Conference Brings Together Experts in Global Fight Against Cryptococcal Meningitis

In 2008, I was a Peace Corps Response volunteer working on HIV/AIDS community outreach in rural Uganda. I never imagined that more than 15 years later I would be back in Kampala to attend the 11th International Conference on Cryptococcus & Cryptococcosis (ICCC) alongside the leading global experts on advanced HIV disease (AHD). The ICCC brought together experts on cryptococcosis, a life-threatening infection for people with AHD, and fostered an exchange of ideas and inter-disciplinary scientific collaborations between participants from over 50 countries.

This is the first time the ICCC was held in Africa which is the epicenter of cryptococcosis infections due to AHD. The Cryptococcus fungus that causes cryptococcosis is found all over the world, and most healthy people are not affected by exposure to it. For those with a compromised immune system, however, it can be a very serious health threat. If breathed in, the spores can multiply and spread from the lungs to the membranes that cover the brain or spinal cord, causing cryptococcal meningitis (CM). CM is the second leading cause of HIV-related death after TB.

Without treatment, CM is almost universally fatal, but early diagnosis and treatment can save lives. Before CM develops, it is possible to detect evidence of the Cryptococcus fungus (known as a cryptococcal antigen) in the blood using a simple diagnostic test called the cryptococcal antigen lateral flow assay (CrAg LFA). In 2015, the CDC Foundation received a grant from Pfizer Inc. to partner with the Mycotic Diseases Branch of the Centers for Disease Control and Prevention (CDC) to assess the costs and health outcomes of using CrAg LFA to screen for CM in South Africa, Uganda and Botswana. In 2017, the CDC Foundation received additional funding from Pfizer to work with CDC to expand the program to Nigeria, Malawi, Mozambique, Eswatini, Tanzania and Lesotho. In 2019, CM monitoring and evaluation efforts were expanded, and as of November 2022, the lifesaving CrAg screening is being routinely implemented in at least 11 countries in Africa, and evaluation on the use of new semi-quantitative CrAG tests is currently being done in Vietnam.

Many of the discussions at the ICCC meeting were around the sustainability of screen and treat programs for CM. Countries are experiencing a shortage of tests and drugs and seeing high turnover of health care workers—a problem made worse by the COVID-19 pandemic. There is also a need for more mentorship and continuous training in how to diagnose and treat CM with antifungal medications. Many low- and middle-income countries lack comprehensive disease surveillance systems and have gaps in diagnostic testing access.

Several of the partners and colleagues at ICCC contributed to the strategic framework “Ending Cryptococcal Meningitis Deaths by 2030,” which outlines why a global strategy to address CM deaths is needed and identifies the necessary elements. As Tom Chiller, MD, MPHTM, chief of CDC’s Mycotic Diseases Branch noted at the conference, ending CM deaths is more complex than just screening and treating. We must find new ways of creating partnerships across the public and private sector to ensure that tests and treatment are available and affordable, healthcare workers are properly trained, data systems are in place and national guidelines are being tailored to the needs of the country. We have the science, but what countries need now are what Dr. Chiller referred to as “crypto champions” to keep the momentum going.

I’ve had the privilege of working and living in the communities in Uganda that are most vulnerable to CM. Much progress has been made for people with AHD since I was last here, but there is still much work to be done. The CDC Foundation is proud of the partnerships we have created through this funding, and we know they will continue to make meaningful progress for years to come. At the ICCC, there was a sense of urgency among the many “crypto champions” gathered in Kampala but also a sense of hope that together, we can stop this deadly but treatable disease.