Are dried blood spots useful as a specimen for detection of hepatitis C (HCV) RNA: a systematic review

Abstract

Background: Diagnosis of hepatitis C virus (HCV) infection involves collecting plasma or serum samples. These specimens are sometimes difficult to obtain from infected patients, especially those in high-risk groups. Dried blood spot (DBS) collection offers an alternate less -invasive collection method which facilitates the collection of blood samples. Objective: To evaluate the diagnostic accuracy of HCV detection in DBS, by assessing the sensitivity and specificity of testing HCV-RNA in DBS compared with venous blood sampling. Methods: A systematic review was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), quality of evidence and risk of bias presented in the selected studies was evaluated using the QUADAS-2 tool. All studies included in this review were peer-reviewed and published between 1989 and 2020. Only studies designed to assess the sensitivity and specificity of DBS viral RNA detection compared to HCV-RNA testing in venous blood were included. Results: 388 titles were collected from the database search. Of these, only eight studies met the eligibility criteria. The sensitivity to HCV-RNA from specimens comprising DBS and plasma/serum varied from 36 per cent to 100 per cent, whereas specificity ranged from 94.3 per cent to 100 per cent. Only three of the reviewed studies were rated as incurring a low risk of bias. Conclusions: DBS testing is sensitive as well as specific and adequate for detecting the RNA of HCV with the exception of one study Tejada-Strop et al. (2015) study where low sensitivity that resulted from the long storage of samples that led to degradation of the RNA. A uniform protocol should be considered in future research when using DBS, including storage conditions. Additionally, further exploration into the possibility of using self-sampled DBSs is sensible. Keywords: Hepatitis C virus (HCV) RNA, dried blood spots (DBS), sensitivity, specificity, detection, diagnosis.