Phased implementation of screening for cryptococcal disease in South Africa

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.