Initiatives to reduce HIV-related deaths remain a global public health priority. These deaths are compounded by weak health systems and lack of access to essential diagnostic tests and medications in low-income and middle-income countries (LMICs). Globally, an estimated 630 000 people living with HIV died in 2022.
The mortality risk is highest among the estimated 4·3 million people living with advanced HIV disease, defined by WHO in adolescents and adults by a CD4 count less than 200 cells per μL or WHO clinical stage 3 or 4 disease.
Public health interventions to improve HIV treatment and care in Africa have tended to have a predominant focus on ambulatory care settings, while failing to address the need to improve treatment and care for people living with HIV in under-resourced public hospitals.
Patients with advanced HIV disease frequently require hospitalisation for the diagnosis and treatment of severe opportunistic infections including cryptococcal meningitis, tuberculosis, and severe bacterial infections. In a 2023 systematic review, Burke and colleagues highlighted the paucity of published studies evaluating interventions to reduce deaths among hospitalised patients with advanced HIV disease and recommended that such studies should be prioritised.
In The Lancet HIV, Sayoki Mfinanga and colleagues report findings of the Driving Reduced AIDS-associated Meningo-encephalitis Mortality (DREAMM) implementation science project conducted in routine care services in five public hospitals in Cameroon, Malawi, and Tanzania. The headline results were a significant reduction in mortality after implementation of an algorithm to rapidly identify, triage, diagnose, and treat people living with HIV who presented with suspected CNS infections.
Read the Full Article: HIV-related CNS infections: translating DREAMM into reality