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Prevalence of Cryptococcal Antigenemia and Cost-Effectiveness of a Cryptococcal Antigen Screening Program – Vietnam

BACKGROUND: An estimated 120,000 HIV-associated cryptococcal meningitis (CM) cases occur each year in South and Southeast Asia; early treatment may improve outcomes. The World Health Organization (WHO) recently recommended screening HIV-infected adults with CD4<100 cells/mm(3) for serum cryptococ...

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Autores principales: Smith, Rachel M., Nguyen, Tuan Anh, Ha, Hoang Thi Thanh, Thang, Pham Hong, Thuy, Cao, Xuan Lien, Truong, Bui, Hien T., Le, Thai Hung, Struminger, Bruce, McConnell, Michelle S., Fanfair, Robyn Neblett, Park, Benjamin J., Harris, Julie R.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Public Library of Science 2013
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3633872/
https://www.ncbi.nlm.nih.gov/pubmed/23626792
http://dx.doi.org/10.1371/journal.pone.0062213
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author Smith, Rachel M.
Nguyen, Tuan Anh
Ha, Hoang Thi Thanh
Thang, Pham Hong
Thuy, Cao
Xuan Lien, Truong
Bui, Hien T.
Le, Thai Hung
Struminger, Bruce
McConnell, Michelle S.
Fanfair, Robyn Neblett
Park, Benjamin J.
Harris, Julie R.
author_facet Smith, Rachel M.
Nguyen, Tuan Anh
Ha, Hoang Thi Thanh
Thang, Pham Hong
Thuy, Cao
Xuan Lien, Truong
Bui, Hien T.
Le, Thai Hung
Struminger, Bruce
McConnell, Michelle S.
Fanfair, Robyn Neblett
Park, Benjamin J.
Harris, Julie R.
author_sort Smith, Rachel M.
collection PubMed
description BACKGROUND: An estimated 120,000 HIV-associated cryptococcal meningitis (CM) cases occur each year in South and Southeast Asia; early treatment may improve outcomes. The World Health Organization (WHO) recently recommended screening HIV-infected adults with CD4<100 cells/mm(3) for serum cryptococcal antigen (CrAg), a marker of early cryptococcal infection, in areas of high CrAg prevalence. We evaluated CrAg prevalence and cost-effectiveness of this screening strategy in HIV-infected adults in northern and southern Vietnam. METHODS: Serum samples were collected and stored during 2009–2012 in Hanoi and Ho Chi Minh City, Vietnam, from HIV-infected, ART-naïve patients presenting to care in 12 clinics. All specimens from patients with CD4<100 cells/mm(3) were tested using the CrAg lateral flow assay. We obtained cost estimates from laboratory staff, clinicians and hospital administrators in Vietnam, and evaluated cost-effectiveness using WHO guidelines. RESULTS: Sera from 226 patients [104 (46%) from North Vietnam and 122 (54%) from the South] with CD4<100 cells/mm(3) were available for CrAg testing. Median CD4 count was 40 (range 0–99) cells/mm(3). Nine (4%; 95% CI 2–7%) specimens were CrAg-positive. CrAg prevalence was higher in South Vietnam (6%; 95% CI 3–11%) than in North Vietnam (2%; 95% CI 0–6%) (p = 0.18). Cost per life-year gained under a screening scenario was $190, $137, and $119 at CrAg prevalences of 2%, 4% and 6%, respectively. CONCLUSION: CrAg prevalence was higher in southern compared with northern Vietnam; however, CrAg screening would be considered cost-effective by WHO criteria in both regions. Public health officials in Vietnam should consider adding cryptococcal screening to existing national guidelines for HIV/AIDS care.
