Study Objectives: This is a 5-year (2021-2026) non-research grant funded by CDC to facilitate implementation of the short course regimen for the treatment of HIV-associated cryptococcal meningitis. Following successful completion of the AMBITION phase III study, the purpose of this project is to leverage individual and institutional experience in delivering the ACTA and AMBITION short-course regimens to facilitate widespread implementation across Botswana with the aim of reducing mortality from CM in real-world settings.

The objectives of the project are to:

1. Perform a comprehensive baseline situational analysis to ascertain the status of cryptococcal meningitis management guidelines, national policy, and resource access in Botswana, map the landscape with regards to local and external implementing partners involved in delivering advanced HIV disease and CM interventions, and develop collaborative, country-specific strategies.
2. Engage stakeholders to integrate short-course regimens into national treatment guidelines and facilitate access to essential antifungals.
3. Train healthcare workers to deliver high quality care for HIV-associated cryptococcal meningitis including screening, diagnosis, and treatment using the short-course regimens and other nationally recommended CM treatment regimens.
4. Increase patient and community awareness of HIV-associated cryptococcal meningitis and encourage health-seeking behaviours and to ensure that the voices of people living with advanced HIV disease and community representatives are meaningfully included and heard across the entire scope of work, the group will develop strategies and tools to increase patient health literacy around HIV-associated fungal infections, collect qualitative data to learn from the experience of patients with HIV-associated fungal infections and facilitate meaningful engagement through a community advisory board.
5. Monitor and evaluate the progress and impact of implementing short-course regimens to support routine HIV programming goals.

Study Design: Implementation study

Study duration: 5 years – October 2021 – September 2026

Sponsor: CDC (USA)

Principal Investigator: Dr David Lawrence – david.s.lawrence@lshtm.ac.uk and Prof Mosepele Mosepele – mosepe.mosepele@gmail.com