BACKGROUND: Cryptococcal meningitis (CM), an opportunistic infection caused by the Cryptococcus fungi, accounts for 15% of global HIV-related deaths. Despite progress in biomedical interventions to prevent and manage CM, mortality rates remain high: an estimated 3 out of 4 PLWHA with CM died in 2021. The HIV Policy Lab’s Advanced HIV Disease (AHD) Dashboard (https://www.advancedhiv.org/) tracks policy alignment between national guidelines and WHO recommendations on CM.
METHODS:

The AHD Dashboard, a collaboration between the Drugs for Neglected Diseases initiative and HIV Policy Lab, compares CM-related national policies with the 2022 WHO Guidelines for the diagnosis, prevention, and management of cryptococcal disease in adults, adolescents, and children with HIV. We track 13 policy indicators related to AHD and CM in Eastern and Southern Africa (ESA) and Western and Central Africa (WCA). Relevant documents for these countries were found via desktop reviews or document repositories of HIV Policy Lab (www.hivpolicylab.org).

RESULTS: Relevant guidelines were found for 35/46 countries. Overall, we found that policy alignment was better in ESA than in WCA.
ESA: Relevant guidelines were found for 17/21 countries. Zambia, Mozambique, and Kenya adopted 11/13 policies while South Africa, Rwanda, and Malawi adopted 7 policies. 16 countries require baseline CD4 testing but 5 lack guidelines on CD4 testing for those reentering ARV care. All countries in ESA have adopted point-of-care rapid cryptococcal antigen (CrAg) test as a screening tool. Only 4 countries have adopted the WHO-recommended liposomal amphotericin B (LAmB)-based induction regimen for the treatment of CM for PLHIVA. In the essential medicines lists, LAmB is least adopted, with only Mozambique including LAmB for CM.
WCA: Relevant guidelines were found for 18/25 countries. Among them, 15 have adopted baseline CD4 testing for people entering care, but only 3 countries require it for people reentering HIV care. 7 countries have adopted CrAg test as screening tool. Pre-emptive and prophylactic fluconazole therapy is adopted by only 6 and 5 countries, respectively. Only DRC has adopted the LAmB-based induction therapy.
CONCLUSIONS: The AHD dashboard is a tool to identify areas for policy reform to align with WHO CM-related recommendations.