Cryptococcal Meningitis in Eswatini

Phased Implementation of Integrated Cryptococcal Meningitis Mortality Reduction Programs in Eswatini

Implementing Partners:

The Kingdom of Eswatini

Despite significant and continuous progress in the expansion of antiretroviral therapy (ART) programs globally, reductions in mortality from acquired immunodeficiency syndrome (AIDS) have slowed in many contexts. Currently, it is estimated that one third of individuals receiving care for human immunodeficiency virus (HIV) are living with advanced HIV disease (AHD), defined as a CD4+ T cell count below 200 cells/μL (Stage 3 or 4). These individuals are at increased risk of opportunistic infections and death, yet often experience challenges in continuing to engage in care.

Cryptococcal meningitis (CM), a critical fungal opportunistic infection, is the second-most common cause of HIV-related mortality in sub-Saharan Africa, where it accounts for an estimated 15-20% of HIV-related deaths. To refocus on AHD-related mortality, a collaboration of global stakeholders developed standard guidelines under the Ending Cryptococcal Meningitis Death by 2030 Framework in 2021.

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Getting to Zero Deaths is a phased project designed within the Ending CM Deaths Framework that aims to optimize AHD and cryptococcal disease care. Integral Global Consulting (IGC)’s goal is to develop an evidence-based and data-driven plan for sustainable and integrated interventions optimizing CM and AHD care in Eswatini. The specific objectives of IGC’s Getting to Zero Deaths project are to:

  1. Build and strengthen collaborative partnerships and regular communications around AHD and cryptococcal disease activities
  2. Map the current AHD and cryptococcal disease cascade of  care  in detail to identify strengths, weaknesses, opportunities, and threats (SWOT analysis)
  3. Convene local, regional, and global experts on the optimal achievable care for AHD and cryptococcal disease in the Eswatini context
  4. Develop an implementation road map with in-country stakeholders outlining targeted and integrated interventions to optimize AHD and cryptococcal disease care
  5. Strengthen monitoring and evaluation (M&E) tools and reporting within existing M&E systems to ensure continuous and reliable data is available for future program monitoring and improvement
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