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Cryptococcal meningitis is a poverty\u2010related disease and the majority of cases occur in settings where resources are limited and access to quality care is often linked to an individual's ability to pay for services. We have previously demonstrated the efficacy, safety and cost\u2010effectiveness of a single, high\u2010dose liposomal amphotericin\u2010based treatment regimen within the AMBITION\u2010cm trial. Here, we present a five\u2010country, within\u2010trial analysis exploring the household economic impact of cryptococcal meningitis.<\/jats:p><\/jats:sec>Methods<\/jats:title>Eight hundred and ten participants were recruited into this sub\u2010study in Botswana, Malawi, South Africa, Uganda and Zimbabwe between January 2018 and February 2021. We collected data on annual household expenditure, direct costs and indirect costs incurred prior to enrolment and during the 10\u2010week trial period. Costs were inflated and converted to 2022 USD. We calculated out\u2010of\u2010pocket expenditure, lost income and catastrophic healthcare expenditure, defined as costs exceeding 20% of annual household expenditure.<\/jats:p><\/jats:sec>Results<\/jats:title>The average total out\u2010of\u2010pocket expenditure plus lost income prior to enrolment was $132 and 17.9% (145\/810, 95% CI 15.3\u201320.5) of participant households had already experienced catastrophic healthcare expenditure. Among the 592 surviving participants, when combining out\u2010of\u2010pocket expenditure and lost income, the average cost was $516 and 29.1% of annual household expenditure across all countries, ranging from $230 (7.6%) in South Africa to $592 (64.2%) in Zimbabwe. More than half (296\/581, 51.0%, 95% CI 46.9\u201355.0) of households experienced catastrophic healthcare expenditure by the end of the trial, ranging from 16.0% (13\/81, 95% CI 7.9\u201324.2) in South Africa to 68.1% (156\/229, 95% CI 62.0\u201374.2) in Uganda.<\/jats:p><\/jats:sec>Conclusions<\/jats:title>This is the first study exploring the household economic impact experienced by those diagnosed with cryptococcal meningitis. The household economic impact of cryptococcal meningitis is high and more than half of households of individuals who survive experience catastrophic healthcare expenditure. It is likely these figures are higher outside of the research setting. This highlights the profound financial impact of this devastating infection and provides a rationale to offer financial and social protection to those affected.<\/jats:p><\/jats:sec>Trial Registration Number<\/jats:title>ISRCTN72509687<\/jats:p><\/jats:sec>","DOI":"10.1002\/jia2.26441","type":"journal-article","created":{"date-parts":[[2025,6,6]],"date-time":"2025-06-06T06:10:32Z","timestamp":1749190232000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Household economic impact of HIV\u2010associated cryptococcal meningitis in five countries in Southern and Eastern Africa"],"prefix":"10.1002","volume":"28","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5439-4039","authenticated-orcid":false,"given":"David S.","family":"Lawrence","sequence":"first","affiliation":[{"name":"Clinical Research Department Faculty of Infectious and Tropical Diseases London School of Hygiene and Tropical Medicine London 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