Performances of Dried Blood Spots and Point-of-Care Devices to Identify Virological Failure in HIV-Infected Patients: A Systematic Review and Meta-Analysis.

To broaden access to HIV viral load monitoring (VLM), the use of blood samples from dried blood spots (DBS) or point-of-care (POC) devices, could be of great help in settings where plasma is not easily accessible. The variety of assays available makes the choice complex. This systematic review and meta-analysis aims to estimate the sensitivity and specificity of DBS and POC devices to identify patients in virological failure using World Health Organization (WHO) recommendations (viral load ≥1000 copies/mL), compared with plasma, for the assays currently available. Four databases were searched for articles, and two reviewers independently identified articles reporting sensitivity and specificity of DBS and/or POC to identify patients in virological failure. We excluded articles that used other thresholds as well as articles with a total number of participants below 50 to avoid reporting bias. Heterogeneity and factors associated with assays' performances were assessed by I2 statistics and metaregression. The protocol of this review follows the PRISMA guidelines. Out of 941 articles, 47 were included: 32 DBS evaluations and 16 POC evaluations. Overall, when using DBS, the Abbott RT HIV-1, Roche CAP-CTM, NucliSENS BioMerieux and Aptima assays presented sensitivity and specificity exceeding 85%, but reported results were highly heterogeneous. Factors associated with better performances were high volume of blood and the use of the same assay for DBS and plasma VLM. Regarding the POC devices, SAMBA I, SAMBA II, and GeneXpert devices presented high sensitivity and specificity exceeding 90%, with less heterogeneity. DBS is suitable VLM, but performances can vary greatly depending on the protocols, and should be performed in trained centers. POC is suitable for VLM with less risk of heterogeneity but is more intensive in costs and logistics.

A bibliometric overview of public health research in Europe.

BACKGROUND: Our aim, within the collaborative study SPHERE (Strengthening Public Health Research in Europe), was to produce a bibliometric overview of public health research literature for Europe. METHODS: A search strategy ('filter') was designed to interrogate the Science Citation Index (SCI) and the Social Science Citation Index (SSCI) databases for research articles published between 01/01/1995 and 31/12/2004 in any language. We analysed output for country by population, Gross Domestic Product (GDP), burden of disease using DALYs, and language. RESULTS: Overlap between the two databases SCI and SSCI was 35%. 210,433 publications were identified after duplicates were removed, a world total of about 20,000 per year. Approximately 7,000 papers per year were produced in Europe and 9,400 by the USA. Thirteen of 28 individual European countries produced more than 100 public health papers per year. Publications per capita were highest in northern European countries. In multiple regression analyses, GDP was a modest predictor (r(2) = 0.53, P < 0.02) of publications for European countries, while population size and disability adjusted life years were not significantly related. Smaller countries and lower producers of public health research were more likely to collaborate with other countries. Of the publications, 3.5% were published in a non-English language, with German the most common. CONCLUSION: There is marked variation in public health publication by country in Europe. Eastern and southern European countries appear to under-invest in public health research compared with northern European countries and compared to relative health need.