title: Prevalence of cryptococcal antigenemia and cost-effectiveness of a cryptococcal antigen screening program--Vietnam.
abstract: BACKGROUND
  An estimated 120,000 HIV-associated cryptococcal meningitis (CM) cases occur each year in South and Southeast Asia; early treatment may improve outcomes. The World Health Organization (WHO) recently recommended screening HIV-infected adults with CD4<100 cells/mm(3) for serum cryptococcal antigen (CrAg), a marker of early cryptococcal infection, in areas of high CrAg prevalence. We evaluated CrAg prevalence and cost-effectiveness of this screening strategy in HIV-infected adults in northern and southern Vietnam.
  
  
  METHODS
  Serum samples were collected and stored during 2009-2012 in Hanoi and Ho Chi Minh City, Vietnam, from HIV-infected, ART-naïve patients presenting to care in 12 clinics. All specimens from patients with CD4<100 cells/mm(3) were tested using the CrAg lateral flow assay. We obtained cost estimates from laboratory staff, clinicians and hospital administrators in Vietnam, and evaluated cost-effectiveness using WHO guidelines.
  
  
  RESULTS
  Sera from 226 patients [104 (46%) from North Vietnam and 122 (54%) from the South] with CD4<100 cells/mm(3) were available for CrAg testing. Median CD4 count was 40 (range 0-99) cells/mm(3). Nine (4%; 95% CI 2-7%) specimens were CrAg-positive. CrAg prevalence was higher in South Vietnam (6%; 95% CI 3-11%) than in North Vietnam (2%; 95% CI 0-6%) (p = 0.18). Cost per life-year gained under a screening scenario was $190, $137, and $119 at CrAg prevalences of 2%, 4% and 6%, respectively.
  
  
  CONCLUSIONS
  CrAg prevalence was higher in southern compared with northern Vietnam; however, CrAg screening would be considered cost-effective by WHO criteria in both regions. Public health officials in Vietnam should consider adding cryptococcal screening to existing national guidelines for HIV/AIDS care.
authors.affiliation: Epidemic Intelligence Service, Scientific Education and Professional Development Program Office, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America. vih9@cdc.gov
authors.forename: Rachel M
authors.initials: RM
authors.lastname: Smith
authors.forename: Tuan Anh
authors.initials: TA
authors.lastname: Nguyen
authors.forename: Hoang Thi Thanh
authors.initials: HT
authors.lastname: Ha
authors.forename: Pham Hong
authors.initials: PH
authors.lastname: Thang
authors.forename: Cao
authors.initials: C
authors.lastname: Thuy
authors.forename: Truong Xuan
authors.initials: TX
authors.lastname: Lien
authors.forename: Hien T
authors.initials: HT
authors.lastname: Bui
authors.forename: Thai Hung
authors.initials: TH
authors.lastname: Le
authors.forename: Bruce
authors.initials: B
authors.lastname: Struminger
authors.forename: Michelle S
authors.initials: MS
authors.lastname: McConnell
authors.forename: Robyn Neblett
authors.initials: RN
authors.lastname: Fanfair
authors.forename: Benjamin J
authors.initials: BJ
authors.lastname: Park
authors.forename: Julie R
authors.initials: JR
authors.lastname: Harris
mesh_terms: D017088:AIDS-Related Opportunistic Infections / Q000191:economics / Q000453:epidemiology* / Q000276:immunology; D000946:Antigens, Fungal / Q000097:blood*; D018791:CD4 Lymphocyte Count; D003362:Cost-Benefit Analysis; D003454:Cryptococcus / Q000276:immunology*; D006801:Humans; D008403:Mass Screening / Q000191:economics; D016919:Meningitis, Cryptococcal / Q000191:economics / Q000453:epidemiology* / Q000276:immunology; D015995:Prevalence; D014744:Vietnam / Q000453:epidemiology
chemical_list: D000946:Antigens, Fungal