AI Article Synopsis

  • Cryptococcal meningitis (CM) is a significant cause of death for people living with HIV in rural sub-Saharan Africa, but a CM diagnosis and treatment program (CM-DTP) in northern Uganda has shown to improve hospital survival rates.
  • A study compared long-term survival of CM patients diagnosed after CM-DTP began to those diagnosed before its implementation and found a notable decrease in 30-day mortality (42.2% vs. 78.5%).
  • While three-year survival rates improved to 25.6% for the CM-DTP group, further efforts are needed to enhance long-term outcomes, as they remain sub-optimal.

Article Abstract

Background: Cryptococcal meningitis (CM) remains a major cause of death among people living with HIV in rural sub-Saharan Africa. We previously reported that a CM diagnosis and treatment program (CM-DTP) improved hospital survival for CM patients in rural, northern Uganda. This study aimed to evaluate the impact on long-term survival.

Methods: We conducted a retrospective study at Lira Regional Referral Hospital in Uganda evaluating long-term survival (≥1 year) of CM patients diagnosed after CM-DTP initiation (February 2017-September 2021). We compared with a baseline historical group of CM patients before CM-DTP implementation (January 2015-February 2017). Using Cox proportional hazards models, we assessed time-to-death in these groups, adjusting for confounders.

Results: We identified 318 CM patients, 105 in the Historical Group, and 213 in the CM-DTP Group. The Historical Group had a higher 30-day mortality of 78.5% compared to 42.2% in the CM-DTP Group. The overall survival rate for the CM-DTP group at three years was 25.6%. Attendance at follow-up visits (HR:0.13, 95% CI: [0.03-0.53], p <0.001), ART adherence (HR:0.27, 95% CI: [0.10-0.71], p = 0.008), and fluconazole adherence: (HR:0.03, 95% CI: [0.01-0.13], p <0.001), weight >50kg (HR:0.54, 95% CI: [0.35-0.84], p = 0.006), and performance of therapeutic lumbar punctures (HR:0.42, 95% CI: [0.24-0.71], p = 0.001), were associated with lower risk of death. Altered mentation was associated with increased death risk (HR: 1.63, 95% CI: 1.10-2.42, p = 0.016).

Conclusion: Long-term survival of CM patients improved after the initiation of the CM-DTP. Despite this improved survival, long-term outcomes remained sub-optimal, suggesting that further work is needed to enhance long-term survival.

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Source
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC11108149PMC
http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0303805PLOS

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