Pathways to care with HIV-associated cryptococcal meningitis in Botswana and Uganda

Findings from a qualitative methods study

Bibliographic Data

ID21258191
AuthorsDavid S Lawrence (0000-0002-5439-4039, London School of Hygiene & Tropical Medicine, corresponding author), Agnes Ssali (0000-0003-4801-0411, London School of Hygiene & Tropical Medicine), Neo Moshashane (Botswana Harvard AIDS Institute Partnership), Georgina Nabaggala (0000-0002-3006-4457, Uganda Virus Research Institute), Lebogang Maphane (Botswana Harvard AIDS Institute Partnership), Thomas S Harrison (0000-0003-3619-4348, St George's, University of London), David B Meya (0000-0002-8854-0321, Infectious Diseases Institute), David Meya, Joseph N Jarvis (0000-0003-1459-5554, London School of Hygiene & Tropical Medicine), Janet Seeley (0000-0002-0583-5272, London School of Hygiene & Tropical Medicine)
Year2023
Volume4
Pages100350
Publication date2023-12-01
Open AccessYes
TypeARTICLE
VenueSSM - Qualitative Research in Health (JOURNAL)
Journal identifiersISSN: 2667-3215 • E-ISSN: 2667-3215
PublisherElsevier BV (PUBLISHER)
DOI10.1016/j.ssmqr.2023.100350
PMID38106376
OpenAlexW4387409211
LanguageEN
Citations received1
References cited32

HIV-associated cryptococcal meningitis remains a key driver of AIDS-related mortality. Mortality is twice as high in those who present later to care and with severe symptoms such as confusion. We embedded a qualitative methods study within a randomised controlled trial in Gaborone, Botswana and Kampala, Uganda with the aim of understanding pathways to care. We conducted in-depth interviews with trial participants and surrogate decision makers and analysed data thematically. Between January 2020 and June 2021 we interviewed 58 individuals. Pathways to care were prolonged because headaches were disregarded by participants and healthcare workers as a common occurrence with a broad differential diagnosis of predominantly benign aetiologies. There was also a lack of awareness of cryptococcal meningitis, and it was often after HIV was diagnosed or disclosed that the pathway accelerated, resulting in hospital admission. We outline key recommendations to reduce mortality and argue for the integration of social and behavioural interventions within differentiated service delivery models for advanced HIV disease

Cryptococcal meningitis · Family medicine · Headaches · Health care · Intensive care medicine · Meningitis · Psychiatry · Psychological intervention · Qualitative research · Viral disease · Fungal Infections and Studies · HIV/AIDS oral health manifestations · Medicine · Nursing · Syphilis Diagnosis and Treatment · Pediatrics

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