Acceptability and Feasibility of Self-Collected Dried Blood Spot Specimens for Viral Load Monitoring among Rural Older People Living with HIV

Self-collected dried blood spot (DBS) samples may be useful in monitoring viral load (VL) in research studies or clinically given that they eliminate the need for participants to travel to study sites or laboratories. Despite this, little information exists about monitoring VL using DBS self-collected at home, and no information exists on DBS for this use among older rural people living with HIV (PLH), a population that could benefit from self-collection given difficulty accessing care. We report on the feasibility and acceptability of self-collected DBS samples, DBS VL results, concordance between self-reported and DBS VL, and factors associated with DBS detectable VL in a rural Southern U.S. sample of PLH aged 50 years and older. Between 2021 and 2022, 61 older rural PLH from 9 Southern U.S. states (M_age = 58, 25% female) completed survey measures and self-collected DBS specimens at home; 51 of these participants completed the same procedures at 3-month follow-up. Nearly all participants (96–98%) collected DBS specimens that could be successfully analyzed for VL, and participants found self-collection highly acceptable. Approximately one quarter of participants had quantifiable detectable VL (≥ 839 copies/mL) at each time point. Concordance between self-reported and DBS VL was 69% at baseline and 82% at follow-up; the majority of those with DBS detectable VL self-reported undetectable VL (86% at baseline and 60% at follow-up). Self-collection of DBS specimens for VL monitoring can add value to research conducted remotely, including research associated with the care of rural and/or older PLH.