Tracking cryptococcal meningitis to monitor HIV program success during the Treat-All era : an analysis of national data in Botswana
© The Author(s) 2024. Published by Oxford University Press on behalf of Infectious Diseases Society of America..
BACKGROUND: Cryptococcal meningitis causes substantial mortality in high-HIV prevalence African countries despite advances in disease management and increasing antiretroviral therapy coverage. Reliable diagnosis of cryptococcal meningitis is cheap and more accessible than other indicators of AHD burden such as CD4 testing or investigation for disseminated tuberculosis; therefore, monitoring cryptococcal meningitis incidence has the potential to serve as a valuable metric of HIV programmatic success.
METHODS: Botswana national meningitis surveillance data from 2015 to 2022 were obtained from electronic health records. All electronic laboratory records from cerebrospinal fluid samples analysed within government healthcare facilities in Botswana were extracted from a central online repository. Adjustments for missing data were made through triangulation with prospective cohort study datasets. Cryptococcal meningitis case frequency was enumerated using a case definition and incidence calculated using national census data.
RESULTS: A total of 1,744 episodes of cryptococcal meningitis were identified; incidence declined from 15.0 (95% CI 13.4-16.7) cases/100,000 person-years in 2015 to 7.4 (95% CI 6.4-8.6) cases/100,000 person-years in 2022. However, the rate of decline slowed following the introduction of universal treatment in 2016. The highest incidence was observed in men and individuals aged 40-44. The proportion of cases diagnosed through cryptococcal antigen testing increased from 35.5% to 86.3%.
CONCLUSION: Cryptococcal meningitis incidence has decreased in Botswana following expansion of ART coverage but persists at a stubbornly high incidence. Most cases are now diagnosed through the cheap and easy-to-use cryptococcal antigen test highlighting the potential of using cryptococcal meningitis as key metric of programme success in the Treat All era.
| Medienart: |
E-Artikel |
|---|
| Erscheinungsjahr: |
2024 |
|---|---|
| Erschienen: |
2024 |
| Enthalten in: |
Zur Gesamtaufnahme - year:2024 |
|---|---|
| Enthalten in: |
Clinical infectious diseases : an official publication of the Infectious Diseases Society of America - (2024) vom: 08. Feb. |
| Sprache: |
Englisch |
|---|
| Beteiligte Personen: |
Milburn, James [VerfasserIn] |
|---|
| Links: |
|---|
| Themen: |
Advanced HIV disease |
|---|
| Anmerkungen: |
Date Revised 08.02.2024 published: Print-Electronic Citation Status Publisher |
|---|
| doi: |
10.1093/cid/ciae066 |
|---|
| funding: |
|
|---|---|
| Förderinstitution / Projekttitel: |
|
| PPN (Katalog-ID): |
NLM368197921 |
|---|
| LEADER | 01000naa a22002652 4500 | ||
|---|---|---|---|
| 001 | NLM368197921 | ||
| 003 | DE-627 | ||
| 005 | 20240209232147.0 | ||
| 007 | cr uuu---uuuuu | ||
| 008 | 240209s2024 xx |||||o 00| ||eng c | ||
| 024 | 7 | |a 10.1093/cid/ciae066 |2 doi | |
| 028 | 5 | 2 | |a pubmed24n1285.xml |
| 035 | |a (DE-627)NLM368197921 | ||
| 035 | |a (NLM)38330295 | ||
| 035 | |a (PII)ciae066 | ||
| 040 | |a DE-627 |b ger |c DE-627 |e rakwb | ||
| 041 | |a eng | ||
| 100 | 1 | |a Milburn, James |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Tracking cryptococcal meningitis to monitor HIV program success during the Treat-All era |b an analysis of national data in Botswana |
| 264 | 1 | |c 2024 | |
| 336 | |a Text |b txt |2 rdacontent | ||
| 337 | |a ƒaComputermedien |b c |2 rdamedia | ||
| 338 | |a ƒa Online-Ressource |b cr |2 rdacarrier | ||
| 500 | |a Date Revised 08.02.2024 | ||
| 500 | |a published: Print-Electronic | ||
| 500 | |a Citation Status Publisher | ||