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spelling pubmed-36338722013-04-26 Prevalence of Cryptococcal Antigenemia and Cost-Effectiveness of a Cryptococcal Antigen Screening Program – Vietnam Smith, Rachel M. Nguyen, Tuan Anh Ha, Hoang Thi Thanh Thang, Pham Hong Thuy, Cao Xuan Lien, Truong Bui, Hien T. Le, Thai Hung Struminger, Bruce McConnell, Michelle S. Fanfair, Robyn Neblett Park, Benjamin J. Harris, Julie R. PLoS One Research Article BACKGROUND: An estimated 120,000 HIV-associated cryptococcal meningitis (CM) cases occur each year in South and Southeast Asia; early treatment may improve outcomes. The World Health Organization (WHO) recently recommended screening HIV-infected adults with CD4<100 cells/mm(3) for serum cryptococcal antigen (CrAg), a marker of early cryptococcal infection, in areas of high CrAg prevalence. We evaluated CrAg prevalence and cost-effectiveness of this screening strategy in HIV-infected adults in northern and southern Vietnam. METHODS: Serum samples were collected and stored during 2009–2012 in Hanoi and Ho Chi Minh City, Vietnam, from HIV-infected, ART-naïve patients presenting to care in 12 clinics. All specimens from patients with CD4<100 cells/mm(3) were tested using the CrAg lateral flow assay. We obtained cost estimates from laboratory staff, clinicians and hospital administrators in Vietnam, and evaluated cost-effectiveness using WHO guidelines. RESULTS: Sera from 226 patients [104 (46%) from North Vietnam and 122 (54%) from the South] with CD4<100 cells/mm(3) were available for CrAg testing. Median CD4 count was 40 (range 0–99) cells/mm(3). Nine (4%; 95% CI 2–7%) specimens were CrAg-positive. CrAg prevalence was higher in South Vietnam (6%; 95% CI 3–11%) than in North Vietnam (2%; 95% CI 0–6%) (p = 0.18). Cost per life-year gained under a screening scenario was $190, $137, and $119 at CrAg prevalences of 2%, 4% and 6%, respectively. CONCLUSION: CrAg prevalence was higher in southern compared with northern Vietnam; however, CrAg screening would be considered cost-effective by WHO criteria in both regions. Public health officials in Vietnam should consider adding cryptococcal screening to existing national guidelines for HIV/AIDS care. Public Library of Science 2013-04-23 /pmc/articles/PMC3633872/ /pubmed/23626792 http://dx.doi.org/10.1371/journal.pone.0062213 Text en https://creativecommons.org/publicdomain/zero/1.0/ This is an open-access article distributed under the terms of the Creative Commons Public Domain declaration, which stipulates that, once placed in the public domain, this work may be freely reproduced, distributed, transmitted, modified, built upon, or otherwise used by anyone for any lawful purpose.
spellingShingle Research Article
Smith, Rachel M.
Nguyen, Tuan Anh
Ha, Hoang Thi Thanh
Thang, Pham Hong
Thuy, Cao
Xuan Lien, Truong
Bui, Hien T.
Le, Thai Hung
Struminger, Bruce
McConnell, Michelle S.
Fanfair, Robyn Neblett
Park, Benjamin J.
Harris, Julie R.
Prevalence of Cryptococcal Antigenemia and Cost-Effectiveness of a Cryptococcal Antigen Screening Program – Vietnam
title Prevalence of Cryptococcal Antigenemia and Cost-Effectiveness of a Cryptococcal Antigen Screening Program – Vietnam
title_full Prevalence of Cryptococcal Antigenemia and Cost-Effectiveness of a Cryptococcal Antigen Screening Program – Vietnam
title_fullStr Prevalence of Cryptococcal Antigenemia and Cost-Effectiveness of a Cryptococcal Antigen Screening Program – Vietnam
title_full_unstemmed Prevalence of Cryptococcal Antigenemia and Cost-Effectiveness of a Cryptococcal Antigen Screening Program – Vietnam
title_short Prevalence of Cryptococcal Antigenemia and Cost-Effectiveness of a Cryptococcal Antigen Screening Program – Vietnam
title_sort prevalence of cryptococcal antigenemia and cost-effectiveness of a cryptococcal antigen screening program – vietnam
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3633872/
https://www.ncbi.nlm.nih.gov/pubmed/23626792
http://dx.doi.org/10.1371/journal.pone.0062213
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