Adherence Screening for cryptococcal meningitis and adherence support reduce mortality among people starting ART in Africa

Michael Carter
Original Article:

Screening and treatment for cryptococcal meningitis combined with a short period of adherence support has the potential to significantly reduce mortality rates among people with very low CD4 counts starting antiretroviral therapy (ART) in resource-limited settings, investigators report in The Lancet.

Twelve-month mortality rates were 28% lower for patients who received the enhanced care package including meningitis screening/treatment and adherence support compared to individuals who received the standard of care.

“Just four short home visits by lay workers to provide adherence support combined with screening for cryptococcal meningitis led to a significant reduction in mortality in patients infected with HIV starting ART with advanced disease,” comment the investigators. “The trial was large, done under real-life conditions, had a low loss to follow-up.”

Approximately 10 million people are now receiving ART in Africa. High loss to follow-up and mortality rates have been observed in this setting. Often, patients have a very low CD4 count when they start therapy and many deaths during the first year of ART are due to tuberculosis (TB) and cryptococcal meningitis.

An international team of investigators wanted to see if antigen screening and pre-emptive anti-fungal treatment for cryptococcal meningitis coupled with adherence support from lay workers reduced short-term mortality rates among people starting antiretroviral therapy.

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