{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,2]],"date-time":"2026-06-02T14:28:58Z","timestamp":1780410538547,"version":"3.54.1"},"reference-count":28,"publisher":"Oxford University Press (OUP)","issue":"10","license":[{"start":{"date-parts":[[2020,4,1]],"date-time":"2020-04-01T00:00:00Z","timestamp":1585699200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"funder":[{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["P30AI045008"],"award-info":[{"award-number":["P30AI045008"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000060","name":"National Institute of Allergy and Infectious Diseases","doi-asserted-by":"publisher","award":["T32AI007044"],"award-info":[{"award-number":["T32AI007044"]}],"id":[{"id":"10.13039\/100000060","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000060","name":"National Institute of Allergy and Infectious Diseases","doi-asserted-by":"publisher","award":["F32AI140511"],"award-info":[{"award-number":["F32AI140511"]}],"id":[{"id":"10.13039\/100000060","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000272","name":"National Institute for Health Research","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100000272","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2021,5,18]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Evidence to inform cryptococcal antigen (CrAg)\u2013screening guidelines among ART-experienced populations is lacking. We performed a study evaluating the utility of reflex CrAg screening in Gaborone, Botswana.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>CD4 count data were collected from the HIV reference laboratory from 2014\u20132016. CrAg screening was performed on samples with CD4 \u2264100 cells\/\u00b5L beginning January 2015. The proportion of CD4 counts \u2264100 cells\/\u00b5L was determined and the frequency of repeat CrAg testing described. Analyses ascertained the impact of ART status on CrAg prevalence and outcomes, and whether CrAg titers could be used for risk stratification.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Overall, 5.6% (3335\/59 300) of individuals tested had CD4 \u2264100 cells\/\u03bcL; 2108 samples with CD4 \u2264100 cells\/\u03bcL from 1645 unique patients were CrAg tested. Over half of samples were from ART-experienced individuals: 40.9% (863) on ART and 12.1% (255) defaulters; 22% (463) of CrAg tests were on repeat samples. CrAg prevalence was 4.8% (72\/1494; 95% CI, 3.8\u20136.0%) among outpatients and 21.9% (32\/151; 95% CI, 15.3\u201328.5%) among inpatients. CrAg prevalence rates did not differ by ART status, but 6-month mortality was significantly lower in CrAg-positive individuals on ART at screening. Ten CrAg positives were identified through repeat testing. A CrAg titer cutoff \u22651:80 provided the best discrimination for 6-month survival.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>CrAg-positivity rates in an ART-experienced population were comparable to those seen in ART-naive populations. Repeat screening identified individuals who seroconverted to CrAg positivity and were at risk of cryptococcal disease. CrAg titers \u22651:80 can help identify the individuals at highest risk of death for more intensive management.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/cid\/ciaa356","type":"journal-article","created":{"date-parts":[[2020,3,30]],"date-time":"2020-03-30T19:15:41Z","timestamp":1585595741000},"page":"1745-1754","source":"Crossref","is-referenced-by-count":16,"title":["Prevalence and Sequelae of Cryptococcal Antigenemia in Antiretroviral Therapy\u2013Experienced Populations: An Evaluation of Reflex Cryptococcal Antigen Screening in Botswana"],"prefix":"10.1093","volume":"72","author":[{"given":"William J","family":"Hurt","sequence":"first","affiliation":[{"name":"Botswana University of Pennsylvania Partnership, Gaborone, Botswana"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mark W","family":"Tenforde","sequence":"additional","affiliation":[{"name":"Botswana University of Pennsylvania Partnership, Gaborone, Botswana"},{"name":"Division of Allergy and 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S","family":"Azama","sequence":"additional","affiliation":[{"name":"Ministry of Health and Wellness, Gaborone, Botswana"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Irene","family":"Goercke","sequence":"additional","affiliation":[{"name":"University of Botswana, Gaborone, Botswana"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fredah","family":"Mulenga","sequence":"additional","affiliation":[{"name":"Botswana National Health Laboratory, Gaborone, Botswana"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nametso","family":"Tlhako","sequence":"additional","affiliation":[{"name":"Botswana University of Pennsylvania Partnership, Gaborone, Botswana"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katlego","family":"Tsholo","sequence":"additional","affiliation":[{"name":"Botswana University of Pennsylvania Partnership, Gaborone, Botswana"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tuhina","family":"Srivastava","sequence":"additional","affiliation":[{"name":"Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tshepo B","family":"Leeme","sequence":"additional","affiliation":[{"name":"Botswana University of Pennsylvania Partnership, Gaborone, Botswana"},{"name":"Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Godfrey","family":"Simoonga","sequence":"additional","affiliation":[{"name":"Ministry of Health and Wellness, Gaborone, Botswana"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Charles","family":"Muthoga","sequence":"additional","affiliation":[{"name":"Botswana University of Pennsylvania Partnership, Gaborone, Botswana"},{"name":"Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kwana","family":"Lechiile","sequence":"additional","affiliation":[{"name":"Botswana University of Pennsylvania Partnership, Gaborone, Botswana"},{"name":"Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Madisa","family":"Mine","sequence":"additional","affiliation":[{"name":"Botswana National Health Laboratory, Gaborone, Botswana"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1459-5554","authenticated-orcid":false,"given":"Joseph N","family":"Jarvis","sequence":"additional","affiliation":[{"name":"Botswana University of Pennsylvania Partnership, Gaborone, Botswana"},{"name":"Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana"},{"name":"Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United 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