Original Research

An audit of the screen-and-treat intervention to reduce cryptococcal meningitis in HIV-positive patients with low CD4 count

Egide Ndayishimiye, Andrew J. Ross
African Journal of Primary Health Care & Family Medicine | Vol 10, No 1 | a1779 | DOI: https://doi.org/10.4102/phcfm.v10i1.1779 | © 2018 Ndayishimiye Egide, Andrew J. Ross | This work is licensed under CC Attribution 4.0
Submitted: 28 February 2018 | Published: 08 August 2018

About the author(s)

Egide Ndayishimiye, Health, College of Health Sciences, University of KwaZulu-Natal, Prince Mshiyeni Memorial Hospital, South Africa
Andrew J. Ross, Department of Family Medicine, School of Nursing and Public Health, College of Health Sciences, University of KwaZulu-Natal, South Africa


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Abstract

Background: HIV-associated cryptococcal meningitis (CCM) and related mortality may be prevented by the effective implementation of a screen-and-treat intervention.

 

Aim: The aim of this study was to assess the effectiveness of the screen-and-treat intervention at a regional hospital in KwaZulu-Natal province, South Africa.

 

Method: This was a descriptive study in which the records of patients seen in 2015 and 2016 with a CD4 count ≤ 100 cell/mm3 were retrieved from National Health Laboratory Service (NHLS) records and matched against patients admitted for HIV-associated CCM.

 

Results: A total of 5.1% (190 out of 3702) patients with CD4 count ≤ 100 cell/mm3 were cryptococcal antigen positive (CrAg +ve), of whom 22.6% (43 out of 190) were admitted with CCM. Patients who were CrAg +ve had significantly lower CD4 counts (mean CD4 = 38.9 ± 28.5) when compared to CrAg –ve patients (mean CD4 = 49.9 ± 37.4) with p = 0.0001. Only 2.6% (5 out of 190) of patients were referred for a lumbar puncture (LP) as part of the screen-and-treat intervention, whilst 38 who were CrAg +ve self-presented with CCM. Eighty-eight patients were admitted for suspected CCM: eight because of the screen-and-treat-intervention (none of whom had meningitis based on cerebrospinal fluid results) and 80 of whom self-presented and had confirmed CCM. The overall mortality of patients admitted with CCM was 30% (24 out of 80).

 

Conclusion: The current ad-hoc screen-and-treat intervention was ineffective in detecting patients at risk of developing CCM. Systems need to be put in place to ensure that all CrAg +ve patients have an LP to detect subclinical CCM to improve the outcome for those with HIV-associated CCM.


Keywords

HIV; cryptococcal meningitis; screen and treat; mortality outcome

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