Prevalence of cryptococcal antigen (CrAg) among HIV-positive patients in Eswatini, 2014–2015
Background: Cryptococcal meningitis is a leading cause of death amongst people living with HIV. However, routine cryptococcal antigen (CrAg) screening was not in the national guidelines in Eswatini. Objectives: A cross-sectional study was conducted between August 2014 and March 2015 to examine CrAg...
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| Format: | Article |
| Language: | English |
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AOSIS
2020-07-01
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| Series: | African Journal of Laboratory Medicine |
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| Online Access: | https://ajlmonline.org/index.php/ajlm/article/view/933 |
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| author | Samson M. Haumba Mitsuru Toda Rossana Jeffries Peter Ehrenkranz Munyaradzi Pasipamire Trong Ao Nomthandazo Lukhele Sikhathele Mazibuko Mandzisi Mkhontfo Rachel M. Smith Tom Chiller |
| author_facet | Samson M. Haumba Mitsuru Toda Rossana Jeffries Peter Ehrenkranz Munyaradzi Pasipamire Trong Ao Nomthandazo Lukhele Sikhathele Mazibuko Mandzisi Mkhontfo Rachel M. Smith Tom Chiller |
| author_sort | Samson M. Haumba |
| collection | DOAJ |
| description | Background: Cryptococcal meningitis is a leading cause of death amongst people living with HIV. However, routine cryptococcal antigen (CrAg) screening was not in the national guidelines in Eswatini.
Objectives: A cross-sectional study was conducted between August 2014 and March 2015 to examine CrAg prevalence at Mbabane Government Hospital in Eswatini.
Methods: We collected urine and whole blood from antiretroviral-therapy-naïve patients with HIV and a cluster of differentiation 4 (CD4) counts 200 cells/mm3 for plasma and urine CrAg lateral flow assay (LFA) screening at the national HIV reference laboratory. Two CD4 cut-off points were used to estimate CrAg prevalence: CD4 100 and 200 cells/mm3. Sensitivity and specificity of urine CrAg LFA was compared to plasma CrAg LFA.
Results: Plasma CrAg prevalence was 4% (8/182, 95% confidence interval [CI]: 2–8) amongst patients with CD4 counts of 200 cells/mm3, and 8% (8/102, 95% CI: 3–15) amongst patients with CD4 counts of 100 cells/mm3. Urine CrAg LFA had a sensitivity of 100% (95% CI: 59–100) and a specificity of 80% (95% CI: 72–86) compared with plasma CrAg LFA tests for patients with CD4 200 cells/mm3. Forty-three per cent of 99 patients with CD4 100 were at World Health Organization clinical stages I or II.
Conclusion: The prevalence of CrAg in Eswatini was higher than the current global estimate of 6% amongst HIV-positive people with CD4 100 cell/mm3, indicating the importance of initiating a national screening programme. Mechanisms for CrAg testing, training, reporting, and drug and commodity supply issues are important considerations before national implementation. |
| first_indexed | 2024-12-12T10:48:13Z |
| format | Article |
| id | doaj.art-8013ac07720b4c1c9bb1213ac7f1ddb3 |
| institution | Directory Open Access Journal |
| issn | 2225-2002 2225-2010 |
| language | English |
| last_indexed | 2024-12-12T10:48:13Z |
| publishDate | 2020-07-01 |
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| series | African Journal of Laboratory Medicine |
| spelling | doaj.art-8013ac07720b4c1c9bb1213ac7f1ddb32022-12-22T00:26:50ZengAOSISAfrican Journal of Laboratory Medicine2225-20022225-20102020-07-0191e1e710.4102/ajlm.v9i1.933262Prevalence of cryptococcal antigen (CrAg) among HIV-positive patients in Eswatini, 2014–2015Samson M. Haumba0Mitsuru Toda1Rossana Jeffries2Peter Ehrenkranz3Munyaradzi Pasipamire4Trong Ao5Nomthandazo Lukhele6Sikhathele Mazibuko7Mandzisi Mkhontfo8Rachel M. Smith9Tom Chiller10University Research Co., LLC, MbabaneEpidemic Intelligence Service (EIS), Division of Scientific Education and Professional Development, Center for Surveillance, Epidemiology, and Laboratory Services (CSELS), Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, United States; and, Mycotic Diseases Branch (MDB), Division of Foodborne, Waterborne, and Environmental Disease (DFWED), National Center for Emerging