Tenforde MW, et al. – A nationwide surveillance study was undertaken to determine the national incidence of cryptococcal meningitis (CM), and describe characteristics of cases during 2000–2014 and temporal trends at 2 national referral hospitals. Despite its well–developed antiretroviral therapy (ART) program, Botswana indicated a substantial burden of advanced HIV, with 2013–2014 incidence of CM comparable to pre–ART era rates in South Africa. Findings thereby suggested that a key population of individuals, often men, had been developing advanced disease and associated opportunistic infections due to a failure to effectively engage in care, highlighting the need for differentiated care models.

Methods

• Authors collected cerebrospinal fluid data from all 37 laboratories performing meningitis diagnostics in Botswana from the period 2000–2014 to identify cases of CM.
• Record of basic demographic and laboratory data was maintained.
• They used complete national data from 2013–2014 to calculate national incidence using UNAIDS population estimates.
• Derivation of temporal trends in cases was performed from national referral centers in the period 2004–2014.

Results

• In 4702 individuals, 5296 episodes of CM were identified; 60.6% were male, and median age was 36 years.
• In this study, overall 2013–2014 incidence was 17.8 (95% confidence interval [CI], 16.6–19.2) cases per 100000 person-years.
• Incidence was 96.8 (95% CI, 90.0–104.0) cases per 100000 person-years in the HIV-infected population; there appeared male predominance across CD4 strata.
• At national referral hospitals, during 2007–2009, cases decreased but cases stabilized during 2010–2014.