Original Research

Prevalence of cryptococcal antigen (CrAg) among HIV-positive patients in Eswatini, 2014–2015

Samson M. Haumba, Mitsuru Toda, Rossana Jeffries, Peter Ehrenkranz, Munyaradzi Pasipamire, Trong Ao, Nomthandazo Lukhele, Sikhathele Mazibuko, Mandzisi Mkhontfo, Rachel M. Smith, Tom Chiller
African Journal of Laboratory Medicine | Vol 9, No 1 | a933 | DOI: https://doi.org/10.4102/ajlm.v9i1.933 | © 2020 Samson M. Haumba, Mitsuru Toda, Rossana Jeffries, Peter Ehrenkranz, Munyaradzi Pasipamire, Trong Ao, Nomthandazo Lukhele, Sikhathele Mazibuko, Mandzisi Mkhontfo, Rachel M. Smith, Tom Chiller | This work is licensed under CC Attribution 4.0
Submitted: 05 November 2018 | Published: 29 July 2020

About the author(s)

Samson M. Haumba, University Research Co., LLC, Mbabane, Eswatini
Mitsuru Toda, Epidemic 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, Georgia, United States
Rossana Jeffries, University Research Co., LLC, Mbabane, United Kingdom
Peter Ehrenkranz, Global Development, Bill and Melinda Gates Foundation, Seattle, Washington, United States
Munyaradzi Pasipamire, Ministry of Health Eswatini National AIDS Programme (ENAP), Mbabane, Eswatini
Trong Ao, Centers for Disease Control and Prevention (CDC), Mbabane, Eswatini
Nomthandazo Lukhele, Ministry of Health Eswatini National AIDS Programme (ENAP), Mbabane, Eswatini
Sikhathele Mazibuko, Ministry of Health Eswatini National AIDS Programme (ENAP), Mbabane, Eswatini
Mandzisi Mkhontfo, University Research Co., LLC, Mbabane, Eswatini
Rachel M. Smith, 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, Georgia, United States
Tom Chiller, 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, Georgia, United States


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Abstract

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.


Keywords

cryptococcal antigenaemia screening; prevalence; people living with HIV; cryptococcal meningitis; advanced HIV disease package; Eswatini

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