Over the past few decades, Australia has made tremendous inroads into combating HIV. But there are still people living with the virus today that don’t know they have it. For the team at the St Vincent’s Centre for Applied Medical Research (AMR), this hard-to-reach minority is a critical factor in containing transmissions and eradicating the virus completely.

According to Associate Professor Philip Cunningham, Chief Scientist at the NSW HIV Reference Lab and St Vincent’s Hospital Sydney’s Chief Research Officer, a routine blood test, something many of us take for granted, is not routine for everyone. There are a myriad of barriers at play, from geographic isolation to cultural constraints to the fear and stigma of the virus itself.  ‘We know that with HIV testing, there’s still about 10% of people in Australia who don’t know they’re infected,’ says Professor Cunningham, ‘We needed to find a more innovative way of reaching this undiagnosed group.’

For Professor Cunningham and his team, the breakthrough came from studying how to test for HIV and Hepatitis C in newborn babies using only a small amount of blood from a heel prick. They questioned whether this simple, low-tech solution could be adapted for adults. The result was DBS testing—a new way to make HIV testing accessible to everyone.

How it works

A few drops of blood from a finger prick are dabbed onto a special paper card. Once the blood dries, the card stabilises and can be mailed through Australia post. It’s simple, painless, and importantly, it can be done in the privacy of your own home. No needles, no clinics, no awkward questions.

Expanding our reach

While DBS testing has made screening for HIV more accessible and convenient for everyone, there are areas of the community where the technology has had a major impact.

• Prisons
  

  DBS testing solves the logistical challenges that drawing blood creates within a correctional facility. ‘It’s difficult to collect blood in a prison because you can’t just go out into the yard with sharp needles,’ explains Professor Cunningham. ‘But with DBS kits, you can overcome the safety issues and this testing method has enabled us to reach very vulnerable people at risk.’

• Injecting drug community
  

  The simplicity of the DBS collection process, via a single finger prick, breaks down barriers for injecting drug users too, who can be fearful of further damaging fragile veins.

• Remote communities
  

  These mailable kits help reach Australians in remote communities, where distance and a lack of resources makes access to healthcare an ongoing challenge. This includes indigenous populations, who are often under-served by traditional systems.

• High risk countries
  

  For immigrants and students from countries with a high prevalence of HIV, DBS kits have become a way for them to engage with the healthcare system without judgment. ‘We’ve seen a significant uptake among overseas students,’ Professor Cunningham says. ‘These are young people who might not want to discuss sexual health with their GP or who don’t have Medicare. DBS testing provides them with a private and affordable way to know their status, which has been incredibly important.’

Global impact

The impact DBS technology is having around the world is profound. Especially in regions where access to advanced medical facilities is limited. In Papua New Guinea, DBS testing has revolutionised the way HIV is diagnosed and treated. By enabling rapid and accurate testing, it empowers healthcare providers there to make informed decisions and improve patient outcomes.

Drug resistance

The team at AMR have also been researching drug resistance to the virus in Papua New Guinea, Timor Leste and across the Asia Western Pacific Region where a large study has uncovered some alarming rates of resistance. Once again, DBS testing is creating pathways for new solutions. ‘All new infections that are identified through DBS testing or any other testing, always get a drug resistance test to see if the person had been infected with a resistant virus,’ says Professor Cunningham. ‘And we’re fortunate in Australia because we pretty much have every drug available. So clinicians can use those drug resistance results to select the right treatment regimen and optimally manage the individual patient’s infection.’

This form of precision, or personalised, medicine is a great example of AMR’s translation focus, ensuring the latest treatments go from lab to patient bedside as quickly as possible. And not just one patient’s bedside. This research is positively impacting public policy and treatment guidelines too.

Positive results

Today DBS testing is joined by other HIV innovations, like PrEP, an anti-HIV medication taken by people who are HIV-negative to significantly reduce their risk of contracting the virus. These breakthroughs continue to impact the rate of new infections. According to David Edler from the Aids Council of NSW (ACON) infection rates over the last ten years have been in steady decline. ‘To give you an example, in 2016, we had 34 reactive results over the 12 month period. In 2023 we had 14—and all of them were people born overseas. We’re now more than halfway through this year and we’ve only had four.’

While numbers are reducing, the key to completely eradicating the virus is getting to that last 10% of people who don’t know they’re HIV positive, and this is where DBS testing is crucial.

The fight for dignity

DBS technology is an important part of the strategy to eliminate HIV transmission in Australia by 2030 – a goal that aligns with global views on HIV eradication. But the fight against HIV has always been more than a fight against a virus. It has been a fight against silence, isolation and shame. AMR’s simple DBS cards don’t just offer critical access to testing, they allow those at risk to retain a sense of dignity. Sometimes the smallest innovation—a drop of blood on treated paper—can make the biggest difference.

Learn more about how DBS tests are collected through this educational video below: