Background: The “Undetectable=Untransmittable” campaign emphasizes the need for individuals living with HIV to reach and maintain viral suppression to prevent new infections. Emerging prevention strategies to monitor viral load (VL) are needed for those disengaged from care or sub-optimally adherent to antiretroviral therapy (ART). eHealth studies with HIV-positive MSM report high acceptability of self-collecting biological specimens, including dried blood spots (DBS) to measure VL; however, little information exists on longitudinal monitoring of VL. We report longitudinal research-based VL test results from home-collected DBS specimens among HIV-positive MSM recruited online.
Methods: In 2018, US HIV-positive MSM (n=78) identified as having detectable VL (DVL) were invited to participate in a study to measure VL longitudinally via self-collected DBS specimens. Consenting participants received DBS kits at baseline and 3-month follow-up with instructions to collect and mail specimens to a research laboratory. RNA was extracted using the Qiagen RNeasy kit. TaqMan-based Real-time Quantitative PCR research assay was used to quantify VL. The lower limit of quantification (LLQ) was estimated at 500 copies/mL. Results were reported as undetectable (UVL), below the LLQ, or a quantitative result if VL >500 copies/mL.
Results: Of 56 consenting participants, 68% were White, 14% Black, and 16% Hispanic. Median age was 42; 51/56 (91%) returned specimens for testing at baseline and 43/51 (84%) at 3-month follow-up. At baseline, 2 specimens were below the LLQ, and 6 had a DVL (median=1475; range=603-2867 copies/mL); at 3-month follow-up, 4 specimens were below the LLQ, and 3 had DVL (median=1804; range=1245-14709 copies/mL). While 74% of men had UVL specimens at both time points, the remainder had VL fluctuations from baseline to follow-up (DVL to UVL=4; UVL to DVL=5; DVL to DVL=2).
Conclusions: Our longitudinal study of HIV-positive MSM with a past DVL showed that at-home DBS collection and research-lab monitoring of VL is feasible. Fluctuating viremia over a 3-month period was identified in a subset of participants. Findings signal interest in DBS home collection by HIV-positive MSM with sub-optimal ART adherence. This approach may improve research data collection and potentially provide a complementary VL monitoring approach in clinical care to increase the proportion of MSM with UVL.

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