An analysis of national guidelines for the prevention, diagnosis and treatment of cryptococcal meningitis in sub-Saharan African countries: gaps and opportunities

BMJ Glob Health. 2026 Feb 19;11(2):e019953. doi: 10.1136/bmjgh-2025-019953.

ABSTRACT

INTRODUCTION: Cryptococcal meningitis (CM) is an infection of the central nervous system that accounts for approximately 19% of AIDS-related mortality worldwide, with the highest burden being in sub-Saharan Africa (SSA). In 2022, the WHO released clinical guidelines on the prevention, diagnosis and treatment of CM, based on strong evidence-based studies. It is not known how these WHO guidelines are being integrated at the national level. This study aims to highlight national clinical guidelines for the prevention, diagnosis and management of CM across SSA and how these guidelines compare to WHO 2022 CM guidelines.

METHODS: A comprehensive search was conducted to gather the current national clinical CM guidelines from all 46 countries in SSA. Methods to acquire copies of national guidelines included using online search engines, official government websites, WHO country office websites, direct contact with WHO officials and officers in national ministries of health as well as surveying the data repository of the International AIDS Society and HIV Policy Lab's Advanced HIV Disease Dashboard. National CM guidelines were analysed to determine if they incorporated the recommendations in the 2022 WHO CM guidelines.

RESULTS: Of the 46 countries in SSA, 37% (17/46) did not have established national CM screening and diagnostic guidelines and 35% (16/46) did not have established national CM treatment guidelines accessible through our methodology. Among the countries with CM guidelines, 21% (10/46) follow WHO recommendations for prevention, 30% (14/46) for diagnosis and 13% (6/46) for treatment.

CONCLUSION: Despite recent evidence to support diagnostic techniques and treatment approaches to improve CM outcomes, most national CM guidelines in SSA are not in accordance with the updated WHO recommendations, stressing a persistent gap in national adoption of CM international evidence-based guidelines.

PMID:41714099 | DOI:10.1136/bmjgh-2025-019953