Date of Award

Spring 5-11-2013

Degree Type


Degree Name

Master of Public Health (MPH)


Public Health

First Advisor


Second Advisor

Dennis Ellenberger, Ph.D.


Early diagnosis of HIV in infants is critical because it can remarkably impact an infant’s survival. DNA PCR is the standard test for diagnosis of HIV-1 in infants and young children less than 18 months of age. For settings that lack the adequate infrastructure for processing whole blood and cold-chain transportation, the collection of dried blood spots (DBS) has facilitated the detection of HIV-1 in infants as early as 4-6 weeks after birth. Molecular testing using DBS provides an accurate method for the identification of HIV-1 but quality testing depends greatly on adequate quality assurance. A voluntary, cost-free external quality assurance program established by the U.S. Centers for Disease Control and Prevention, Global AIDS Program was implemented to monitor the performance of laboratories conducting HIV EID from DBS in an effort to provide the critically needed external quality assurance measures in resource-constrained settings. Known HIV- positive and negative DBS specimens to be used as internal controls and ten blinded DBS specimens are shipped internationally tri-annually with a 30 day testing result turnaround. Peer comparison is provided after each testing time point. Advances by resource-constrained countries to conduct EID have resulted in more children being tested, which resulted in enrollment and participation expanding significantly to include greater than 104 laboratories from 36 countries. Mean test scores have improved with each testing but false negative results are twice as likely as false positive discordant outcomes.