دورية أكاديمية
Diagnostic capacity for invasive fungal infections in advanced HIV disease in Africa: a continent-wide survey.
| العنوان: | Diagnostic capacity for invasive fungal infections in advanced HIV disease in Africa: a continent-wide survey. |
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| المؤلفون: | Lakoh S; College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone., Kamudumuli PS; University of Maryland Global Initiative Corporation, Lilongwe, Malawi., Penney ROS; Global Action For Fungal Infections, Geneva, Switzerland., Haumba SM; Center for Global Health Practice and Impact, Georgetown University, Mbabane, Eswatini., Jarvis JN; Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK; Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana., Hassan AJ; National HIV/AIDS Program, Garowe, Puntland, Somalia., Moudoute NLE; Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon., Ocansey BK; Department of Medical Microbiology, University of Ghana Medical School, Accra, Ghana; Manchester Fungal Infection Group, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK., Izco S; Office of HIV/AIDS, Tuberculosis and Hepatitis, Ministry of Health and Social Welfare, Malabo, Equatorial Guinea., Kipkerich S; National Public Health Reference Laboratories, Ministry of Health, Nairobi, Kenya., Sacarlal J; Department of Microbiology, Faculty of Medicine, Universidade Eduardo Mondlane, Maputo, Mozambique., Awopeju AT; Department of Medical Microbiology and Parasitology, University of Port Harcourt, Port Harcourt, Nigeria., Govender NP; National Institute for Communicable Diseases, a Division of the National Health Laboratory Service, School of Pathology, University of the Witwatersrand, Johannesburg, South Africa; Division of Medical Microbiology, University of Cape Town, Cape Town, South Africa; Institute of Infection and Immunity, St George's University of London, London, UK; MRC Centre for Medical Mycology, University of Exeter, Exeter, UK., Munyanji CIM; Directorate of Health Laboratories, Ministry of Public Health, Hygiene and Prevention, Kinshasa, DR Congo., Guyguy K; Department of Microbiology, Kinshasa University Hospital, University of Kinshasa, Kinshasa, DR Congo., Orefuwa E; Global Action For Fungal Infections, Geneva, Switzerland., Denning DW; Global Action For Fungal Infections, Geneva, Switzerland; Manchester Fungal Infection Group, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK. Electronic address: ddenning@manchester.ac.uk. |
| المصدر: | The Lancet. Infectious diseases [Lancet Infect Dis] 2023 May; Vol. 23 (5), pp. 598-608. Date of Electronic Publication: 2022 Dec 21. |
| نوع المنشور: | Journal Article; Research Support, Non-U.S. Gov't |
| اللغة: | English |
| بيانات الدورية: | Publisher: Elsevier Science Country of Publication: United States NLM ID: 101130150 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1474-4457 (Electronic) Linking ISSN: 14733099 NLM ISO Abbreviation: Lancet Infect Dis Subsets: MEDLINE |
| أسماء مطبوعة: | Original Publication: New York, NY : Elsevier Science ; The Lancet Pub. Group, 2001- |
| مواضيع طبية MeSH: | HIV Infections*/complications , HIV Infections*/diagnosis , Histoplasmosis* , Pneumonia, Pneumocystis* , Invasive Fungal Infections* , Cryptococcus*, Humans ; Africa/epidemiology ; Antigens, Fungal |
| مستخلص: | Background: Fungal infections are common causes of death and morbidity in those with advanced HIV infection. Data on access to diagnostic tests in Africa are scarce. We aimed to evaluate the diagnostic capacity for invasive fungal infections in advanced HIV disease in Africa. Methods: We did a continent-wide survey by collecting data from 48 of 49 target countries across Africa with a population of more than 1 million; for Lesotho, only information on the provision of cryptococcal antigen testing was obtained. This survey covered 99·65% of the African population. We did the survey in six stages: first, questionnaire development, adaptation, and improvement; second, questionnaire completion by in-country respondents; third, questionnaire review and data analysis followed by video conference calls with respondents; fourth, external validation from public or private sources; fifth, country validation by video conference with senior figures in the Ministry of Health; and sixth, through five regional webinars led by the Africa Centres for Disease Control and Prevention with individual country profiles exchanged by email. Data was compiled and visualised using the Quantum Geographic Information System software and Natural Earth vectors to design maps showing access. Findings: Data were collected between Oct 1, 2020, and Oct 31, 2022 in the 48 target countries. We found that cryptococcal antigen testing is frequently accessible to 358·39 million (25·5%) people in 14 African countries. Over 1031·49 million (73·3%) of 1·4 billion African people have access to a lumbar puncture. India ink microscopy is frequently accessible to 471·03 million (33·5%) people in 23 African countries. About 1041·62 million (74·0%) and 1105·11 million (78·5%) people in Africa do not have access to histoplasmosis and Pneumocystis pneumonia diagnostics in either private or public facilities, respectively. Fungal culture is available in 41 countries covering a population of 1·289 billion (94%) people in Africa. MRI is routinely accessible to 453·59 million (32·2%) people in Africa and occasionally to 390·58 million (27·8%) people. There was a moderate correlation between antiretroviral therapy usage and external expenditure on HIV care (R 2 =0·42) but almost none between external expenditure and AIDS death rate (R 2 =0·18), when analysed for 40 African countries. Interpretation: This survey highlights the enormous challenges in the diagnosis of HIV-associated Pneumocystis pneumonia, cryptococcal disease, histoplasmosis, and other fungal infections in Africa. Urgent political and global health leadership could improve the diagnosis of fungal infections in Africa, reducing avoidable deaths. Funding: Global Action For Fungal Infections. Competing Interests: Declaration of interests We declare no competing interests. (Copyright © 2023 Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license. Published by Elsevier Ltd.. All rights reserved.) |
| التعليقات: | Comment in: Lancet Infect Dis. 2023 May;23(5):517-519. (PMID: 36565715) |
| معلومات مُعتمدة: | MC_PC_MR/P006922/1 United Kingdom MRC_ Medical Research Council |
| المشرفين على المادة: | 0 (Antigens, Fungal) |
| تواريخ الأحداث: | Date Created: 20221224 Date Completed: 20230425 Latest Revision: 20230518 |
| رمز التحديث: | 20230518 |
| DOI: | 10.1016/S1473-3099(22)00656-9 |
| PMID: | 36565714 |
| قاعدة البيانات: | MEDLINE |
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Full Text Finder | تدمد: | 1474-4457 |
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| DOI: | 10.1016/S1473-3099(22)00656-9 |