Real-Life Feasibility of HIV Drug Resistance Testing Using Dried Filter Analytes in Kenyan Children and Adolescents Living with HIV Akarsh Manne, a Alexander DeLong, a Winstone Nyandiko, b,c Allison K. DeLong, a Rachel Vreeman, b,d Vladimir Novitsky, a Anthony Ngeresa, b Edwin Sang, b Ashley Chory, d Josephine Aluoch, b Eslyne Jepkemboi, b Millicent Orido, b Celestine Ashimosi, b Festus Sang, b Joseph W. Hogan, a,b Rami Kantor, a,b for the RESPECT (Resistance in a Pediatric Cohort) Study a Brown University, Providence, Rhode Island, USA b Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya c Moi University College of Health Sciences, Eldoret, Kenya d Icahn School of Medicine at Mount Sinai, New York, New York, USA Akarsh Manne and Alexander DeLong are co-first authors. Akarsh Manne was the primary senior technologist who was responsible for all laboratory aspects of the study and is therefore first among the two co-first authors. Alexander DeLong was an undergraduate student who was working with Akarsh Manne on some laboratory aspects of this study and was therefore second among the two co-first authors. ABSTRACT HIV-1 drug resistance remains a global challenge, yet access to testing is limited, particularly in resource-limited settings. We examined feasibility and limitations of genotyping using dried filter analytes in treatment-experienced Kenyan youth with HIV. Youth infected with HIV perinatally were enrolled in 2016–2018 at the Academic Model Providing Access to Healthcare in Eldoret, western Kenya. Samples were shipped in real-time at ambient temperature to the US, and those with viral load (VL).1,000 copies/mL were tested based on convenience. Dried blood spots genotyping was attempted when unsuccessful from Hemaspots. Multiple logistic regression was used to examine predictors of genotyping success. Samples from 49 participants (median age 15 years, 43% female, median CD4 496 cells/ mL [18%], median 8 years on therapy, me- dian VL 11,827 copies/mL) were shipped after median 7 days from collection, arrived in 20 shipments after median 5 days, and extracted after median 2 days (1 day for sam- ples processed on arrival; and 42 days for frozen Hemaspots). Overall, 29/49 (59%) sam- ples with VL . 1,000 copies/mL and 25/32 (78%) with VL . 5,000 copies/mL were gen- otyped by either Hemaspots or DBS. Successful genotyping was associated with higher Hemaspot volume and higher VL. Real-life HIV-1 drug resistance testing from dried filter analytes is feasible, even in settings with constrained resources. Findings, particularly relevant where resistance testing is limited for clinical care, raise awareness to imple- mentation practicability of this guidelines-recommended test in care of more individu- als and populations. Further optimization of filter analytes is needed to overcome related challenges. IMPORTANCE In this manuscript we use dried filter analytes shipped from Kenya to the US in real time, to demonstrate the real-life feasibility of conducting HIV drug resist- ance testing in a vulnerable population of young children and adolescents with HIV in a resource limited setting. Such testing, which is recommended in resource-rich set- tings, is unavailable in most resource limited settings for individual clinical care. We show that real-life HIV drug resistance testing from dried filter analytes is feasible, even in settings with constrained resources. These findings raise awareness to the impor- tance of HIV drug resistance for individual care, even in such settings, and emphasize the implementation practicability of this guidelines-recommended test. Editor Takamasa Ueno, Kumamoto University Copyright © 2022 Manne et al. This is an open-access article distributed under the terms of the Creative Commons Attribution 4.0 International license. Address correspondence to Rami Kantor, rkantor@brown.edu. The authors declare no conflict of interest. Received 21 December 2021 Accepted 24 February 2022 Published 7 April 2022 March/April 2022 Volume 10 Issue 2 10.1128/spectrum.02675-21 1 RESEARCH ARTICLE