title: Improving estimates of HIV-1 seroprevalence among childbearing women: use of smaller blood spots.
abstract: OBJECTIVE
  Nationwide, human immunodeficiency virus type 1 (HIV-1) seroprevalence surveys using dried neonatal blood specimens are critical to estimating HIV-1 seroprevalence among childbearing women. However, the noninclusion of blood specimens deemed "quantity not sufficient" (QNS) for HIV-1 antibody testing potentially introduces bias. In Wisconsin beginning in 1990, we modified the survey protocol to reduce QNS rates and assess bias introduced by QNS specimens.
  
  
  METHODS
  The HIV-1 antibody assay was modified to use four 1/8-in blood spots when a single 1/4-in blood spot could not be obtained. Both methods obtain identical blood volumes for testing.
  
  
  RESULTS
  During a 27-month period, 7396 (4.8%) of 154,683 specimens were deemed QNS using 1/4-in blood spots. Of these, 6590 (89%) were of sufficient quantity to be tested using four 1/8-in blood spots; 6 (0.09%) specimens tested with 1/8-in blood spots were HIV-1 Western blot assay positive compared with 44 (0.03%) of 147,287 1/4-in specimens (odds ratio = 3.0; 95% confidence interval = 1.2, 7.4).
  
  
  CONCLUSIONS
  Because noninclusion of QNS specimens potentially introduces bias, incorporating the results of HIV-1 antibody testing of QNS specimens using four 1/8-in blood spots can improve the accuracy of HIV-1 seroprevalence estimates in these serologic surveys.
authors.affiliation: Bureau of Public Health, Wisconsin Division of Health, Madison.
authors.forename: N J
authors.initials: NJ
authors.lastname: Hoxie
authors.forename: J M
authors.initials: JM
authors.lastname: Vergeront
authors.forename: J R
authors.initials: JR
authors.lastname: Pfister
authors.forename: G L
authors.initials: GL
authors.lastname: Hoffman
authors.forename: P A
authors.initials: PA
authors.lastname: Markwardt-Elmer
authors.forename: J P
authors.initials: JP
authors.lastname: Davis
mesh_terms: D015982:Bias; D001800:Blood Specimen Collection / Q000379:methods* / Q000592:standards; D015153:Blotting, Western / Q000379:methods* / Q000592:standards; D002985:Clinical Protocols / Q000592:standards; D005069:Evaluation Studies as Topic; D005260:Female; D015528:HIV Seroprevalence; D015497:HIV-1; D006801:Humans; D007231:Infant, Newborn; D008423:Maternal Age; D015997:Neonatal Screening / Q000379:methods* / Q000592:standards; D044469:Racial Groups; D015203:Reproducibility of Results; D014922:Wisconsin / Q000453:epidemiology