The Current State of Laboratory Fungal Diagnostics and Availability of Antifungal Treatment in Africa: A ECMM and ISHAM Survey

Abstract

Background: Africa is a favourable environment for fungal infections, given the high burden of risk factors. The diversity of clinical manifestations of fungal diseases represent a diagnostic and therapeutic challenge, especially in low- and middle-income countries. Studies assessing the current state of mycological laboratory capacities and antifungal treatment availability on the African continent are lacking. Methods: An online survey was developed asking about antifungal drug availability and laboratory infrastructure. The survey was directly sent to 164 African members and contacts of International Society for Human and Animal Mycology (ISHAM) and the European Confederation of Medical Mycology (ECMM), two of the leading societies in the mycology field, in 2019-2020. Institutions were classified whether they were able to potentially achieve Blue status, which is the entry level of the ECMM Excellence Centres initiative. Results: We have received 40 responses (24.4% response rate) from 21 African countries. Only five institutions (12·5%) located in Cameroon, Kenya, Nigeria, Sudan, and Uganda potentially fulfil the minimum laboratory requirements for ECMM Excellent Centres Blue status. Difficulties included lack of access to susceptibility testing for both yeasts and moulds (available in 30% of institutions), and Aspergillus antigen detection (available in 47.5% of institutions as in- house or outsourced test), whilst institutions reported higher availability of cryptococcosis diagnostic tools (60·0% antigen detection and 77·5% India Ink). Whilst fluconazole was available in 90% of institutions, access to mould-active antifungal drugs such as amphotericin B deoxycholate, itraconazole, voriconazole and posaconazole (available for 52·5%, 52·5%, 35·0% and 5.0% of institutions, respectively) was more limited. Interpretation: The region has huge gaps in diagnostic and treatment access. United and targeted efforts are mandatory to face the growing challenges in medical mycology and to further improve diagnostic and treatment resources across Africa. Funding: None to declare. Declaration of Interest: In the last 5 years, DF has received payment for research grants, lectures, advisory boards, and/or travel reimbursements, not related to this study, from Pfizer, GSK, Gilead, MSD and United Medical. AA received honoraria from Pfizer and Gilead and travel grant from Astellas, not related to this study. JS has received research grants by the Ministry of Education and Research (BMBF) and Basilea Pharmaceuticals Inc. and has received travel grants by German Society for Infectious Diseases (DGI e.V.) and Meta-Alexander Foundation, not related to this study. JG has received funds for participating at educational activities organized on behalf of Astellas, Gilead, MSD, Scynexis, and Biotoscana-United Medical; he has also received research funds from FIS, Gilead, Scynexis, and Cidara, outside the submitted work. JFM received grants from F2G and Pulmozyme. He has been a consultant to Scynexis and Merck and has received speaker’s fees from United Medical, TEVA and Gilead. NPG has current research grants from the National Institutes of Health, Centers for Disease Control and Prevention, Bill and Melinda Gates Foundation and the UK Medical Research Council, not related to this study. ROO has received payment for research grants, lectures, advisory boards, and/or travel reimbursements, not related to this study, from Pfizer and Gilead. BKO has received research funds from FIT, UK not related to this work and funds to organize a symposium from IMMY. COM has received research grants from, presented for and been on advisory boards for Pfizer (Australia), Gilead Sciences and Merck, Sharp and Dohme, not related to this study. All funds are paid directly to her institution. ACP has received research grants, given paid talks and consulted for Pfizer, Gilead, MSD, United Medical, Teva, and IMMY, not related to this study.