ArticleJournal of acquired immune deficiency syndromes (1999)2025
Effectiveness of a National Reflex Laboratory Cryptococcal Antigen Screening Program for People With Advanced HIV Disease in South Africa: A Nationwide-Sampled Cohort Study (CAST-NET).
Article in Journal of acquired immune deficiency syndromes (1999), 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
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.
The trial behind it
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.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
2 citing papers in PubMed.
- Ten years on: Ongoing challenges in screening for cryptococcal antigenaemia in people with advanced HIV disease in South Africa.Southern African journal of HIV medicine · 2026Article
- Operationalizing the WHO Blueprint for Fungal Disease and Antifungal Resistance in Fragile Health Systems: Insights from Somalia.Infection and drug resistance · 2026Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
10 authors.
Funding
Abstract
backgroundCryptococcal antigen (CrAg) screening and pre-emptive treatment of antigenemia can reduce mortality among people living with HIV.
settingWe evaluated the effectiveness of a national CrAg screening program in South Africa.
methodsWe enrolled a retrospective cohort of adults aged ≥18 years with a CD4 count <100 cells/µL and new antigenemia diagnosis at 442 facilities in a stratified-random sample of 27 subdistricts, 2017-2019. We determined a composite outcome of incident cryptococcal meningitis or death through 6 months.
resultsOverall, 99% (85,791/86,274) of eligible patients had CrAg testing in the study subdistricts; 5124 (6.0%) tested CrAg positive. Among 1651 with imaged medical records and without concurrent meningitis, 76% (1261/1651) were outpatients. CrAg results were documented in records for 75% (1245/1651). Only 39% (649/1651) had a meningitis symptom review documented at a median of 14 days (IQR, 5-44) from their CrAg blood draw. Fluconazole was dispensed for 50% (827/1651) but only 32% (523/1651) had an adequate daily dose of ≥800 mg dispensed. The proportion with meningitis or death within 6 months was 23% (382/1651; 95% CI: 19% to 27%). Hospitalized patients had a 2.29 higher adjusted odds of meningitis/death within 6 months vs. outpatients (95% CI: 1.72 to 3.04; P < 0.001).
conclusionsNationwide reflex laboratory CrAg screening was successfully implemented. However, challenges existed for health care providers to act on positive CrAg results to exclude meningitis and dispense pre-emptive antifungal therapy. Our findings emphasize the critical need for improved linkage from reflex CrAg screening to clinical care, in both ambulatory and in-patient settings, to maintain the effectiveness of this intervention.
Indexed as
Identifiers
What OpenQuestion holds
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.