Diagnosis of cryptococcal meningitis in people living with HIV in low-income countries: barriers and strategies

The impact of recent diagnostic and treatment advances for cryptococcal disease has been constrained by gaps in implementation. Closing the diagnostic gap requires strengthening decentralized CD4 testing; expanding reflex and point-of-care CrAg, including use of semi-quantitative CrAg assays to prioritize those at highest risk for urgent LP and/or enhanced antifungal treatment; strengthening healthcare provider training, referral systems, LP access, and enhancing community engagement. Integration of these measures into national HIV programs alongside operational research could reduce mortality for patients and costs for health systems.