{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,13]],"date-time":"2026-03-13T13:23:59Z","timestamp":1773408239256,"version":"3.50.1"},"reference-count":24,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2013,2,1]],"date-time":"2013-02-01T00:00:00Z","timestamp":1359676800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Tropical Med Int Health"],"published-print":{"date-parts":[[2013,4]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Objectives<\/jats:title><jats:p>To test the hypothesis that a screening and treatment intervention for early cryptococcal infection would improve survival among <jats:styled-content style=\"fixed-case\">HIV<\/jats:styled-content>\u2010infected individuals with low <jats:styled-content style=\"fixed-case\">CD<\/jats:styled-content>4 cell counts.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Newly enrolled patients at <jats:styled-content style=\"fixed-case\">F<\/jats:styled-content>amily <jats:styled-content style=\"fixed-case\">AIDS C<\/jats:styled-content>are and <jats:styled-content style=\"fixed-case\">E<\/jats:styled-content>ducation <jats:styled-content style=\"fixed-case\">S<\/jats:styled-content>ervices (<jats:styled-content style=\"fixed-case\">FACES<\/jats:styled-content>) in <jats:styled-content style=\"fixed-case\">K<\/jats:styled-content>enya with <jats:styled-content style=\"fixed-case\">CD<\/jats:styled-content>4\u00a0\u2264\u00a0100 cells\/\u03bcl were tested for serum cryptococcal antigen (s<jats:styled-content style=\"fixed-case\">CrA<\/jats:styled-content>g). Individuals with s<jats:styled-content style=\"fixed-case\">CrA<\/jats:styled-content>g titre\u00a0\u2265\u00a01:2 were treated with high\u2010dose fluconazole. Cox proportional hazard models of <jats:styled-content style=\"fixed-case\">K<\/jats:styled-content>aplan\u2013<jats:styled-content style=\"fixed-case\">M<\/jats:styled-content>eier curves were used to compare survival among individuals with <jats:styled-content style=\"fixed-case\">CD<\/jats:styled-content>4\u00a0\u2264\u00a0100 cells\/\u03bcl in the intervention and historical control groups.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The median age was 34\u00a0years [<jats:styled-content style=\"fixed-case\">IQR<\/jats:styled-content>: 29,41], 54% were female, and median <jats:styled-content style=\"fixed-case\">CD<\/jats:styled-content>4 was 43 cells\/\u03bcl [<jats:styled-content style=\"fixed-case\">IQR<\/jats:styled-content>: 18,71]. Follow\u2010up time was 1224 person\u2010years. In the intervention group, 66% (514\/782) were tested for s<jats:styled-content style=\"fixed-case\">CrA<\/jats:styled-content>g; of whom, 11% (59\/514) were s<jats:styled-content style=\"fixed-case\">CrA<\/jats:styled-content>g positive. Mortality was 25% (196\/782) in the intervention group and 25% (191\/771) in the control group. There was no significant difference between the intervention and control group in overall survival [<jats:styled-content style=\"fixed-case\">h<\/jats:styled-content>azard <jats:styled-content style=\"fixed-case\">r<\/jats:styled-content>atio (<jats:styled-content style=\"fixed-case\">HR<\/jats:styled-content>): 1.1 (95%<jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content>:0.9,1.3)] or three\u2010month survival [<jats:styled-content style=\"fixed-case\">HR<\/jats:styled-content>: 1.0 (95%<jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content>:0.8,1.3)]. Within the intervention group, s<jats:styled-content style=\"fixed-case\">CrA<\/jats:styled-content>g\u2010positive individuals had significantly lower survival rates than s<jats:styled-content style=\"fixed-case\">CrA<\/jats:styled-content>g\u2010negative individuals [<jats:styled-content style=\"fixed-case\">HR<\/jats:styled-content>:1.8 (95%<jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content>: 1.0, 3.0)].<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>A screening and treatment intervention to identify s<jats:styled-content style=\"fixed-case\">CrA<\/jats:styled-content>g\u2010positive individuals and treat them with high\u2010dose fluconazole did not significantly improve overall survival among <jats:styled-content style=\"fixed-case\">HIV<\/jats:styled-content>\u2010infected individuals with <jats:styled-content style=\"fixed-case\">CD<\/jats:styled-content>4 counts\u00a0\u2264\u00a0100 cells\/\u03bcl compared to a historical control, perhaps due to intervention uptake rates or poor efficacy of high\u2010dose oral fluconazole.<\/jats:p><\/jats:sec>","DOI":"10.1111\/tmi.12067","type":"journal-article","created":{"date-parts":[[2013,2,1]],"date-time":"2013-02-01T15:59:36Z","timestamp":1359734376000},"page":"495-503","source":"Crossref","is-referenced-by-count":33,"title":["The impact of routine cryptococcal antigen screening on survival among <scp>HIV<\/scp>\u2010infected individuals with advanced immunosuppression in <scp>K<\/scp>enya"],"prefix":"10.1111","volume":"18","author":[{"given":"A.