| 520 | |a © The Author(s) 2024. Published by Oxford University Press on behalf of Infectious Diseases Society of America. | ||
| 520 | |a BACKGROUND: Cryptococcal meningitis causes substantial mortality in high-HIV prevalence African countries despite advances in disease management and increasing antiretroviral therapy coverage. Reliable diagnosis of cryptococcal meningitis is cheap and more accessible than other indicators of AHD burden such as CD4 testing or investigation for disseminated tuberculosis; therefore, monitoring cryptococcal meningitis incidence has the potential to serve as a valuable metric of HIV programmatic success | ||
| 520 | |a METHODS: Botswana national meningitis surveillance data from 2015 to 2022 were obtained from electronic health records. All electronic laboratory records from cerebrospinal fluid samples analysed within government healthcare facilities in Botswana were extracted from a central online repository. Adjustments for missing data were made through triangulation with prospective cohort study datasets. Cryptococcal meningitis case frequency was enumerated using a case definition and incidence calculated using national census data | ||
| 520 | |a RESULTS: A total of 1,744 episodes of cryptococcal meningitis were identified; incidence declined from 15.0 (95% CI 13.4-16.7) cases/100,000 person-years in 2015 to 7.4 (95% CI 6.4-8.6) cases/100,000 person-years in 2022. However, the rate of decline slowed following the introduction of universal treatment in 2016. The highest incidence was observed in men and individuals aged 40-44. The proportion of cases diagnosed through cryptococcal antigen testing increased from 35.5% to 86.3% | ||
| 520 | |a CONCLUSION: Cryptococcal meningitis incidence has decreased in Botswana following expansion of ART coverage but persists at a stubbornly high incidence. Most cases are now diagnosed through the cheap and easy-to-use cryptococcal antigen test highlighting the potential of using cryptococcal meningitis as key metric of programme success in the Treat All era | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Botswana | |
| 650 | 4 | |a Cryptococcal meningitis | |
| 650 | 4 | |a advanced HIV disease | |
| 650 | 4 | |a opportunistic infections | |
| 700 | 1 | |a Ntwayagae, Ookeditse |e verfasserin |4 aut | |
| 700 | 1 | |a Suresh, Rachita |e verfasserin |4 aut | |
| 700 | 1 | |a Ngoni, Kebatshabile |e verfasserin |4 aut | |
| 700 | 1 | |a Northcott, Cassie |e verfasserin |4 aut | |
| 700 | 1 | |a Penny, James |e verfasserin |4 aut | |
| 700 | 1 | |a Kinsella, Matthew |e verfasserin |4 aut | |
| 700 | 1 | |a Mechie, Imogen |e verfasserin |4 aut | |
| 700 | 1 | |a Ensor, Samuel |e verfasserin |4 aut | |
| 700 | 1 | |a Thamae, Goitseone |e verfasserin |4 aut | |
| 700 | 1 | |a Leeme, Tshepo |e verfasserin |4 aut | |
| 700 | 1 | |a Lawrence, David S |e verfasserin |4 aut | |
| 700 | 1 | |a Chebani, Tony |e verfasserin |4 aut | |
| 700 | 1 | |a Grint, Daniel |e verfasserin |4 aut | |
| 700 | 1 | |a Tenforde, Mark W |e verfasserin |4 aut | |
| 700 | 1 | |a Avalos, Ava |e verfasserin |4 aut | |
| 700 | 1 | |a Ramaabya, Dinah |e verfasserin |4 aut | |
| 700 | 1 | |a Ogando, Justus |e verfasserin |4 aut | |
| 700 | 1 | |a Mokomane, Margaret |e verfasserin |4 aut | |
| 700 | 1 | |a Mine, Madisa |e verfasserin |4 aut | |
| 700 | 1 | |a Jarvis, Joseph N |e verfasserin |4 aut | |
| 773 | 0 | 8 | |i Enthalten in |t Clinical infectious diseases : an official publication of the Infectious Diseases Society of America |d 1992 |g (2024) vom: 08. Feb. |w (DE-627)NLM012603007 |x 1537-6591 |7 nnns |
| 773 | 1 | 8 | |g year:2024 |g day:08 |g month:02 |
| 856 | 4 | 0 | |u http://dx.doi.org/10.1093/cid/ciae066 |3 Volltext |
| 912 | |a GBV_USEFLAG_A | ||
| 912 | |a GBV_NLM | ||
| 951 | |a AR | ||
| 952 | |j 2024 |b 08 |c 02 | ||