title: HIV-Associated Cryptococcal Meningitis: Bridging the Gap Between Developed and Resource-Limited Settings.
abstract: Cryptococcal meningitis is a major cause of HIV-associated morbidity and mortality worldwide. Most cases occur in low-income countries, where over half of patients die within 10 weeks of diagnosis compared to as few as 10 % of patients from developed countries. A host of factors, spanning the HIV care continuum, are responsible for this gap in treatment outcomes between developed and resource-limited settings. We explore factors responsible for this outcomes gap and describe low-cost, highly effective measures that can be implemented immediately to improve outcomes in resource-limited settings. We also explore health-system challenges that must be addressed to reduce mortality further, recent research in disease prevention, and novel short-course treatment regimens that, if efficacious, could be implemented in resource-limited settings where the cost of standard treatment regimens is currently prohibitive.
authors.affiliation: Division of Allergy and Infectious Diseases, University of Washington School of Medicine, Seattle, WA USA ; University of Washington Medical Center, 1959 NE Pacific Street, Health Sciences Division #356423, Seattle, WA 98195 USA.
authors.forename: Mark W
authors.initials: MW
authors.lastname: Tenforde
authors.affiliation: Institute of Infection and Immunity, St. George's University of London, London, UK ; Centre for Opportunistic, Tropical and Hospital Infections, National Institute for Communicable Diseases, Johannesburg, South Africa ; National Institute for Communicable Diseases, 1 Modderfontein Road, Sandringham, Johannesburg, 2131 South Africa.
authors.forename: Rae
authors.initials: R
authors.lastname: Wake
authors.affiliation: Botswana-UPenn Partnership, Gaborone, Botswana.
authors.forename: Tshepo
authors.initials: T
authors.lastname: Leeme
authors.affiliation: Botswana-UPenn Partnership, Gaborone, Botswana ; Division of Infectious Diseases, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA USA ; Department of Clinical Research, Faculty of Infectious Diseases and Tropical Medicine, London School of Hygiene and Tropical Medicine, London, UK.
authors.forename: Joseph N
authors.initials: JN
authors.lastname: Jarvis
keywords: Cryptococcal meningitis; Health system strengthening; Prevention; Resource-limited settings