1. Cryptococcal Antigen Screening Among Antiretroviral Therapy–Experienced People With HIV With Viral Load Nonsuppression in Rural Uganda
- Author
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Joel Peter Opio, Jane Nakaweesi, Barbara Mukasa, Catherine Senyimba, Pallen Mugabe, Joseph Baruch Baluku, and Shem Mwebaza
- Subjects
0301 basic medicine ,medicine.medical_specialty ,Cryptococcal antigen ,030106 microbiology ,Population ,Human immunodeficiency virus (HIV) ,ART-experienced ,Disease ,medicine.disease_cause ,Major Articles ,03 medical and health sciences ,0302 clinical medicine ,cryptococcal meningitis ,Disease Screening ,Internal medicine ,medicine ,030212 general & internal medicine ,education ,nonsuppression ,education.field_of_study ,business.industry ,HIV ,CrAg ,Antiretroviral therapy ,viral load ,AcademicSubjects/MED00290 ,Infectious Diseases ,Oncology ,business ,Viral load ,Fluconazole ,medicine.drug - Abstract
Background The World Health Organization recommends screening for the cryptococcal antigen (CrAg), a predictor of cryptococcal meningitis, among antiretroviral therapy (ART)–naïve people with HIV (PWH) with CD4 Methods We reviewed routinely generated programmatic reports on cryptococcal disease screening from 104 health facilities in 8 rural districts of Uganda from January 2018 to July 2019. A lateral flow assay (IMMY CrAg) was used to screen for cryptococcal disease. PWH were eligible for CrAg screening if they were ART-naïve with CD4 1000 copies/mL after at least 6 months of ART. We used Pearson’s chi-square test to compare the frequency and yield of CrAg screening. Results Of 71 860 ART-experienced PWH, 7210 (10.0%) were eligible for CrAg screening. Among 15 417 ART-naïve PWH, 5719 (37.1%) had a CD4 count measurement, of whom 937 (16.4%) were eligible for CrAg screening. The frequency of CrAg screening was 11.5% (830/7210) among eligible ART-experienced PWH compared with 95.1% (891/937) of eligible ART- naïve PWH (P Conclusions The low frequency and high positivity yield of CrAg screening among ART-experienced PWH with VL nonsuppression suggest a need for VL- directed CrAg screening in this population. Studies are needed to evaluate the cost-effectiveness and impact of CrAg screening and fluconazole prophylaxis on the outcomes of ART-experienced PWH with VL nonsuppression.
- Published
- 2021
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