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.