In many parts of the world, traveling to a clinic for routine blood tests can be a significant financial and logistical challenge, particularly for HIV patients. However, a new technological advancement is making it easier for these patients to collect and ship a drop of their blood using paper-based devices that absorb the sample and store it for analysis in distant laboratories.

While this technology has been instrumental in tracking adherence to drug regimens and monitoring disease progression, the most commonly used devices do not control the volume of blood collected, potentially leading to inaccurate readings of a person’s infection status.

Recognizing this limitation, researchers at Tufts University’s Department of Chemistry, led by Associate Professor Charlie Mace and postdoctoral scholar Giorgio Morbioli, have engineered a paper device with wax-printed patterns that create precise channels and collection spots. This innovation ensures that the device consistently collects the same volume of blood, enhancing the accuracy of test results.

In a clinical pilot study involving 75 South African patients living with HIV, the Tufts research team’s device, called a plasma spot card, demonstrated superior accuracy compared to the industry gold standard, the Roche plasma spot card. The Tufts device accurately measured the extent of a patient’s HIV infection 90.5% of the time, compared to 82.7% for the Roche device. Additionally, the Tufts device was better at detecting drug-resistant viral mutations, identifying 63% of such mutations compared to 42% for the Roche device.

Mace’s team reported their findings in the Proceedings of the National Academy of Sciences on February 18.

Our intuition told us that, because paper will have a defined saturation volume for a unit of area, by patterning a spot with a specific size and shape, we should be able to predict how much plasma it collects, said Mace, the study’s senior author. Our cards also needed to be compatible with current workflows to prevent resistance to adoption.

To conduct the pilot, Mace, with introductions from HIV experts Michael Jordan and Alice Tang at Tufts University School of Medicine, partnered with the National Institute for Communicable Diseases (NICD) in Johannesburg, South Africa. The NICD is a major center for disease surveillance, diagnostics, and public health research. NICD scientists provided real-world insights and allowed Tufts researchers to compare the plasma spot cards in a clinical setting where they would be actively used.

Mace is now exploring opportunities to move the technology into regular practice through partnerships with laboratories and researchers both in the United States and internationally. His lab continues to iterate on the device to enhance its accuracy and capabilities while pursuing steps toward commercialization.

We intentionally focus on developing technologies that are simple, both in construction and operation, said Mace. Those kinds of restrictions can make research more difficult, but ultimately we believe in that approach, because simplicity should lead to accessibility and affordability, which are both clearly needed in health care.

This innovation holds significant promise for improving healthcare access in rural and underserved communities across the United States. For instance, in states like Mississippi and Alabama, where HIV infection rates are higher than the national average, such devices could provide a more accessible and cost-effective means of monitoring HIV patients.

Moreover, the simplicity and affordability of the Tufts device could revolutionize how healthcare providers in the U.S. manage chronic diseases beyond HIV. For example, similar devices could be used to monitor diabetes, cardiovascular health, and other conditions that require regular blood testing.

However, there are potential counterarguments to consider. Some critics may argue that the accuracy of paper-based devices could still be affected by environmental factors such as humidity and temperature. Additionally, the reliability of the device in real-world settings, especially in areas with limited healthcare infrastructure, remains to be fully tested.

Despite these concerns, the Tufts device represents a significant step forward in making healthcare more accessible and affordable. As Mace and his team continue to refine the technology, it is likely to become an integral part of healthcare systems both domestically and internationally.