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Cryptococcosis Preventing a Deadly Fungal Disease Together THANK YOU.

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Presentation on theme: "Cryptococcosis Preventing a Deadly Fungal Disease Together THANK YOU."— Presentation transcript:

1 Cryptococcosis Preventing a Deadly Fungal Disease Together THANK YOU

2 Round table programme update: Cryptococcosis Preventing a Deadly Fungal Disease TimeTitleSpeaker 17:30-17:45Diagnosis of Cryptococcus: From the lab to the field Dr. Nelesh Govender (NICD) 17:45-18:05Lateral flow assay demonstrationSean Bauman (Immy) 18:05-18:20The South African Screening program Dr. Samuel Oladoyinbo (CDC South Africa) Dr. Thapelo Maotoe (USAID South Africa) 18:20-18:35Clinical managementGraeme Meintjes (University of Cape Town) 18:35-18:50Cryptococcal screening in UgandaDavid Meya (Makerere University) David Boulware (University of Minnesota) 18:50-19:00Q&AAll

3 Diagnosis of Cryptococcus: From the lab to the field Nelesh Govender National Institute for Communicable Diseases and University of the Witwatersrand, Johannesburg

4 Estimated causes of death in sub-Saharan Africa, excluding HIV, 2009 Death from cryptococcal meningitis in sub-Saharan Africa

5 Pathogenesis of disease

6 How cryptococcal screening works Identify HIV-infected patients with CD4<100 Test for cryptococcal antigenaemia before symptom onset Treat with oral fluconazole Prevent cryptococcal meningitis and deaths Pre-emptive fluconazole CrAg+ No symptoms Cryptococcal meningitis

7 Conventional diagnostic tests

8 Expanded range of diagnostic tests WHO ASSURED criteria India inkCultureLALFAEIA Affordable++++++++++++++ Sensitive73% - 94%Reference90% - 100%98% - 100%93% - 100% Specific95% - 100%Reference83% -100%95% - 100%93% - 100% User-friendly+++++ +++++ Rapid and robust5 minDays35 min10 minHours Equipment-free+++++++++++ Delivered++++++++++++ WHO Rapid Advice Guidelines. December 2011.

9 Cryptococcal lateral flow assay Sean Bauman, IMMY

10 LFA performance as a diagnostic test Thokozile Gloria Zulu – FRIDAY, 7 NOVEMBER

11 A comprehensive screening programme Who should be screened and where? Develop clinical algorithm Integrate screening into ART and TB programmes Train healthcare personnel Educate patients Perform monitoring and evaluation to determine effectiveness

12

13 1. REFLEX LABORATORY SCREENING SCREENING STRATEGIES

14 NHLS CD4 lab footprint

15 Reflex Laboratory Screening

16

17 NHLS-CMJAH CD4 lab node and 25 facilities

18 2. CLINICIAN-INITIATED LABORATORY SCREENING SCREENING STRATEGIES

19

20 3. CLINICIAN-INITIATED POINT-OF- CARE SCREENING SCREENING STRATEGIES

21 Point-of-care testing LFA is being validated for use in whole blood and/or urine – Diagnostic test for meningitis (n=295) Whole blood: 99% sensitive; 100% specific Urine: 95% sensitive; 100% specific – Screening 100% correlation with whole blood and plasma in CD4 lab Finger prick whole blood testing underway for screening Could occur in combination with POC CD4 testing or with clinical WHO staging in settings where POC CD4 testing is not available CrAg-positive patients still need referral for LP Advantage: minimises patient loss to follow-up and treatment delays Disadvantage: lack of quality control, requires clinician awareness

22 Summary Screening can detect cryptococcal disease earlier and prevent deaths The simple, quick and accurate lateral flow assay expands the number of implementation strategies for screening The choice of screening strategy depends on infrastructure, clinician practices and ability to train

23 Acknowledgements Members of the South African Cryptococcal Screening Initiative Group: National Department of Health: Yogan Pillay, Thobile Mbengashe; Gauteng Department of Health: Zukiswa Pinini, Lucky Hlatshwayo, Nobantu Mpela; Free State Department of Health: Yolisa Tsibolane; Right to Care: David Spencer, Inge Harlen, Barbara Franken, Shabir Banoo, Pappie Majuba, Ian Sanne; Wits Reproductive and HIV Research Institute: W.D. Francois Venter, Ambereen Jaffer, Bongiwe Zondo, Judith Mwansa, Andrew Black, Thilligie Pillay, Mamotho Khotseng, Vivian Black; Aurum: Dave Clark, Lauren de Kock; Health Systems Trust: Waasila Jassat, Richard Cooke, Petro Rousseau; Anova: James McIntyre, Kevin Rebe, Helen Struthers; BroadReach: Mpuma Kamanga, Mapule Khanye, Madaline Feinberg, Mark Paterson; Technical Advisors: Tom Chiller (CDC Atlanta), Monika Roy (CDC Atlanta), Joel Chehab (CDC Atlanta), Ola Oladoyinbo (CDC South Africa), Adeboye Adelakan (CDC South Africa), Thapelo Maotoe (USAID South Africa); Expert Clinicians: Jeffrey Klausner, Tom Harrison, Joseph Jarvis, Tihana Bicanic, Ebrahim Variawa, Nicky Longley, Robin Wood, Stephen Lawn, Linda-Gail Bekker, Gary Maartens, Francesca Conradie; Data Safety and Monitoring Committee: Graeme Meintjes, Yunus Moosa, Halima Dawood, Kerrigan McCarthy, Alan Karstaedt; National Health Laboratory Service: Wendy Stevens, Lindi Coetzee, Debbie Glencross, Denise Lawrie, Naseem Cassim, Floyd Olsen; National Institute for Communicable Diseases/NHLS: Verushka Chetty, Nelesh Govender.

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