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

Haumba, SM; Toda, M; Jeffries, R; Ehrenkranz, P; Pasipamire, M; Ao, T; Lukhele, N; Mazibuko, S; Mkhontfo, M; Smith, RM; Chiller, T

Journal article

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

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.

Publication status:: Published

Peer review status:: Peer reviewed

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APA Style

Haumba, S. M., Toda, M., Jeffries, R., Ehrenkranz, P., Pasipamire, M., Ao, T., Lukhele, N., Mazibuko, S., Mkhontfo, M., Smith, R. M., & Chiller, T. (2020). Prevalence of cryptococcal antigen (CrAg) among HIV-positive patients in Eswatini, 2014–2015. African Journal of Laboratory Medicine, 9(1).

MLA Style

Haumba, S. M., et al. “Prevalence of Cryptococcal Antigen (CrAg) among HIV-Positive Patients in Eswatini, 2014–2015.” African Journal of Laboratory Medicine, vol. 9, no. 1, AOSIS, 2020.

Chicago Style

Haumba, SM, M Toda, R Jeffries, P Ehrenkranz, M Pasipamire, T Ao, N Lukhele, et al. 2020. “Prevalence of Cryptococcal Antigen (CrAg) among HIV-Positive Patients in Eswatini, 2014–2015.” African Journal of Laboratory Medicine 9 (1).
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