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Mongolia has undergone healthcare modifications because of political changes resulting from the dissolution of the former Soviet Union. Dramatic increases in unemployment, alcoholism, commercial sex, homelessness, and sexually transmitted infections (STIs) have occurred.1 There has been rapid spread of HIV infection in neighbouring countries. Mongolia also has a high prevalence of hepatitis B.2 Although the Mongolian ministry of health is eager to perform surveillance for STIs, including viral hepatitis, resources for collection, storage, and testing of specimens are meagre. We evaluated the utility of a filter paper blood collection technique for determining rates of HIV, syphilis, and viral hepatitis B and C in this resource limited setting.3–6
The study was approved by the institutional review boards at the University of Alabama at Birmingham and the Mongolian ministry of health. Volunteers including commercial sex workers, itinerant traders, homeless people, and attendees at the STI clinic were sampled in Ulaanbaatar, Mongolia. All subjects completed a questionnaire and provided blood via a finger stick.
Blood was collected as filter paper spots using Schleicher and Schuell (Keene, NH, USA) no 903 filter paper following the National Committee for Clinical Laboratory Standards protocol. Samples were dried, stored at room temperature for the duration of the 2 week visit to Mongolia, and then refrigerated upon arrival to the testing laboratory. For every blood spot, a ¼ inch disc containing about 5 μl of serum was punched out of the filter paper. Disc samples were eluted in 400 μl of phosphate buffered saline for samples to be tested for HBsAg and HCVAb, 200 μl of specimen diluent solution for samples to be tested for HIV, or 500 μl of 0.9% saline solution for rapid plasmin reagin (RPR) and FTA-ABS tests.
A total of 593 volunteers were enrolled. The prevalence of infection using the filter paper technique was 1.9% for syphilis, 10.5% for hepatitis C, and 21.6% for chronic hepatitis B. The prevalence of hepatitis C was higher among homeless people compared to other risk groups (21.13% v 5.2–9.7%) (table 1). For 128 volunteers with chronic hepatitis B, 86 of them (67.2%) occurred in STI clinics attendees. Eleven individuals had reactive tests for syphilis. Three individuals had repetitively reactive ELISAs for HIV, however, none was confirmed by western blot. A total of 232 volunteers (39.1%) reported use of condoms routinely, 55/593 (9.27%) had a history of blood transfusion, and 9/593 (1.5%) reported use of injecting drugs. Neither condom use, number of sexual partners, nor a history of blood transfusion were predictors of hepatitis B infection. No correlations were found between the prevalence of hepatitis C virus infection and the use of drugs or history of blood transfusions.
We found the filter paper technique for blood collection to be a reliable and useful method for serological studies in resource poor areas where blood collection and/or specimen transport may be difficult. Specimens were easily collected, stored, and transported before testing. Rates of viral hepatitis were high but rates of syphilis and HIV unexpectedly low. Future prevalence testing using this method will be able to determine trends of these communicable diseases in Mongolia.
This project was funded through the World AIDS Foundation (WAF No 175 98–054). This work was presented in part at the 40th Interscience Conference on Antimicrobial Agents and Chemotherapy (ICAAC Meeting) in Toronto, Ontario, September 2000.
Contributors IT helped design the project, organised and participated in specimen collection, performed data entry and analysis, and drafted the manuscript; MA organised and facilitated the study in Mongolia and reviewed the manuscript; SV helped design the project, reviewed data analysis and manuscript prepartion; JWG processed laboratory specimens for HIV testing and mentored IT in same, reviewed manuscript; EHH processed laboratory specimens for syphilis testing and mentored IT in same, reviewed manuscript; JS helped design project, was the principal mentor for IT for all aspects of the project, and assisted in writing the manuscript.