{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,13]],"date-time":"2025-10-13T20:06:40Z","timestamp":1760386000593,"version":"3.40.5"},"reference-count":44,"publisher":"Public Library of Science (PLoS)","issue":"9","license":[{"start":{"date-parts":[[2023,9,28]],"date-time":"2023-09-28T00:00:00Z","timestamp":1695859200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Background<\/jats:title>\n<jats:p>Coronavirus disease (COVID-19), caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), was first reported in Wuhan, China. Due to the rapid spread globally, it was declared a pandemic in March 2020. Social distancing and lockdown measures were introduced to limit transmission. These strategies could potentially impact the diagnosis and treatment of patients with advanced HIV who are susceptible to secondary infections like cryptococcal disease. In South Africa, reflexed cryptococcal antigenaemia (CrAg) testing and pre-emptive antifungal treatment are recommended preceding antiretroviral therapy initiation for patients with a CD4&lt;100 cells\/\u03bcl. This study aimed to assess the impact of COVID-19 on CrAg testing in South Africa.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Methods<\/jats:title>\n<jats:p>Specimen-level data was extracted for individuals \u226515 years from the National Health Laboratory Services repository for calendar years 2018 to 2021. Test volumes and CrAg positivity were assessed at national and provincial levels, by age category and gender. The percentage change in annual and monthly CrAg test volumes for 2020 and 2021 (during lockdown levels) are compared to data reported for 2018. The monthly median CD4 and the percentage of samples with a count &lt;25, 25\u201350, 51\u201375 and &gt;75-&lt;100 cells\/\u03bcl were assessed.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Results<\/jats:title>\n<jats:p>Specimen data of 11 944 929 CD4 results included 1 306 456 CrAg tests. Annual CD4 and CrAg test volumes declined by 22.4% and 27.8% for 2020 and 2021 respectively (relative to 2018). There were 23 670 CrAg positive outcomes in 2018 compared to 21 399 (-9.6%) and 17 847 (-24.6%) in 2020 and 2021 respectively. A monthly test volume reduction of up to 36.6%, 35.5%, 36.1% and 13.3% was reported for infection waves one to four. CrAg detection increased from 6.3% in 2018 to 7.5% in 2020. More testing was offered to males (&gt;56%) with a higher detection rate of 8.1% in 2020. Between 81.0% and 81.8% of testing was for patients aged 20 to 49 years. The monthly percentage of specimens &lt;25 cells\/\u03bcl ranged from 30.2% (June 2019) to 35.3% (August 2020). Overall, the monthly median CD4 ranged from 39 (IQR: 15\u201370)(August 2020) to 45 (IQR: 19\u201372)(March 2019) cells\/\u03bcl. In 2020, the provincial percentage change in CrAg test volumes ranged from 2.9% to -33.7%.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Conclusion<\/jats:title>\n<jats:p>Our findings confirmed the impact of lockdown measures on both the absolute number of CrAg tests performed and detection (increase in 2020). A smaller impact on the median CD4 was noted. The long-term impact on patient management in immune- compromised individuals needs further investigation.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0292062","type":"journal-article","created":{"date-parts":[[2023,9,28]],"date-time":"2023-09-28T17:29:16Z","timestamp":1695922156000},"page":"e0292062","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":2,"title":["Using laboratory data to assess the impact of coronavirus (COVID-19) on reflex cryptococcal antigenaemia (CrAg) testing in South Africa"],"prefix":"10.1371","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4389-2849","authenticated-orcid":true,"given":"Naseem","family":"Cassim","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lindi Marie","family":"Coetzee","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9869-5271","authenticated-orcid":true,"given":"Manuel Pedro","family":"da Silva","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Wendy Susan","family":"Stevens","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Deborah Kim","family":"Glencross","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"340","published-online":{"date-parts":[[2023,9,28]]},"reference":[{"issue":"18","key":"pone.0292062.ref001","doi-asserted-by":"crossref","first-page":"1708","DOI":"10.1056\/NEJMoa2002032","article-title":"Clinical Characteristics of Coronavirus Disease 2019 in China","volume":"382","author":"WJ Guan","year":"2020","journal-title":"N Engl J Med"},{"issue":"8","key":"pone.0292062.ref002","doi-asserted-by":"crossref","first-page":"727","DOI":"10.1056\/NEJMoa2001017","article-title":"A Novel Coronavirus from Patients with Pneumonia in China, 2019","volume":"382","author":"N Zhu","year":"2020","journal-title":"N Engl J Med"},{"journal-title":"COVID-19 Public Health Emergency of International Concern (PHEIC) Global research and innovation forum","year":"2020","author":"World Health Organisation (WHO)","key":"pone.0292062.ref003"},{"journal-title":"WHO Director-General\u2019s Opening Remarks at the Media Briefing on COVID-19\u201324","year":"2020","author":"World Health Organisation (WHO)","key":"pone.0292062.ref004"},{"issue":"1","key":"pone.0292062.ref005","first-page":"157","article-title":"WHO Declares COVID-19 a Pandemic.","volume":"91","author":"D Cucinotta","year":"2020","journal-title":"Acta Biomed."},{"journal-title":"Considerations for implementing and adjusting public health and social measures in the context of COVID-19","year":"2021","author":"World Health Organisation (WHO).","key":"pone.0292062.ref006"},{"key":"pone.0292062.ref007","doi-asserted-by":"crossref","first-page":"159","DOI":"10.1016\/j.puhe.2020.06.033","article-title":"COVID-19 in South Africa: lockdown strategy and its effects on public health and other contagious diseases.","volume":"185","author":"S Hatefi","year":"2020","journal-title":"Public Health."},{"journal-title":"First case of Covid-19 announced\u2014an update","year":"2020","author":"National Institute for Communicable Diseases (NICD).","key":"pone.0292062.ref008"},{"issue":"24","key":"pone.0292062.ref009","doi-asserted-by":"crossref","first-page":"e95","DOI":"10.1056\/NEJMc2014960","article-title":"The South African Response to the Pandemic","volume":"382","author":"SS Abdool Karim","year":"2020","journal-title":"N Engl J Med"},{"journal-title":"South African Government. 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