and Zoonotic Infectious Diseases (NCEZID), Centers for Disease Control and Prevention (CDC), Atlanta, GeorgiaUniversity Research Co., LLC, MbabaneGlobal Development, Bill and Melinda Gates Foundation, Seattle, WashingtonMinistry of Health Eswatini National AIDS Programme (ENAP), MbabaneCenters for Disease Control and Prevention (CDC), MbabaneMinistry of Health Eswatini National AIDS Programme (ENAP), MbabaneMinistry of Health Eswatini National AIDS Programme (ENAP), MbabaneUniversity Research Co., LLC, MbabaneMycotic Diseases Branch (MDB), Division of Foodborne, Waterborne, and Environmental Disease (DFWED), National Center for Emerging and Zoonotic Infectious Diseases (NCEZID), Centers for Disease Control and Prevention (CDC), Atlanta, GeorgiaMycotic Diseases Branch (MDB), Division of Foodborne, Waterborne, and Environmental Disease (DFWED), National Center for Emerging and Zoonotic Infectious Diseases (NCEZID), Centers for Disease Control and Prevention (CDC), Atlanta, GeorgiaBackground: Cryptococcal meningitis is a leading cause of death amongst people living with HIV. However, routine cryptococcal antigen (CrAg) screening was not in the national guidelines in Eswatini. Objectives: A cross-sectional study was conducted between August 2014 and March 2015 to examine CrAg prevalence at Mbabane Government Hospital in Eswatini. Methods: We collected urine and whole blood from antiretroviral-therapy-naïve patients with HIV and a cluster of differentiation 4 (CD4) counts 200 cells/mm3 for plasma and urine CrAg lateral flow assay (LFA) screening at the national HIV reference laboratory. Two CD4 cut-off points were used to estimate CrAg prevalence: CD4 100 and 200 cells/mm3. Sensitivity and specificity of urine CrAg LFA was compared to plasma CrAg LFA. Results: Plasma CrAg prevalence was 4% (8/182, 95% confidence interval [CI]: 2–8) amongst patients with CD4 counts of 200 cells/mm3, and 8% (8/102, 95% CI: 3–15) amongst patients with CD4 counts of 100 cells/mm3. Urine CrAg LFA had a sensitivity of 100% (95% CI: 59–100) and a specificity of 80% (95% CI: 72–86) compared with plasma CrAg LFA tests for patients with CD4 200 cells/mm3. Forty-three per cent of 99 patients with CD4 100 were at World Health Organization clinical stages I or II. Conclusion: The prevalence of CrAg in Eswatini was higher than the current global estimate of 6% amongst HIV-positive people with CD4 100 cell/mm3, indicating the importance of initiating a national screening programme. Mechanisms for CrAg testing, training, reporting, and drug and commodity supply issues are important considerations before national implementation.https://ajlmonline.org/index.php/ajlm/article/view/933cryptococcal antigenaemia screeningprevalencepeople living with hivcryptococcal meningitisadvanced hiv disease packageeswatini |
| spellingShingle | Samson M. Haumba Mitsuru Toda Rossana Jeffries Peter Ehrenkranz Munyaradzi Pasipamire Trong Ao Nomthandazo Lukhele Sikhathele Mazibuko Mandzisi Mkhontfo Rachel M. Smith Tom Chiller Prevalence of cryptococcal antigen (CrAg) among HIV-positive patients in Eswatini, 2014–2015 African Journal of Laboratory Medicine cryptococcal antigenaemia screening prevalence people living with hiv cryptococcal meningitis advanced hiv disease package eswatini |
| title | Prevalence of cryptococcal antigen (CrAg) among HIV-positive patients in Eswatini, 2014–2015 |
| title_full | Prevalence of cryptococcal antigen (CrAg) among HIV-positive patients in Eswatini, 2014–2015 |
| title_fullStr | Prevalence of cryptococcal antigen (CrAg) among HIV-positive patients in Eswatini, 2014–2015 |
| title_full_unstemmed | Prevalence of cryptococcal antigen (CrAg) among HIV-positive patients in Eswatini, 2014–2015 |
| title_short | Prevalence of cryptococcal antigen (CrAg) among HIV-positive patients in Eswatini, 2014–2015 |
| title_sort | prevalence of cryptococcal antigen crag among hiv positive patients in eswatini 2014 2015 |
| topic | cryptococcal antigenaemia screening prevalence people living with hiv cryptococcal meningitis advanced hiv disease package eswatini |
| url | https://ajlmonline.org/index.php/ajlm/article/view/933 |
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