The DREAMM (Driving Reduced AIDS-associated Meningo-encephalitis Mortality) project is a multi-centre implementation project which will evaluate the new semi-quantitative cryptococcal lateral flow assay (Biosynex crypto PS) in three African low and middle income countries (LMICs) (Cameroon, Malawi & Tanzania). The overall aim of the project is to drive down the unacceptably high mortality associated with HIV-associated meningo-encephalitis in LMICs. The project is backed by Institut Pasteur and Centers for Disease Control and is in collaboration between St George’s University of London and UNC Project Malawi, NIMR Tanzania and Hopital Central Yaounde. The new test is nested within an algorithm for the optimised diagnosis and treatment of patients presenting with HIV-associated meningo-encaphalitis. The project has ambition to provide long standing capacity building at each of the sites and is driven by the local African Principal Investigators (PIs) (Dr Cecilia Kanyama, Lilongwe, Malawi; Dr Charles Kouanfack, Yaounde, Cameroon; Dr Sayoki Mfinanga, NIMR, Dar Es Salaam Tanzania). Optimised and sustainable laboratory and patient pathways with an emphasis on the use of point of care (POC) tests as well as standard microbiological techniques will be devised. The local African PIs will be facilitated by the chief investigator, Dr Angela Loyse, who will play a key role in overall project implementation and improving access to essential diagnostic tests and drugs for HIV-associated meningo-encephalitis patients in African LMICs.
The project is in three phases:
2) Training in laboratory and clinical aspects of management of HIV-associated meningo-encephalitis with an emphasis on POC tests including Biosynex crypto PS. The laboratory training program will be led by Institut Pasteur
3) Implementation. 450 patients will be recruited during this phase. The primary end point is two week all cause mortality.
Study findings will be fed back to local African Ministries of Health (MOH), international collaborators and within the cryptoMAG forum, and new guidelines on the management of HIV-associated meningo-encephalitis in African LMICs devised, ensuring long lasting impact for African LMICs.