SUAC0206 | PROGRAMMATIC OUTCOMES OF ENHANCED AHD CARE IN MALAWI: A FOCUS ON CRYPTOCOCCAL AND TUBERCULOSIS CO-INFECTIONS

Lucky Makonokaya, Louiser Upile Kalitera, Lloyd Chilikutali, Cathy Golowa, Eddie Matiya, Thulani Maphosa | Elizabeth Glaser Pediatric AIDS Foundation, Lilongwe, Malawi

Tuberculosis (TB) and cryptococcal disease remain the leading causes of death among people with advanced HIV disease (AHD) in sub-Saharan Africa. To combat these issues, the World Health Organization (WHO) recommends an enhanced care package, including opportunistic infection (OI) screening and early treatment. We assessed 12-month survival and retention outcomes among AHD clients receiving routine care in Malawi. We conducted a retrospective cohort study using data from 22 primary and secondary health facilities in central Malawi. Adults on antiretroviral therapy enrolled in the AHD care program between June 2021 and September 2023 were included and followed for 12 months. Data were extracted from facility registers and electronic medical records using a digital tool and analyzed with Stata version 18. Descriptive statistics summarized baseline characteristics. Kaplan-Meier survival analysis assessed retention, whereas Cox proportional hazards models determined factors linked to attrition, controlling for demographic and clinical variables, including TB and cryptococcal antigenemia at enrollment. Of 1,042 participants, 51.2% were female, with a median age of 38 years (IQR 28–47); two-thirds resided in rural areas, and 50.5% were newly diagnosed with HIV. At enrollment, 36.1% had TB or cryptococcal disease. The 12-month mortality rate was 7.6%. Clients with cryptococcal antigenemia had significantly higher attrition compared to those without OIs (p=0.003). In multivariate analysis, cryptococcal antigenemia was strongly associated with attrition (adjusted hazard ratio [aHR] 4.56; 95% CI, 1.76–11.83). TB at enrollment was not significantly associated with attrition. Clients with cryptococcal antigenemia experienced markedly lower retention and higher attrition risk, illustrating the importance of strengthened management and follow-up strategies within routine AHD care. Targeted interventions for cryptococcal disease are essential to improving survival outcomes among people with advanced HIV disease in Malawi.