cryptococcal antigen screening in uganda
DESCRIPTION
Cryptococcal Antigen Screening in Uganda. David R Boulware MD MPH Radha Rajasingham MD David B Meya MMed. Infectious Disease Institute Makerere University. Etiologies of Meningitis in Africa. Cape Town, South Africa. Kampala, Uganda. Jarvis J et al. AIDS 2009. Unpublished 2006-2011 data. - PowerPoint PPT PresentationTRANSCRIPT
Cryptococcal Antigen Screening in Uganda
David R Boulware MD MPHRadha Rajasingham MD
David B Meya MMed
Infectious Disease Institute Makerere University
CryptococcusTBBacterialAseptic/Viral
Cape Town, South Africa Kampala, Uganda
CryptococcusTBBacterialAseptic/Viral
Jarvis J et al. AIDS 2009
Etiologies of Meningitis in Africa
Unpublished 2006-2011 data
0% 5% 10% 15% 20% 25%
Masaka, Uganda, CD4<200
Thailand (Rural), HIV+ pneumonia
Benin City, Nigeria, CD4<200
Bangkok, Thailand, CD4<100
Cape Town, South Africa, CD4<100
Cambodia, CD4<100
Kampala, Uganda, CD4<100, HIV clinic
Mbarara, Uganda, HIV clinic pop.
Tororo, Uganda, CD4<100
Kumasi, Ghana, CD4 <100
Kinshasa, DRC, HIV clinic pop.
Kisumu, Kenya, CD4<100
Kampala, Uganda, CD4<100
hospitalized
Cryptococcal Antigen (CrAg) Prevalence
Rhein J. Neurobehavioiral HIV Med 2012
Meya D. Clin Infect Dis 2010
Long Term Survival in Kampala
Butler E. et al. Submitted
CrAg Latex Agglutination
CrAg Lateral Flow Assay
No CrA
g Scre
ening
Cost Effectiveness
Rajasingham MOAB0102
Masaka, Uganda, CD4<200
Thailand (Rural), HIV+ pneumonia
Benin City, Nigeria, CD4<200
Bangkok, Thailand, CD4<100
Cape Town, South Africa, CD4<100
Cambodia, CD4<100
Kampala, Uganda, CD4<100, HIV clinic
Mbarara, Uganda, HIV clinic pop.
Tororo, Uganda, CD4<100
Kumasi, Ghana, CD4 <100
Kinshasa, DRC, HIV clinic pop.
Kisumu, Kenya, CD4<100
Kampala, Uganda, CD4<100
hospitalized
Cost per Life Saved by CrAg LFA Screening vs. Prevalence
Rhein J. Neurobehavioiral HIV Med 2012$2.50 CrAg LFA total test cost
• Conversely, the cost of hospitalization and 14 days of amphotericin for
treatment of cryptococcal meningitis is:– $425 per episode in Uganda [WEPE028]– $2883 per episode in South Africa
• Thus for the treatment costs of 1 cryptococcal meningitis episode, one could perform CRAG LFA screening on: – 170 persons in Uganda– 1153 persons in South Africa.
• Above a CRAG+ prevalence of 1%, pre-ART CRAG screening is COST SAVING compared to the cost of any Cryptococcal Meningitis treatment
CRAG Screening is Cost Saving
Rajasingham MOAB0102
CrAg Screening concept is great, but will it work in the
real world?
ORCAS Trial• Operational Research in CrAg Screening
• Multisite CrAg Screening Project in Uganda• Implementation Science• Stepped Wedge Design, RCT• Roll out over 2 years
IDI
CrAg Roll Out
Design Lab-reflex test +POC CD4Clinician-based
ORCAS Endpoints
• Primary: 6-month Survival
• Secondary: – Cryptococcal meningitis free survival time– Uptake of screening & pre-emptive treatment– Cost Effectiveness– Concordance between LFA & latex, other body
fluids
Multiple ORCAS Partners
• Infectious Disease Institute– David Meya, Radha Rajasingham, Yuka Manabe
• University of Minnesota– David Boulware, Melissa Rolfes, Josh Rhein
• CDC and CDC-Uganda– Jonathan Kaplan, Emmy Bangizi Muramuzi,
Anthony Mukasa Mubiru, Ben Park, et al.