The document discusses efforts to address diagnostic and treatment deficits for fungal diseases globally through the Global Action Fund for Fungal Infections (GAFFI). GAFFI aims to greatly reduce illness and death from fungal diseases worldwide by ensuring universal access to diagnostics and antifungal treatments by 2025. It outlines the large burden of fungal diseases, which affect over 1 billion people. GAFFI is working to measure disease impact, improve education, and advocate for expanded access to diagnosis and treatment in low- and middle-income countries through demonstration projects in Guatemala and Kenya.

1. Addressing diagnostic and
treatment deficits in fungal diseases
across the world
David W. Denning
The University of Manchester
Global Action Fund for Fungal Infections

2. 600 different
fungi are
human pathogens
30 are common
4 are the main
killers
More species
extinctions due to
fungi than
bacteria or
viruses
Chytridiomycosis
in amphibian spp

3. Global Action Fund for Fungal Infections
(GAFFI)
in association with
Leading Fungal Education International (LIFE)

4. Vision
To greatly reduce illness and death associated
with fungal diseases worldwide
www.GAFFI.org

5. Why GAFFI?
Too many people have no access to
life-saving diagnostics and antifungal
medicines
www.GAFFI.org

6. The size of the problem
www.GAFFI.org
About 1 billion with skin, hair and nails fungal disease
Over 350 million people affected by serious fungal
infection worldwide
• About 135 million women have recurrent yeast or
Candida infections
• About 200 million children have disfiguring hair
fungal infectin
~25 million with life-threatening and major morbidity

7. Deaths from fungal
infections need to fall
Fungal Infection TB (2016) Malaria (2016)
>1,660,000
1,700,000
(375,000
with HIV)
445,000
www.GAFFI.org

8. GBD 2015 Mortality and Causes of Death Collaborators Lancet 2016;388:1459
*
*
*
*
*
* = fungal
component
*
*

9. GAFFI’s overall goals
• Measure the impact of serious fungal disease
• Universal access to diagnostic testing
• Universal access to antifungal treatments
• Educate healthcare professionals
• Advocacy, Advocacy, Advocacy
www.GAFFI.org

10. The intersection of serious fungal diseases with TB,
AIDS, cancer, asthma and COPD/emphysema
TB
Cancer
Histoplasmosis
Asthma
COPD
Pneumocystis
Fungal asthma
Candida
Aspergillus
Crypto
meningitis
AIDS
Chronic
aspergillosis
Aspergillus
Fungal
keratitis
Tinea
capitis
Mycetoma
Chromoblastomycosis
No underlying diseases – normal people
www.GAFFI.org

11. Life-treatening aspergillosis
complicating cancer and leukaemia
www.GAFFI.org

12. www.GAFFI.org
Fungal disease of the lungs in
outside the hospital
‘Fungal asthma’
~200 million adult asthmatics
Fungal asthma in children –
2% of 100 million

13. GAFFI is calling for:
By 2025, ensure that 95% of people with
serious fungal disease are diagnosed and
95% treated
www.GAFFI.org

14. National burden estimates –
75 countries covered
Algeria, Argentina, Austria, Australia, Bangladesh, Belgium,
Belarus, Benin, Brazil, Burkina Faso, Cameroon, Canada, Chile,
China, Colombia, Congo, Czech Republic, Denmark, Dominican
Republic, Ecuador, Egypt, France, Gambia, Germany, Greece,
Guatemala, Hungary, India, Indonesia, Iraq, Iran, Ireland, Israel,
Italy, Japan, Jordan, Kazahkstan, Kenya, Lithuania, Madagascar,
Malawi, Malayasia, Macedonia, Mexico, Mongolia, Mozambique,
Myanmar, Nepal, Netherlands, New Zealand, Nigeria, Norway,
Qatar, Pakistan, Peru, Philippines, Poland, Portugal, Romania,
Russia, Saudi Arabia, Senegal, Serbia, Singapore, South Africa,
South Korea, Spain, Sri Lanka, Sweden, Tanzania, Thailand,
Taiwan, Trinidad and Tobago, Turkey, Uganda, UK, Ukraine,
Uruguay, USA, Uzbekistan, Venezuela, Vietnam, Zambia.
Abstract papers published or in press Estimates in progress

15. Demonstration sites
Guatemala and Kenya
To document that improving
diagnosis, offering treatment with
excellent training makes a real
difference – on a public health basis
www.GAFFI.org

16. 1.1 million deaths from AIDS in 2015
~300,000 – 400,000 due to TB
~50% due to fungal diseases
www.GAFFI.org
Average age of death of fungal infection in
AIDS = 35 years

