10 year Roadmap by 2025 David W. Denning President GAFFI The University of Manchester

GAFFI is calling for: By 2025, ensure that 95% of people with serious fungal disease are diagnosed and 95% treated

Deaths from fungal infection need to fall Fungal InfectionTB (2013)Malaria (2013) >1,350,0001,500,000627,000

1.5 million deaths from AIDS in ,000 due to TB 700,000 due to fungal disease?

Diagnosis Ensure that affordable diagnostic tests for all common and uncommon fungal infections are made available and focused on rapid, non- culture testing.

GAFFI is calling for: At least one expert in fungal disease diagnostics in each country. The focus should be on non-culture-based tests. Strong clinical links are very important.

Core tests for mycology reference laboratories

Treatment – GAFFI’s aim Ensure distribution of antifungal agents on the WHO Essential Medicine List to reach all those who need them.

WHO Essential Medicines List Griseofulvin Fluconazole Amphotericin B Flucytosine Topicals GAFFI has applied for itraconazole to be added

GAFFI is calling for: a network of expert clinicians and ‘train the trainer’ programs, supported by clinical guidelines, in each country and region

ISHAM members and mycology experts need to grasp these issues and try and impact on clinical practice across the world and in each part of each country

Public health Public health mycology is a non-existent discipline, which needs fostering by Schools of Public Health, scholarship programs, development of surveillance networks and incorporation into mainstream global health institutions.

Global public health and fungal diseases WHO Cryptococcal/HIV guidelines (2013/5) Amphotericin B and flucytosine placed on WHO Essential Medicine List (2013) Mycetoma accepted as Neglected Tropical Disease (2013) WHO skin and oral health in HIV guidelines (2014)

Global public health and fungal diseases WHO Cryptococcal/HIV guidelines (2013/5) Amphotericin B and flucytosine placed on WHO Essential Medicine List (2013) Mycetoma accepted as Neglected Tropical Disease (2013) WHO skin and oral health in HIV guidelines (2014) Very few national surveillance programs DALYs and QALYs only for cryptococcal meningitis GBD/IHME efforts have ignored all fungal diseases Economic modelling only for invasive mycoses in high income countries

Support Reduce AIDS deaths to <500,000 by 2020 Focus on the commonest lethal fungal infections - cryptococcal meningitis, Pneumocystis pneumonia, disseminated histoplasmosis and chronic pulmonary aspergillosis after tuberculosis A major goal is to reduce AIDS deaths due to fungal infections

Reducing AIDS deaths due to fungal infections:

Universal access to diagnostics for serious fungal disease Universal access to antifungal agents Accurate data on the number and severity of fungal infections Health professional education related to better recognition and care for patients with serious fungal disease Friends of GAFFI - our 4 tasks

‘Leave no one behind’ Too many people have no access to life- saving diagnostics and antifungal medicine This has to change