Assessment of Clinical Guideline Use in the Prevention, Diagnosis, and Treatment of Cryptococcal Meningitis Among Health Care Providers in Ethiopia
Open forum infectious diseases
Open Forum Infect Dis. 2025 Nov 24;12(12):ofaf715. doi: 10.1093/ofid/ofaf715. eCollection 2025 Dec.
ABSTRACT
BACKGROUND: Cryptococcal meningitis (CM) is a significant cause of morbidity and mortality in individuals with advanced HIV. Ethiopia, with a high HIV burden and significant socioeconomic challenges, has limited data on CM. Understanding clinical practices is crucial to identifying gaps and improving disease management.
METHODS: A survey was conducted among health care workers (HCWs), microbiologists, and pharmacists across 9 Ethiopian health facilities from July to November 2024. Eligibility required active involvement in HIV or CM care. Ethics approval and informed consent were secured. Three profession-specific questionnaires were used to assess knowledge of CM care and challenges. Data were analyzed in R, version 4.3.2.
RESULTS: A total of 311 participants were included: HCWs, n = 202; microbiologists, n = 65; and pharmacists, n = 44. Most participants, 188/202 (93.1%) HCWs, 42/44 (95.5%) pharmacists, and 54/65 (83.1%) microbiologists, recognized the need for additional guideline training. Only 59/202 (29%) HCWs reported that screening for cryptococcal antigenemia was always performed. Among antifungals, fluconazole was the most available, with 21/44 (48%) pharmacists and 49/202 (24%) HCWs reporting it as always in stock. Liposomal amphotericin B (L-Amb) was reported as available by only 7/44 (16%) pharmacists and 44/202 (22%) HCWs. The most significant barriers to guideline implementation were insufficient policy support and challenges in integrating guidelines into electronic health records, as reported by 152/202 (75.2%) and 143/202 (70.8%) HCWs, respectively.
CONCLUSIONS: There are substantial gaps in CM care, highlighting the importance of improving resource allocation, technical assistance, additional training, and financial support.
