Call for immediate action on diagnostics for fungal disease to reduce deaths in Africa from AIDS, TB, and cancer.

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Kigali Rwanda, 12th December 2022 – Africa Centres for Disease Control and Prevention (Africa CDC) and Global Action for Fungal Infections (GAFFI) launch Diagnostics for fungal disease in Africa report at a side event during the 2nd International Conference on Public Health in Africa (CPHIA 2022).

Fungal disease of the lungs and brain is lethal if not diagnosed and treated early; and responsible for up to 50% of AIDS, 10-25% of TB, and 10-25% of leukaemia deaths. At the CPHIA 2022, which will take place from December 13-15, 2022, the lack of key diagnostics in many African countries is highlighted.

A two-year survey of 48 of the 55 countries in Africa – covering 99.65% of the 1.4 billion population – finds many diagnostics lacking or infrequently used. In partnership with Africa CDC, today, GAFFI issues a report of the status of the African continent with respect to 18 diagnostic procedures – most of these listed as Essential by the World Health Organization (WHO).

Dr Mohammed Abdulaziz, who leads the Division of Disease Control and Prevention at Africa CDC opened the meeting and declared:

“The toll of fungal disease in vulnerable patients has gone unchecked for too long. We welcome this report and expect it to galvanise action to implement, in a stepwise fashion, improved diagnostics for serious fungal disease.”

Cryptococcal meningitis:

Rapid testing was frequently done in 14 countries (358 million), but completely lacking in 22 countries (613 million). Immediately fatal if not diagnosed and treated.

Pneumocystis pneumonia:

Molecular testing was only done in 8 countries, and 1,105 million are not covered. Immediately fatal if not diagnosed and treated.

Fungus Aspergillus:

Long term infection can mimic TB of the lungs. The simple lateral flow assay for Aspergillus antibody to detect infection has been trialled in Uganda, DRC, Gambia, Sierra Leone, Benin, and Tanzania, but is only routinely available in Morocco – leaving 900 million without access. Aspergillus lung infection has at least a 50% five-year mortality if untreated.

Cancer diagnosis:

Not possible without histopathology – regularly done in 19 countries (690 million), but completely lacking in 7 countries (46 million). To prevent death in leukaemia (and some intensive care patients) rapid fungal diagnosis with Aspergillus antigen is possible using a lateral flow assay (LFA). It is not available in 39 countries (1,032 million). 

The launch meeting highlighted  the ‘quick wins’ in initiating rapid diagnostics for fungal disease, combined with extensive training for laboratory staff and clinicians.

Professor Denning of GAFFI and the University of Manchester, who led the survey and report, stated:

“The costs of testing are relatively low compared with high costs of premature death, inappropriate antibiotic use in mis-diagnosed cases, and long-term illness. If lower AIDS, TB, and cancer deaths are to materialise, fungal diagnostics are critical to that effort.”

The report in English and in French is available here. This includes individual country profiles for 48 countries.