Better outcomes for AIDS patients with cryptococcal meningitis are in prospect following a crucial sharing and planning meeting in Geneva, March 18-19 2013. At the instigation of the US Centres for Disease Control, attendees from LIFE, WHO, Medicines Sans Frontieres (MSF), Clinton Health Access and numerous universities and public health institutions, the key barriers to access to cryptococcal antigen testing and antifungal drugs amphotericin B, flucytosine and fluconazole were identified.
Key recommendations were:
- Wider dissemination of best clinical practices and guidelines including dissemination of the complete WHO comprehensive guidelines from June 2013 to accelerate country adoption.
- WHO Essential Medications application reviewed and resubmitted for amphotericin B and flucytosine to be moved from the complementary to the core list
- Improve estimates of cryptococcal disease burden/drug demand forecasting, with multiple approaches including collection of diagnostic data.
- Improvement of both cryptococcal diagnosis and screening by promoting the new rapid LFA test. Dissemination of LFA information and verification protocol to PEPFAR implementing partners combined with forecasting LFA diagnostic kit procurement.
- Improvement of antifungal drug pricing, supply and registration, with specific lobbying for price reduction and generic manufacture of both oral flucytosine and injectable amphotericin B.
- Facilitate drug registration, especially in Sub-Saharan Africa, through the African Medicines Regulatory Harmonization Programme.
- Research and development of safer, less toxic drug formulations and means of delivering amphotericin B, which might be partly alleviated with shorter course regimens and lower doses of oral flucytosine (studies ongoing).
- Motivating global funding and support, especially through PEPFAR, UNITAID and The Global Fund.
Attendees included Tihana Bicanic (St. George’s University London, Joe Jarvis (St. George’s University London), Harry Thangaraj (St. George’s University London, Director Access to Pharmaceuticals Project), Philippa Easterbrook (WHO HIV Treatment and Care), Tom Chiller (CDC, Mycotic Diseases Branch), Monika Roy (CDC, Mycotic Diseases Branch), Joel Chehab (CDC, Mycotic Diseases Branch), Barbara Milani (MSF), Arax Bozadjian (MSF Access Campaign, HIV-focussed Pharmacist), Jennifer Cohn (MSF), Teri Roberts (MSF), Shaffiq Essajee (Clinton Health Access Initiative, Colleen Connell (CHAI), David Lee Chin Management Sciences for Health, Director, Technical Strategy and Quality Center for Pharmaceutical Management), David Boulware (University of Minnesota), Nelesh Govender (NICD/NHLS South Africa), David Denning (LIFE and The University of Manchester) and Juan Luis Rodriguez-Tudela (LIFE).