Feasibility and clinical outcomes of routine point-of-care screening for opportunistic infections among people with advanced HIV disease in Guyana.

Objectives

We evaluated the feasibility and outcomes of implementing comprehensive Point-of-care (POC) opportunistic infections (OIs) screening among people with Advanced HIV disease (AHD) in Guyana.

Methods

We conducted a prospective multicentre cohort study across seven sites between February 2024 and March 2025. Adults with suspected AHD, defined as CD4 <200 cells/mm3 or signs/symptoms suggestive of OIs, were enrolled. All participants received a package for OI screening consisting of urinary TB-LAM, serum cryptococcal antigen, urinary Histoplasma antigen and rapid CD4 testing. Outcomes at 30 and 90 days were recorded. Primary outcome was feasibility, measured as the proportion completing the full screening panel. Secondary outcomes included diagnostic yield, care-package compliance and factors associated with negative outcomes (death or loss to follow-up).

Results

We enrolled 112 individuals; 88.4% completed the full diagnostic panel. A total of 24 participants had positive tests (21.4%). At 90 days, mortality was 5.4% and loss to follow-up was 11.6%. Positive diagnostic-test results were associated with worse outcomes at 30 and 90 days. In multivariable analysis, not initiating ART, requiring hospitalization for OI care or treatment, and lower haemoglobin independently predicted negative outcomes. Only 37.5% of participants with positive results completed the disease-specific diagnostic workup, and 41.7% initiated directed treatment for the detected OI.

Conclusions

Routine POC screening for OIs among people with AHD in Guyana is feasible and detects a high burden of OIs. However, major gaps in completion of diagnostic algorithms, inconsistent availability of OI treatments and delays in ART initiation reduce the potential clinical impact of early detection.