Experts from 27 countries have developed consensus on which diagnostic tests should be deemed 'essential' by the World Health Organisation (WHO). Lead by the Global Action Fund for Fungal Diseases (Gaffi), clinical practitioners from low- and middle-income countries debated the diagnostic performance, value for money and ease of use of seven tests.
These diagnostic tools are:
Cryptococcal antigen for cryptococcal meningitis in Aids
Histoplasma antigen for disseminated histoplasmosis in Aids
Toxoplasma antibody for brain abscess in Aids and infection in pregnancy to avoid brain damaged new-borns
Pneumocystis PCR for pneumonia in adults and children with Aids
Aspergillus antibody to diagnose chronic pulmonary aspergillosis, often confused with tuberculosis
TB LAM, a urine antigen test for rapid diagnosis of disseminated tuberculosis in AIDS that has been shown to save lives
Therapeutic antifungal drug monitoring for the life-saving, Essential Medicines itraconazole, voriconazole and flucytosine, to ensure adequate levels in the blood, often a problem in AIDS and children especially.
The WHO has a listing of essential medicines for decades and has just launched a process for approving key tests for improved health and public health.
The consensus meeting is being held in Uganda, which ranks fourth in Africa in terms of scientific publications and has made enormous contributions to understanding HIV-associated diseases, and fungal meningitis in particular. Like many other African countries fungal diagnostics are limited in scope to cryptococcal antigen (some countries), and microscopy and culture (very few countries). More rapid non-culture tests are not available, and this general neglect contributes to the 1-million Aids deaths annually worldwide.
“Fast, accurate diagnosis is essential to reduce deaths from Aids. Gaffi’s modelling suggests that making the key diagnostic tests available for only 60% of needy patients, with treatments, could save over a million lives in the next five years. Our consensus meeting is another key step on that road, with later endorsement of the conclusions required by the WHO,” says Professor David Denning of the University of Manchester and President of Gaffi.
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