among HIV Patients Initiating ART in Rural HIV Clinics with Regular Absence of CD4 Testing Services in Tanzania Gladys Mbwanji Diana Faini Amina Nyuri Andrew Katende Aneth V Kalinjuma ID: 627065
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Implementing CRAG Screening among HIV Patients Initiating ART in Rural HIV Clinics with Regular Absence of CD4 Testing Services in Tanzania
Gladys Mbwanji
Diana Faini, Amina
Nyuri
, Andrew Katende,
Aneth
V
Kalinjuma
,
Dorcas
Mnzava
,
Maja
Weisser
,
David
Boulware,Emilio
Letang,
on behalf of the KIULARCO Study GroupSlide2
AIMSTo determine the CRAG prevalence in Kilombero district, rural southwest of Tanzania.To demonstrate feasibility of integrating point -of-care CRAG screening and pre-emptive antifungal therapy in routine HIV care in rural clinics regardless of
availability of CD4 testing facilities
.
To demonstrate survival improvement for cryptococcal meningitis after implementation of optimal therapy at the district’s referral center.Slide3
METHODSSummary of the CRAG screening algorithm
Study area and recruitment sitesSlide4
Variablen
%
CRAG Testing site (n = 943)
Patients from peripheral
clinics
514
54.5
Patients from referral hospital
429
45.6CRAG prevalence by testing site454.8From peripheral clinics (no CD4)244.7From referral center (CD4 guided lab-reflex CRAG testing)214.9CSF CRAGPositive2146.7Negative2044.4LP not done48.9Treatment, CRAG+ no CM (n=24) No fluconazole312.52 wks of fluconazole Induction course 1666.72wks fluconazole induction +8wks consolidation1041.7ART1145.8Outcomes at 6mo CRAG+ no CM (n=24) Died 1770.8Alive729.2
RESULTSSlide5
Variablen
%
Presence of neurological symptoms among those with meningitis (n=21)
Yes
18
85.7
None
3
14.3
Treatment among those with meningitis (n=21)Fluconazole monotherapy 314.3Fluconazole + short course Ampho B 1885.7ART1361.9Cumulative Mortality Incidence among those with meningitis2 weeks 419.010 weeks 942.96 months 1361.9RESULTSSlide6
Our CRAG screening algorithm tailored for rural Tanzanian HIV clinics was effective in improving cryptococcal detection among HIV patients enrolling into care in spite the of lack of CD4 testing services.
Universal CRAG screening at the time of ART initiation is a feasible and cost-effective strategy that could maximize clinical outcomes in rural
sub-Saharan Africa
only
if coupled with a reliable governmental supply of
fluconazole.
CONCLUSIONS