Ten years on: Ongoing challenges in screening for cryptococcal antigenaemia in people with advanced HIV disease in South Africa.

Screening for early asymptomatic cryptococcal antigenaemia is a crucial step in preventing symptomatic cryptococcal meningitis and reducing mortality among people with advanced HIV disease. However, even when early cryptococcal disease is detected, a significant number of people with advanced HIV disease still develop meningitis and die, suggesting barriers to care following a positive serum cryptococcal antigen result. Ten years after the initiation of a national screening programme in South Africa, we discuss progress and implementation challenges and highlight potential solutions identified through a clinical trial to reduce barriers to care for people with early cryptococcal disease. Analysing systems that care for individuals with early cryptococcal disease and creating interventions to optimise available resources are key steps in reducing HIV-associated cryptococcal disease mortality worldwide.