Are Dried Blood Spot Samples As Sensitive As Blood for the Detection of Hepatitis C virus in Clinical and Community Settings? (Systematic Review)

Abstract

Abstract Hepatitis C virus (HCV) infection is common on a global scale and particularly affects highrisk groups, including intravenous drug users, sex workers, prisoners, and the homeless population. A key challenge is diagnosing HCV in hard to-reach populations or high-risk groups in the community and clinical setting due to reluctance to present to services and to undergo venepuncture. Blood samples are crucial for the detection of HCV and for diagnosis and the potential for dried blood spots (DBS) obtained through a small finger prick may yield improved screening and acceptability of HCV testing in these populations. The aim of this review was to evaluate the diagnostic accuracy of DBS for the detection of HCV in the community and clinical settings. A comprehensive search strategy was completed, focusing on studies published within the last 10 years (2010-2020), adopting a primary methodology and reporting at least the sensitivity of DBS versus whole blood samples for HCV detection. The search produced 17 studies that met the review inclusion criteria. The collective data set suggested that DBS had a generally high sensitivity for HCV detection compared to blood samples, particularly for antibody and RNA tests. Core antigen testing was prone to some variation depending on methods employed and storage of DBS samples. Specificity was consistently high for all methods when DBS samples were used. There was no clear difference in community or clinical settings in terms of diagnostic accuracy. Therefore, the use of DBS has the potential to be implemented in the community and clinical settings and has a high level of diagnostic accuracy for HCV. More data are needed to integrate DBS sampling into algorithms for HCV diagnosis and to evaluate patient perceptions of the acceptability of DBS sampling and service use.