Blood cryptococcal antigen (CrAg) titers >160 are associated with concurrent subclinical cryptococcal meningitis (CM). When lumbar puncture (LP) is not immediately available in a CrAg screening program, semi-quantitative CrAg assays may provide risk stratification for CM. Two semi-quantitative assays (SQ [Immuno-Mycologics, Norman, OK, USA] and CryptoPS [Biosynex, Strasbourg, France]) were evaluated against a qualitative lateral flow assay (LFA) using 194 plasma samples from a cohort of HIV-seropositive individuals with CD4 counts 160. Fifty individuals with antigenemia had an LP; a clinically useful SQ score that identified all ten cases of subclinical CM was ≥3 (100% sensitivity, 55% specificity). Patients with an SQ score of 3 or 4 also had a 2.2-fold increased adjusted hazards of 6-month mortality (95% CI: 0.79–6.34; p = 0.13) versus those with score of <3. Nine of ten patients with subclinical CM had a strong-positive CryptoPS result versus 10/40 without subclinical CM (p < 0.001). Semi-quantitative assays offered a sensitive though not specific means of gauging the risk of concurrent CM in this patient population. Lay summary: We evaluated two single-step laboratory tests that can quantify the amount of cryptococcal antigen in plasma of patients with advanced HIV disease and could thus gauge the risk of concurrent cryptococcal meningitis and subsequent mortality. These tests are not a substitute for a lumbar puncture.

Two cases of cryptococcal meningitis went undetected by a cryptococcal antigen (CrAg) lateral flow assay on blood in a reflex CrAg screen-and-treat programme in South Africa, although Cryptococcus neoformans was identified by culturing the cerebrospinal fluid specimens. Further investigations into these discordant diagnostic results included multilocus sequence typing (which showed no mutations in the CAP59 gene) and transmission electron microscopy using a capsule-staining protocol (which revealed a >50% reduction in capsular material in both cases, relative to a control culture). A multi-disciplinary approach for resolving discordant diagnostic test results is recommended.

Objective: Reflex cryptococcal antigen (CrAg) screening of blood specimens with a CD4 count of 3% of results as discordant. Conclusion: Routine CrAg screening results were reliable, with <1% of samples having discordant results, mainly due to interpretation and transcription errors.

Background: Major depression (MD) during pregnancy complicates maternal and neonatal outcomes. Despite its significant impact, there is a lack of evidence on the prevalence and associated factors of MD among pregnant women in Uganda. We assessed the magnitude and factors associated with MD among pregnant women attending antenatal care (ANC) at a large teaching hospital in Northern Uganda. Methods: Between June and August 2023, we enrolled pregnant women aged 18 years or older attending ANC clinic at Gulu Regional Referral Hospital in Northern Uganda. Data were collected using a validated semi-structured questionnaire. MD was evaluated using DSM-V criteria and was defined as having (1) at least two weeks of either persistent low mood or excessive sadness, (2) plus additional symptoms from the MD diagnostic criterion A, for a total of at least five MD symptoms, and (3) the symptoms caused significant distress or problem and significantly altered behaviour or functionality. Modified Poisson regression analyses with robust standard errors was constructed to evaluate for factors independently associated with major depression. Adjusted prevalence ratio (aPR) whose 95% confidence interval (CI) did not include the null value (0) or p < 0.05 was considered statistically significant. Results: We enrolled 329 participants, with a mean age of 26.1± 5.5 years. Overall, 29.8% (n = 98) had MD; 37 (11.2%) mild, 49 (14.9%) moderate, and 12 (3.6%) severe MD. Having a co-wife (aPR: 1.64, 95% CI:1.09–2.45, p = 0.016), an arranged marriage (aPR: 1.56, 95% CI: 1.02–2.42, p = 0.042), partner’s income in second quartile (aPR: 2.14, 95% CI: 1.29–3.54, p = 0.003), experiencing physical violence (aPR: 1.75, 95% CI: 1.09–3.81, p = 0.019), controlling behaviours from partner (aPR: 3.60, 95% CI: 1.79–7.26, p < 0.001), and planned pregnancy (aPR: 0.53%, 955 CI: 0.35–0.81, p = 0.003) were independently associated with MD. Conclusion: Major Depression affects nearly one-third of pregnant women in Northern Uganda. Major Depression is more prevalent among women with co-wives, in arranged marriages, with unplanned pregnancies, whose partners had low income, who experienced physical violence or controlling behaviours from a partner. These findings highlight the urgent need for targeted interventions, including prevention, screening, and treatment services for Major Depression within Antenatal Care clinics. Implementing such measures is crucial to improving maternal, foetal, and neonatal health outcomes in the region.

Background: Point‐of‐care rapid diagnostic testing plays a critical role in HIV detection and timely linkage to care, particularly in decentralized healthcare settings. To support testing reliability, the National Health Laboratory Service in South Africa conducts a national proficiency testing (PT) program as part of its broader quality assurance framework. This study assessed national PT performance and explored interprovincial differences. Methods: A retrospective analysis was conducted using data from three PT survey rounds (0121, 0221, and 0122) carried out between January 2021 and October 2022. Each participating facility tested six blinded serum samples per round using routinely available HIV rapid diagnostic tests. Performance was categorized as acceptable ( ≥ 80%) or unacceptable ( < 80%) in accordance with ISO 17043 standards. Descriptive statistics were used to summarize participation and performance. Chi‐square tests assessed differences by province, and binary logistic regression was used to explore factors associated with unacceptable performance. Results: Of the 12,636 PT panels distributed across three survey rounds to approximately 4200 facilities per round, 12,447 (98.50%) were returned with valid results. Acceptable results ( ≥ 80%) were consistently high, with 97.89% in Survey 0121, 98.37% in Survey 0221, and 98.31% in Survey 0122, yielding an overall average of 98.19% (12,222/12,447) of facility–panel submissions achieving acceptable performance scores, with a mean score of 98% across rounds. A total of 793 errors (1.05%) were identified, including 351 false‐negative results (0.46%) and 442 false‐positive results (0.58%). In addition, 46 discordant results ( < 0.10%) were recorded. Significant interprovincial variation in PT performance was observed ( p < 0.001), with the Northern Cape consistently reporting the highest proportion of unacceptable scores. In contrast, Limpopo and Mpumalanga achieved 100% acceptable performance across all three rounds. Logistic regression did not identify any statistically significant predictors of underperformance, although facilities in the Northern Cape showed increased odds of unacceptable scores. Conclusion: The HIV PT program demonstrated high national uptake and strong overall performance in decentralized settings. However, persistent regional disparities underscore the need for targeted quality assurance interventions and strengthened oversight in underperforming provinces to ensure comparable diagnostic quality across the national HIV testing program.