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Histoplasmosis is a frequent cause of infections in people living with HIV/AIDS (PLWHA). This study introduces the application of a Histoplasma capsulatum urine antigen lateral flow assay (LFA) for diagnosing disseminated histoplasmosis in PLWHA in Suriname. The LFA's diagnostic accuracy was compared with the current diagnostic approach, aiming to assess whether this test resulted in improved early detection and management. Additionally, the prevalence of histoplasmosis among advanced stage HIV patients without clinical suspicion of infection was evaluated using the same LFA. In total, 98 patients were included in the study, of which 58 were classified as "possible disseminated histoplasmosis (DH)" based on clinical criteria and 40 as 'controls". Of these possible DH cases, only 19 (32.7%) had a positive LFA. During the study, decisions for treatment were made without the treating physician being aware of the LFA result. Only 55% of the patients who started treatment for histoplasmosis based on clinical criteria had a positive LFA, and 21% of untreated patients had a positive LFA. This study shows that combining clinical signs with LFA results enhances diagnostic accuracy and is cost effective, resulting in better treatment decisions. Author summary: People living with HIV in Suriname often present to care in a late stage of their infection. A common infection in these patients is Disseminated Histoplasmosis (DH). This is caused by a fungus, Histoplasma capsulatum. DH is currently difficult to diagnose. This study evaluated the use of a urine test for the diagnosis of DH, called LFA, in patients with advanced-stage HIV-infection. In the study, 98 advanced-stage HIV infected patients were included. Of these, 58 had signs and symptoms that could be attributable to DH. The other 40 patients were not suspected of DH. In all these patients the usual workup was done. The urine histoplasmosis LFA was carried out afterwards, so the result did not influence clinical decisions. We compared the clinical diagnoses of all patients to the results of the LFA. The results show that only 55% of the patients with a clinical diagnosis of DH and who started antifungal treatment had a positive LFA. Of the untreated patients 21% had a positive LFA. We conclude that treatment decisions solely based on clinical signs and symptoms lead to both over- and undertreatment and that adding this test to the clinical workup of patients suspected of DH, is cost-effective. [ABSTRACT FROM AUTHOR]

The early detection of sickle cell disease (SCD) is vital to reduce mortality among affected children. Suriname currently lacks a newborn screening programme (NSP) for SCD. We performed a pilot programme to evaluate the scalability of such an initiative. Dried blood spots were collected from five birth centres and subjected to electrophoresis analysis. The programme scalability was evaluated using the non-adoption, abandonment, scale-up, spread, and sustainability framework. Challenges across six domains (illness, technology, value proposition, adopter system, organisation, and societal system), were categorised hierarchically as simple 😊, complicated 😐, or complex 😢. It has been proven that implementing programmes with mainly complicated challenges is difficult and those in mainly complex areas may be unachievable. SCD was detected in 33 of 5185 (0.64%) successfully screened newborns. Most of the domains were classified as simple or complicated. Disease detection and technology suitability for screening in Suriname were confirmed, with favourable parental acceptance. Only minor routine adjustment was required from the medical staff for programme implementation. Complex challenges included a reliance on external suppliers for technical maintenance, ensuring timely access to specialised paediatric care for affected newborns, and securing sustainable financial funding. Scaling up is challenging but feasible, particularly with a targeted focus on identified complex challenges.