Editorial

Phased implementation of screening for cryptococcal disease in South Africa

Nelesh Premapragasan Govender, Verushka Chetty, Monika Roy, Tom Chiller, Samuel Oladoyinbo, Thapelo Maotoe, Wendy S Stevens, Zukiswa Pinini, David Spencer, W D Francois Venter, Waasila Jassat, David Cameron, Graeme Meintjes, Thobile Mbengashe, Yogan Pillay

Abstract


In South Africa, the incidence of HIV-associated cryptococcal meningitis remains high despite the increased coverage of antiretroviral treatment, and in routine care settings, the disease is associated with a case-fatality ratio of more than 50%. Laboratory-based screening and pre-emptive antifungal treatment of cryptococcal disease have been suggested for routine implementation as part of the National Strategic Plan for HIV, STIs and TB, 2012 - 2016. In the first phase of a national screening programme, screening will begin at almost 500 healthcare facilities in the Gauteng and Free State provinces, and NHLS laboratories will reflexively test the remnant specimen of any blood sample with a CD4+ T-lymphocyte count <100 cells/µl for cryptococcal antigen using a lateral flow assay. A clinical treatment algorithm has been developed to guide patient management at a primary healthcare level. Screening should be prioritised across the country, because the programme has the potential to significantly impact on the burden of disease and deaths associated with cryptococcal meningitis.

Authors' affiliations

Nelesh Premapragasan Govender, National Institute for Communicable Diseases, a Division of the National Health Laboratory Service - Centre for Opportunistic, Tropical and Hospital Infections and Faculty of Health Sciences, University of the Witwatersrand, Johannesburg

Verushka Chetty, National Institute for Communicable Diseases, a Division of the National Health Laboratory Service – Centre for Opportunistic, Tropical and Hospital Infections, Johannesburg

Monika Roy, Mycotic Diseases Branch, Centers for Disease Control and Prevention, Atlanta

Tom Chiller, Mycotic Diseases Branch, Centers for Disease Control and Prevention, Atlanta

Samuel Oladoyinbo, Care and Treatment Branch, Centers for Disease Control and Prevention, Pretoria

Thapelo Maotoe, Care and Treatment Branch, United States Agency for International Development, Pretoria

Wendy S Stevens, National Priority Programmes Unit, National Health Laboratory Service and Department of Molecular Medicine and Haematology, University of the Witwatersrand, Johannesburg

Zukiswa Pinini, HIV/AIDS and STIs Directorate, Gauteng Department of Health, Johannesburg

David Spencer, Right to Care, Johannesburg

W D Francois Venter, WITS Reproductive Health and HIV Institute and Department of Medicine, University of the Witwatersrand, Johannesburg

Waasila Jassat, Health Systems Trust, Midrand

David Cameron, Foundation for Professional Development, Pretoria

Graeme Meintjes, Institute of Infectious Diseases and Molecular Medicine and Department of Medicine, University of Cape Town, and Department of Medicine, Imperial College London, UK

Thobile Mbengashe, National Department of Health, Pretoria

Yogan Pillay, National Department of Health, Pretoria

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Cite this article

South African Medical Journal 2012;102(12):914-917. DOI:10.7196/SAMJ.6228

Article History

Date submitted: 2012-09-19
Date published: 2012-10-08

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