National Clinical Guidelines for the Prevention, Diagnosis, and Treatment of Cryptococcal Meningitis in Sub-Saharan African Countries
Ryan S. Walker1, Temesgen Nurye3, Carla Kim2, Kiran Thakur2
1Columbia University Vagelos College of Physicians and Surgeons, 2Department of Neurology, Columbia University Vagelos College of Physicians and Surgeons, 3University of California, San Francisco
Objective:
This study aimed to discuss differences among national clinical guidelines for prevention, diagnosis and management of cryptococcal meningitis (CM) across sub-Saharan Africa and how they compare to WHO’s 2022 guidelines.
Background:
CM is an infection of the central nervous system that accounts for approximately 19% of AIDS-related mortality worldwide with the highest burden being in sub-Saharan Africa. CM prevalence has declined since the advent of ART, but progress has stagnated since 2014. In 2022, the WHO released evidence-based clinical guidelines to prevent, diagnose, and treat CM to reduce HIV-associated mortality.
Design/Methods:
A comprehensive online search was conducted to gather the most recent national clinical CM guidelines from all 46 countries in sub-Saharan Africa. Methods to collect national CM guidelines included: searching Google, official government websites, WHO country office websites, calling national pubic health officials, surveying a website from the International AIDS Society that collated national HIV policies and guidelines, and collaborating with the HIV Policy Lab for their data repository. National CM guidelines were analyzed for the presence of all variables included in the 2022 WHO guidelines and overt discrepancies. Ambiguous national variables were considered aligned with WHO recommendations if reasonable judgment from a person with appropriate clinical experience and training following both guidelines would result in the same clinical action.
Results:
Out of the 46 countries in sub-Saharan Africa, 16/46 (35%) of countries lack relevant national CM guidelines accessible via our methods. 10/29 (34%) countries with CM prevention guidelines fully implement WHO recommendations. 21/29 (72%) countries with diagnostic CM guidelines include the WHO-preferred diagnostic method. 7/30 (23%) of countries with CM treatment guidelines include the preferred induction phase medication.
Conclusions:
Most national CM guidelines in sub-Saharan Africa do not adhere to all WHO recommendations. A follow-up study is in the works to assess healthcare workers’ adherence to WHO guidelines and identify barriers.
Disclaimer: Abstracts were not reviewed by Neurology® and do not reflect the views of Neurology® editors or staff.