ArticleJournal of acquired immune deficiency syndromes (1999)2016
Implementation and Operational Research: Evaluation of a Public-Sector, Provider-Initiated Cryptococcal Antigen Screening and Treatment Program, Western Cape, South Africa.
Article in Journal of acquired immune deficiency syndromes (1999), 2016. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 20 papers, 2 of them syntheses that pooled it.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
20 citing papers in PubMed, 2 syntheses or guidelines pooled it, 33 citations in OpenAlex.
- Pooled it
- CD4 Cell Count Threshold for Cryptococcal Antigen Screening of HIV-Infected Individuals: A Systematic Review and Meta-analysis.Clinical infectious diseases : an official publication of the Infectious Diseases Society of America · 2018Pooled it
- Reflexive Laboratory-Based Cryptococcal Antigen Screening and Preemptive Fluconazole Therapy for Cryptococcal Antigenemia in HIV-Infected Individuals With CD4 <100 Cells/µL: A Stepped-Wedge, Cluster-Randomized Trial.Journal of acquired immune deficiency syndromes (1999) · 2019Trial
- Reflexed cryptococcal antigenaemia detection rates in the Western Cape, South Africa.Southern African journal of HIV medicine · 2025Article
- Economic impact of extending reflexed cryptococcal antigenaemia CD4 threshold in South Africa.Southern African journal of HIV medicine · 2024Article
- Prevalence and Sequelae of Cryptococcal Antigenemia in Antiretroviral Therapy-Experienced Populations: An Evaluation of Reflex Cryptococcal Antigen Screening in Botswana.Clinical infectious diseases : an official publication of the Infectious Diseases Society of America · 2021Article
- Establishing targets for advanced HIV disease: A call to action.Southern African journal of HIV medicine · 2021Article
- Continuous quality improvement in HIV and TB services at selected healthcare facilities in South Africa.Southern African journal of HIV medicine · 2021Review
- Asymptomatic cryptococcal antigenemia in HIV-infected patients: a review of recent studies.Chinese medical journal · 2020Review
- Cryptococcal Antigenemia in Human Immunodeficiency Virus Antiretroviral Therapy-Experienced Ugandans With Virologic Failure.Clinical infectious diseases : an official publication of the Infectious Diseases Society of America · 2020Article
- The Continuing Value of CD4 Cell Count Monitoring for Differential HIV Care and Surveillance.JMIR public health and surveillance · 2019Article
- Laboratory-Reflex Cryptococcal Antigen Screening Is Associated With a Survival Benefit in Tanzania.Journal of acquired immune deficiency syndromes (1999) · 2019Article
- Southern African HIV Clinicians Society guideline for the prevention, diagnosis and management of cryptococcal disease among HIV-infected persons: 2019 update.Southern African journal of HIV medicine · 2019Article
- Pathways to care and outcomes among hospitalised HIV-seropositive persons with cryptococcal meningitis in South Africa.PloS one · 2019Article
- Cryptococcal Meningitis Diagnostics and Screening in the Era of Point-of-Care Laboratory Testing.Journal of clinical microbiology · 2019Review
- A qualitative evaluation of an implementation study for cryptococcal antigen screening and treatment in Uganda.Medicine · 2018Observational
- A Prospective Evaluation of a Multisite Cryptococcal Screening and Treatment Program in HIV Clinics in Uganda.Journal of acquired immune deficiency syndromes (1999) · 2018Article
- The Continuing Burden of Advanced HIV Disease Over 10 Years of Increasing Antiretroviral Therapy Coverage in South Africa.Clinical infectious diseases : an official publication of the Infectious Diseases Society of America · 2018Article
- Cost-effectiveness of CRAG-LFA screening for cryptococcal meningitis among people living with HIV in Uganda.BMC infectious diseases · 2017Article
- Article
Corrections and comments
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Authors and funding
10 authors at 5 institutions in 3 countries.
Funding
Abstract
backgroundScreening for serum cryptococcal antigen (CrAg) may identify those at risk for disseminated cryptococcal disease (DCD), and preemptive fluconazole treatment may prevent progression to DCD. In August 2012, the Western Cape Province (WC), South Africa, adopted provider-initiated CrAg screening. We evaluated the implementation and effectiveness of this large-scale public-sector program during its first year, September 1, 2012-August 31, 2013.
methodsWe used data from the South African National Health Laboratory Service, WC provincial HIV program, and nationwide surveillance data for DCD. We assessed the proportion of eligible patients screened for CrAg (CrAg test done within 30 days of CD4 date) and the prevalence of CrAg positivity. Incidence of DCD among those screened was compared with those not screened.
resultsOf 4395 eligible patients, 26.6% (n = 1170) were screened. The proportion of patients screened increased from 15.9% in September 2012 to 36.6% in August 2013. The prevalence of positive serum CrAg was 2.1%. Treatment data were available for 13 of 24 CrAg-positive patients; 9 of 13 were treated with fluconazole. Nine (0.8%) incident cases of DCD occurred among the 1170 patients who were screened for CrAg vs. 49 (1.5%) incident cases among the 3225 patients not screened (P = 0.07).
conclusionsRelatively few eligible patients were screened under the WC provider-initiated CrAg screening program. Unscreened patients were nearly twice as likely to develop DCD. CrAg screening can reduce the burden of DCD, but needs to be implemented well. To improve screening rates, countries should consider laboratory-based reflexive screening when possible.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.