Fig. 1

Model Schematic. Abbreviations: CRAG-LFA—cryptococcal antigen lateral flow assay, CM—cryptococcal meningitis, ART—antiretroviral therapy. Decision-analytic model schematic. We modeled progression or relapse of CM over a 5 year time period for a cohort of PLWH with CD4 < 100. In both model arms, symptomatic patients at baseline receive evaluation for CM assumed to include a lumbar puncture (LP), and treatment if diagnosed with CM. We assumed ART initiation in all arms. The model compares two interventions for prevention of cryptococcal morbidity for those without a baseline diagnosis of CM: 1) No screening, in which patients receive no CM screening or prophylaxis 2) CRAG-LFA, in which all patients receive serum CRAG-LFA screening. Individuals with positive CRAG were assumed to receive the cryptococcal preemptive treatment for cryptococcal antigenemia with fluconazole 800 mg for 2 weeks, followed by fluconazole 400 mg for 8 weeks. CRAG-negative individuals receive no further antifungal therapy. a outlines the two main model arms. b demonstrates the diagnostic evaluation and treatment for suspected CM cases