\u2010C. L.","family":"Meyer","sequence":"first","affiliation":[{"name":"Family AIDS Care and Education Services, Research Care and Training Program Centre for Microbiology Research Kenya Medical Research Institute Nairobi Kenya"},{"name":"Department of Neurology University of California San Francisco San Francisco CA USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"C. K.","family":"Kendi","sequence":"additional","affiliation":[{"name":"Family AIDS Care and Education Services, Research Care and Training Program Centre for Microbiology Research Kenya Medical Research Institute Nairobi Kenya"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"J. A.","family":"Penner","sequence":"additional","affiliation":[{"name":"Family AIDS Care and Education Services, Research Care and Training Program Centre for Microbiology Research Kenya Medical Research Institute Nairobi Kenya"},{"name":"Department of Family Practice University of British Columbia Vancouver BC Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"N.","family":"Odhiambo","sequence":"additional","affiliation":[{"name":"Family AIDS Care and Education Services, Research Care and Training Program Centre for Microbiology Research Kenya Medical Research Institute Nairobi Kenya"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"B.","family":"Otieno","sequence":"additional","affiliation":[{"name":"Family AIDS Care and Education Services, Research Care and Training Program Centre for Microbiology Research Kenya Medical Research Institute Nairobi Kenya"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"E.","family":"Omondi","sequence":"additional","affiliation":[{"name":"Family AIDS Care and Education Services, Research Care and Training Program Centre for Microbiology Research Kenya Medical Research Institute Nairobi Kenya"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"E.","family":"Opiyo","sequence":"additional","affiliation":[{"name":"Family AIDS Care and Education Services, Research Care and Training Program Centre for Microbiology Research Kenya Medical Research Institute Nairobi Kenya"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"E. A.","family":"Bukusi","sequence":"additional","affiliation":[{"name":"Family AIDS Care and Education Services, Research Care and Training Program Centre for Microbiology Research Kenya Medical Research Institute Nairobi Kenya"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"C. R.","family":"Cohen","sequence":"additional","affiliation":[{"name":"Department of Obstetrics, Gynecology, and Reproductive Sciences University of California San Francisco San Francisco CA USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2013,2]]},"reference":[{"key":"e_1_2_6_2_1","doi-asserted-by":"publisher","DOI":"10.1086\/604716"},{"key":"e_1_2_6_3_1","doi-asserted-by":"publisher","DOI":"10.1086\/319348"},{"key":"e_1_2_6_4_1","first-page":"175","article-title":"Fluconazole donation and outcomes assessment in cryptococcal meningitis","volume":"97","author":"Collett G","year":"2007","journal-title":"South African Medical Journal"},{"key":"e_1_2_6_5_1","doi-asserted-by":"publisher","DOI":"10.1097\/00002030-200205030-00009"},{"key":"e_1_2_6_6_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11904-012-0127-7"},{"key":"e_1_2_6_7_1","doi-asserted-by":"publisher","DOI":"10.1086\/597262"},{"key":"e_1_2_6_8_1","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/cir613"},{"key":"e_1_2_6_9_1","first-page":"1","article-title":"Predictors of outcome in routine care for Cryptococcal meningitis in Western Kenya: lessons for HIV outpatient care in resource\u2010limited settings","author":"Kendi C","year":"2012","journal-title":"Postgraduate Medical Journal"},{"key":"e_1_2_6_10_1","doi-asserted-by":"publisher","DOI":"10.1097\/QAD.0b013e32830007cd"},{"key":"e_1_2_6_11_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-3156.2007.01874.x"},{"key":"e_1_2_6_12_1","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/cir379"},{"key":"e_1_2_6_13_1","doi-asserted-by":"publisher","DOI":"10.1086\/593194"},{"key":"e_1_2_6_14_1","doi-asserted-by":"publisher","DOI":"10.1097\/QAD.0b013e3280106d6a"},{"key":"e_1_2_6_15_1","doi-asserted-by":"publisher","DOI":"10.1093\/clinids\/22.5.838"},{"key":"e_1_2_6_16_1","doi-asserted-by":"publisher","DOI":"10.1086\/655143"},{"key":"e_1_2_6_17_1","doi-asserted-by":"publisher","DOI":"10.1097\/QAI.0b013e31811ed32c"},{"key":"e_1_2_6_18_1","doi-asserted-by":"publisher","DOI":"10.1136\/pgmj.77.914.769"},{"key":"e_1_2_6_19_1","doi-asserted-by":"publisher","DOI":"10.1016\/0163-4453(90)91727-U"},{"key":"e_1_2_6_20_1","doi-asserted-by":"publisher","DOI":"10.1097\/QAD.0b013e328322ffac"},{"key":"e_1_2_6_21_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jinf.2010.03.015"},{"key":"e_1_2_6_22_1","doi-asserted-by":"publisher","DOI":"10.1097\/00126334-199908010-00011"},{"key":"e_1_2_6_23_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(06)68337-2"},{"key":"e_1_2_6_24_1","doi-asserted-by":"publisher","DOI":"10.1186\/1758-2652-14-48"},{"key":"e_1_2_6_25_1","unstructured":"World Health Organization(2011)Rapid advice: diagnosis prevention and management of cryptococcal disease in HIV\u2010infected adults adolescents and children.World Health Organization Geneva Switzerland."}],"container-title":["Tropical Medicine &amp; International Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1111%2Ftmi.12067","content-type":"unspecified","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/tmi.12067","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,11,22]],"date-time":"2023-11-22T16:35:56Z","timestamp":1700670956000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/tmi.12067"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2013,2]]},"references-count":24,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2013,4]]}},"alternative-id":["10.1111\/tmi.12067"],"URL":"https:\/\/doi.org\/10.1111\/tmi.12067","archive":["Portico"],"relation":{},"ISSN":["1360-2276","1365-3156"],"issn-type":[{"value":"1360-2276","type":"print"},{"value":"1365-3156","type":"electronic"}],"subject":[],"published":{"date-parts":[[2013,2]]}}}