Improving meningitis survival among people living with AIDS in Tanzania

Maximising meningitis detection and prompt referral in a rural district

Scientific version
  • Researchers:
    Dr David Boulware, Dr Diana Faini, Dr Emilio Letang
  • Start Date:
    14 May 2015
  • Category:
    Treatment
  • Location:
    Ifakara Health Institute, Ifakara, Tanzania
Improving meningitis survival among people living with AIDS in Tanzania

What is this project about?

Cryptococcal meningitis is the most common cause of meningitis among people with AIDS, affecting 1 million people annually, 75% of them in sub-Saharan Africa. It is caused by a fungus that commonly occurs in the environment and its symptoms usually present before or right after starting anti-retroviral treatment.

In Tanzania 7 out of every 10 patients with the infection die, mostly because clinicians rarely suspect the disease and the basic tests to quickly confirm the infection are widely unavailable in the clinics.
This project aims to demonstrate that provision of the affordable test kits to clinics and training of clinicians on when to suspect cryptococcal meningitis, will lead to earlier diagnosis. The team will also demonstrate that prompt referral of infected patients to secondary-level health facilities stocked with recommended antifungal medicines will improve treatment outcomes.

Why is it important?

The World Health Organisation (WHO) already recommends screening HIV patients for cryptococcal antigen (CRAG) to increase early detection and early treatment before illness advances. However, challenges remain on the best way to scale-up CRAG screening through a simple approach that can be incorporated into the already overburdened routine HIV care in resource-constrained areas.

In addition, cryptococcal meningitis mortality in sub Saharan Africa is partially as a result of unavailability of Amphotericin B, the first line anti cryptococcal therapy – it is expensive and has associated toxicities and side effects. In contrast a shortened dose of Amphotericin B combined with fluconazole has been shown to be more cost effective and has less toxicity.

Potential outcomes

If successful, this innovative approach could be scaled up to national level and subsequently incorporated into the routine national HIV care and treatment guidelines in Tanzania, as well as other resource limited settings.

Objectives

  • Demonstrate feasibility and cost-benefit of integrating point-of-care CRAG screening
  • In hospitals and clinics with CD4 testing available: CRAG testing of HIV positive people as well as HIV testing among hospitalised patientsIn clinics with no CD4 testing services: Using WHO clinical staging or presence of meningitis symptoms as criteria for CRAG screening
  • Demonstrate survival improvement for cryptococcal meningitis after implementation of optimal antifungal therapy
  • Demonstrate the impact of a structure referral system for pateitns with meningitis in improving the outcomes of disease