilis ( n =7), HAV ( n =5), HSV ( n =5), HTLV ( n =3), and HPV ( n =1). The majority of studies reported high sensitivity (≥90%) and specificity (≥90%). However, the quality of the studies varied greatly. No evidence was found on the validity of chlamydia and gonorrhoea testing using DBS specimens. Conclusion Our findings support the validity of DBS testing for STBBI surveillance where sufficient evidence was available, but validity is highly dependent on thorough method development and validation. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement This study did not receive any funding. Kathryn M. Sibley is supported by a Tier 2 Canada Research Chair in Integrated Knowledge Translation in Rehabilitation Sciences. ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes All data generated or analysed during this study are included in this published article (and its Supplementary Information files).