Our long-term goal is to improve outcomes from meningitis in rural, northern Uganda, an area within the meningitis belt of Africa, where there has been poor infrastructure related to the diagnosis and management of meningitis. Each year, approximately five million people worldwide are affected by meningitis. According to the WHO, the estimated number of annual deaths related to meningitis is 300,000, with infants and children at greatest risk. A global health initiative to defeat meningitis by 2030 was developed by the WHO and partners. The key goals are to: a) eliminate epidemics of bacterial meningitis (BM), b) reduce cases and deaths from vaccine-preventable BM, and c) reduce disability and improve quality of life. In 2017, we developed a CM diagnosis and treatment program (CM-DTP) at Lira Regional Referral Hospital (LRRH) in rural, northern Uganda as a quality improvement initiative designed to improve the diagnosis and treatment of CM. This ongoing program is a joint effort by collaborators on this application: University of Minnesota (UMN), the Infectious Diseases Institute (IDI) at Makerere University, and Lira University/LRRH. Through the CM-DTP, patients admitted to LRRH with signs and symptoms of meningitis undergo rapid HIV testing, HIV-positive patients then undergo rapid cryptococcal antigen (CrAg) testing, and patients diagnosed with CM receive standard of care antifungal treatment. Although this program was effective at improving the diagnosis and treatment of CM, the program also pointed out major gaps in meningitis care related to the diagnosis and treatment of meningitis due etiologies other than CM. Of 281 adult patients who presented with meningitis at LRRH from 2017 to 2019, we diagnosed CM in 99 (35.2%), but the etiology of meningitis for the other 64.8% of patients was unknown, due to lack of diagnostic capabilities. The specific aims are directed at improving infrastructure for the diagnosis and treatment of meningitis by building microbiology laboratory capacity, directing treatments at etiologies, and educating health care workers. Aim 1 is to identify the etiology of meningitis in 400 patients at LRRH through expanded microbiology laboratory capacity developed through this grant, aim 2 is to direct treatment of patients with meningitis based on etiology, and for each etiology, track outcomes including death, cognitive impairment and neurological deficits, and aim 3 is to build human resources capacity among health care workers to identify, diagnose, and treat meningitis at LRRH, Lira University, and surrounding health facilities. This project will build microbiology laboratory and human resources capacity for the diagnosis and treatment of meningitis in Lira and will provide vital information about the burden, etiology, and outcomes of meningitis in a setting that is representative of many resource-limited regions in rural SSA. Building capacity to diagnose different etiologies of meningitis at Lira University/LRRH will allow recognition of meningitis outbreaks in the area if they should occur and allow public health measures, such as vaccines or mitigation efforts, to be implemented for outbreak control.

Project Narrative: Each year, approximately five million people worldwide are affected by meningitis, causing 300,000 deaths, with infants and children at greatest risk. The goals of this project are to understand the burden and causes of meningitis in northern Uganda, a region with poor health care infrastructure, in order to improve outcomes by optimizing treatment and informing public health measures to prevent meningitis and respond to outbreaks.