Project Overview

Project title: HIV-associated Histoplasmosis Assessment in LOwer-resource settings, a prospective observational study with nested modelling to estimate burden of disease and predict impact of point-of-care testing on morbidity and mortality

Abbreviation: HIV-HALO study

Despite early success with antiretroviral therapy (ART) in reducing HIV-related deaths, progress has stalled, and advanced HIV disease (AHD) remains a major issue—especially among patients who disengage from care. The WHO promotes a public health strategy using point-of-care (POC) tests to diagnose common opportunistic infections like TB and cryptococcal disease. However, histoplasmosis, another serious but treatable infection, is often overlooked due to limited data and diagnostic challenges, particularly outside the Americas.

Histoplasmosis is a fungal infection linked to soil handling and cave exploration in bat and bird habitats. Histoplasmosis is a systemic mycosis caused by the dimorphic fungus Histoplasma capsulatum. It is found in soil contaminated with bird or bat droppings, and manifests as a spectrum of pulmonary and extrapulmonary diseases. Due to the lack of resources and infrastructure in many African countries, there is limited data available on the epidemiology of HIV-associated histoplasmosis in this region. Most published studies are from case reports, rather than systematic reviews or population-based studies. As a result, the true burden of HIV-associated histoplasmosis in Africa is poorly understood. In addition, mortality can be high. Disseminated histoplasmosis mortality ranged from 22% to 53% in several studies. New POC tests for histoplasmosis exist, but their impact is unclear due to scarce prevalence data. Traditional diagnostic research is difficult in low-resource settings, especially in Africa. To overcome this, the study will use advanced tools like computational modeling and complex systems theory to better understand and tackle public health challenges, potentially improving HIV-related care and outcomes.