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Improved 12-month survival when community support given with cryptococcal antigen screening in HIV

March 14 2015

Around 10 million people in Africa receive antiretroviral therapy (ART) for HIV infection, but mortality in the first few months and during the first year is higher than in Europeans. Tuberculosis and cryptococcal meningitis account for the majority of deaths in Africa in HIV patients.

A paper published in the Lancet online this week has highlighted that  the provision of a short period of community support from lay workers alongside screening for cryptococcal antigen,  substantially reduces mortality  in patients with advanced HIV  disease, who are commencing antiretroviral therapy. The mortality was 30% less in patients who had  received this package which cost between  $30 -70  per patient.

This open label randomised trial took place in Tanzania and Zambia with 1999 patients and the result was consistent  in both countries.  Patients  with a CD4+ count of less than 200 cells per μL and over 18 years were eligible for recruitment. Four home visits (weekly)from a community worker were provided during the first 4 weeks of ART treatment  to the community/antigen tested group.


Screening for cryptococcal antigen  was done using a point-of-care serum rapid antigen test (IMMY, Norman, OK, USA).  Participants who were serum antigen negative were started on ART immediately. Those who were serum antigen positive – in fact 4% of that group – were given either Amphotericin B treatment or fluconazole treatment depending on whether cryptococcal antigen was determined in CSF.  ART was delayed by 2 weeks in patients who were serum cryptococcal antigen positive.

 The shortage of qualified health care workers is a challenge in Africa,  but this study indicates that some simple community support alongside screening for cryptococcal antigen  could be an easily implemented strategy for reducing mortality in HIV patients with advanced disease.   

Sayoki Mfinanga et al Lancet March 10th, 2015