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Manchester Doctors Lead the WHO Initiative to Define Essential Health Tests in Advanced AIDS and Fungal Diseases

Prof. David Denning GAFFI President

GAFFI’s modeling suggests that making the key diagnostic tests available for only 60% of needy patients, with treatments, could save over a million lives in the next 5 years.”
— Professor David Denning
KAMPALA, UGANDA, April 11, 2018 / -- In Kampala today, experts from 27 countries have developed consensus on which diagnostic tests should be deemed ‘Essential’ by the World Health Organization. The WHO has had a listing of essential medicines for decades and has just launched a process for approving key tests for improved health and public health.

Lead by the Global Action Fund for Fungal Infections (GAFFI), clinical practitioners from low and middle-income countries debated the diagnostic performance, value for money and ease of use of 7 tests:

• Cryptococcal antigen for cryptococcal meningitis in AIDS
• Histoplasma antigen for disseminated histoplasmosis in AIDS
• Toxoplasma antibody for brain abscess in AIDS and infection in pregnancy to avoid brain damaged newborns
• Pneumocystis PCR for pneumonia in adults and children with AIDS
• Aspergillus antibody to diagnose chronic pulmonary aspergillosis, often confused with tuberculosis
• TB LAM an urine antigen test for rapid diagnosis of disseminated tuberculosis in AIDS that has been shown to save lives
• Therapeutic antifungal drug monitoring for the life-saving, Essential Medicines itraconazole, voriconazole and flucytosine, to ensure adequate levels in the blood, often a problem in AIDS and children especially.

The consensus meeting is being held in Uganda which ranks 4th in Africa in terms of scientific publications and has made enormous contributions to our understanding of HIV disease and fungal meningitis in particular. Like many other African countries fungal diagnostics are limited in scope to cryptococcal antigen (some countries), microscopy and culture (very few countries). More rapid non-culture tests are not available, and this general neglect contributes to the 1 million AIDS deaths annually worldwide.

The call to action by the WHO was voiced in the New England Journal of Medicine (Schroeder, 2016) in 2016 and the week of April 16th the WHO is holding its first Advisory meeting (SAGE). GAFFI’s input will inform the advisory group.
Professor David Denning of the University of Manchester and President of GAFFI, commented: “Fast, accurate diagnosis is essential to reduce deaths from AIDS. GAFFI’s modeling suggests that making the key diagnostic tests available for only 60% of needy patients, with treatments, could save over a million lives in the next 5 years. Our consensus meeting is another key step on that road, with later endorsement of the conclusions required by the WHO.”

Notes for Editors

GAFFI is a registered International Foundation based in Geneva and UK Charity and is focused on 4 major tasks related to serious fungal infections. These are:
• Universal access to diagnostics for serious fungal disease

• Universal access to antifungal agents
• Accurate data on the number and severity of fungal infections
• Health professional education related to better recognition and care for patients with serious fungal disease

GAFFI issued its 10 year Roadmap ’95-95 by 2025’ in 2015 calling on all governments and international health agencies to ensure 95% of the global population have access to fungal diagnostics and antifungal therapies by 2025: GAFFI has enabled several antifungal drugs to be listed on the World Health Organisation’s Essential Medicine List.

Schroeder LF, Guarner J, Elbireer A, Castle PE, Amukele TK. Time for a Model
List of Essential Diagnostics. N Engl J Med. 2016 Jun 30;374(26):2511-4.

Luisa Morlano
The Goodwork Organisation Ltd
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