Fungal Infections: Invisible Until It’s Too Late
David W Denning, FRCP, FRCPath, FMedSci, outlines the "95-95 by 2025" initiative to diagnose and treat 95% of serious fungal infections globally by 2025, focused on improving access in underserved regions.
In 2015, fungal infections affected over 1 billion people globally each year, leading to an estimated 11.5 million life-threatening infections and more than 1.5 million deaths annually. Despite their significant impact, fungal diseases have historically been under-recognized and underfunded in global health efforts. In response, the Global Action Fund for Fungal Infections (GAFFI) launched a global initiative called "95-95 by 2025," which aims to diagnose and treat 95% of individuals with serious fungal infections by the end of 2025.1-2
David W Denning, FRCP, FRCPath, FMedSci, professor of infectious diseases and global health at the University of Manchester, played a key role in developing GAFFI’s initiatives. Denning, also former chief executive of GAFFI, discussed the challenges of diagnosing and treating fungal infections and the goals of the 95-95 by 2025 initiative.
“We convened a meeting alongside one of the International AIDS meetings in Seattle in 2015 with about 60-70 people, including people from all over the world,” Denning said. “Some from Africa, South America, Asia, as well as people from the WHO and other major funding agencies to address the problem of how we're going to stop people dying of fungal disease. One of the problems with fungal disease is that it’s fairly invisible until it’s too late. You have to start looking for it in at-risk patients. So, examples of patients with AIDS, patients who have a transplant, patients with really complicated lung disease, patients with leukemia, lymphoma, that sort of group of patients."
Denning highlighted the lack of diagnostic infrastructure in many regions, particularly in Sub-Saharan Africa and Asia. He noted, “We learned that many countries, particularly in Sub-Saharan Africa, but also in many parts of Asia, don’t have a diagnostic service for fungal disease, and many of them don’t have any of the modern treatments for fungal disease. So, we ended up writing a roadmap that included a very basic summary of how many infections there might be in the world with these problems, and also the approaches, the diagnostics, and the treatments that are relevant to that."
Denning explained their goal, “Our aspiration 10 years ago now was that 95% of the world's population would have access to these diagnostics, and 95% would have access to the relevant anti-fungal therapies, particularly the generic anti-fungal therapies that are less expensive than the more recently issued ones."
Denning discussed the barriers to achieving this goal, including drug approval delays and the lack of resources in many countries. Denning explained, “For example, in South Africa, fluconazole was on the roster for approval for five years before they finally approved it, and yet it’s a core drug for fungal meningitis in AIDS. As you know, South Africa has the largest population of HIV patients per capita in the world.”
Denning noted that these delays are just one example of the challenges in ensuring access to affordable treatments. He said, “There are lots of different tests. There's lots of different lab approaches to handling those tests, and the registration processes for drugs are complicated in many countries.”
Denning discussed the progress made in countries like Guatemala, where GAFFI helped fund a project in 13 centers across the country. Denning described the process, “In Guatemala, we funded a small demonstration project and helped run it with about 13 centers across the country looking after patients with HIV and AIDS. We provided the wherewithal for them to run a rapid diagnostic service for two important fungal infections which are common: histoplasmosis and cryptococcal meningitis, in tandem with diagnostics for TB, which is also common there.”
The program successfully improved diagnostic accuracy, reduced misdiagnosis of tuberculosis as fungal infections, and ultimately led to a decrease in mortality. Denning shared, “We diagnosed many fungal infections, we diagnosed fewer TB infections, and that was because they were misdiagnosed as TB when actually they were a fungus. The overall mortality from these late-stage patients went down by 8% in basically two and a half years. And that’s a really big change.”
Denning expressed hope that similar programs could be replicated in other regions facing similar challenges, “We’d like to reproduce that other places. The idea here was to show that if you applied these diagnostics, and you provided the results quickly, and you trained the clinicians in parallel, you could really make a difference.”
Stay tuned for the next part of our conversation where we dive deeper into the initiative.