17. Reducing AIDS deaths due to fungal
infections – potential impact of 60%
coverage of diagnostics and treatments
for main 4 fungal infections in AIDS
www.GAFFI.org - Appendix 7Denning DW. Phil Trans R Soc 2016; 371: 20150468

18. www.gaffi.org/why/burden-of-disease-maps/
registration

19. “Minimizing HIV deaths
through rapid fungal
diagnosis and better
care in Guatemala”
Activity report
2017

20. HIV centres
participating in the
project
Nombre del Hospital Ciudad
1
Hospital Regional de Cobán Hellen Lossi de
Laugerud
Cobán
2 Hospital Regional de Escuintla Escuintla
3 Hospital Regional de Occidente Quetzaltenango
4 Hospital Regional de Coatepeque Juan José Ortega José Ortega
5 Hospital Regional de Cuilapa Cuilapa
6 Hospital Regional de Petén San Benito
7 Hospital Regional de Zacapa Zacapa
8
Hospital Nacional de Huehuetenango Dr. Jorge Vides
Molina
Huehuetenango
9 Hospital Nacional de Malacatán Malacatán
10 Hospital Nacional de Retalhuleu Retalhuleu
11 Hospital La Amistad Japón Guatemala Puerto Barrios
12 Hospital Infantil Elisa Martínez Puerto Barrios
13 Clínica Familiar Luis Ángel García * Guatemala City
*

21. Activities and Results
Training programs
Case
discussion +
diagnosis,
treatment
and patients
care talks.
Participants:
Hospital and
UAI´s
medical, lab
and
pharmacy
personnel.
Hospital La Amistad Japón Guatemala,
August 17th 2017
Hospital Regional de Escuintla, June 19th 2017 Hospital Regional de Cuilapa, July 3rd 2017
Hospital Regional de Cobán, November 3rd 2017

22. Patients and samples, diagnosis
Sample
turn
around
Ordering
and
results by
mobile
phone

23. Cases diagnosed
Cohort cases
Reference HIV
Unit
HIV Units Total
Histoplasma capsulatum (HC) 22 92 114
Cryptococcus neoformans 40 29 69
C. albidus 1 1
Coccidiodes posadasii 1 1
Sporothrix schenckii 1 1
Mycobacterium tuberculosis (MTB) 43 85 128
M. avium 2 0 2
M. fortuitum 2 2
M. gordonae 1 1
M. abscessus 2 2
Coinfections
HC/MTB 2 8 10
Cryptococcus/HC 2 2 4
Cryptococcus/MTB 1 1
Total positive cases 112 224 336
Total negative cases 541 1168 1709
Total 653 1392 2045

24. Cohort cases
Reference HIV
Unit
HIV Units Total
Histoplasma capsulatum (HC) 22 92 114
Cryptococcus neoformans 40 29 69
C. albidus 1 1
Coccidiodes posadasii 1 1
Sporothrix schenckii 1 1
Mycobacterium tuberculosis (MTB) 43 85 128
M. avium 2 0 2
M. fortuitum 2 2
M. gordonae 1 1
M. abscessus 2 2
Coinfections
HC/MTB 2 8 10
Cryptococcus/HC 2 2 4
Cryptococcus/MTB 1 1
Total positive cases 112 224 336
Total negative cases 541 1168 1709
Total 653 1392 2045
Cases diagnosed
Incidence of life-
threatening infection:
16.4%

25. Cohort cases
Reference HIV
Unit
HIV Units Total
Histoplasma capsulatum (HC) 22 92 114
Cryptococcus neoformans 40 29 69
C. albidus 1 1
Coccidiodes posadasii 1 1
Sporothrix schenckii 1 1
Mycobacterium tuberculosis (MTB) 43 85 128
M. avium 2 0 2
M. fortuitum 2 2
M. gordonae 1 1
M. abscessus 2 2
Coinfections
HC/MTB 2 8 10
Cryptococcus/HC 2 2 4
Cryptococcus/MTB 1 1
Total positive cases 112 224 336
Total negative cases 541 1168 1709
Total 653 1392 2045
Cases diagnosed
55.3% Fungal Infections

26. When the results are compared with the
same period of 2016, before the system was
launched, 91% increase in the number of
histoplasmosis, cryptococcosis and
tuberculosis is detected
(336 vs 176)
Cost = <$200,000 per year
Impact

27. Life-threatening fungal diseases in Kenya
- strengthening pathology, radiology and
mycology diagnostic capabilities
Fungal Infections Program for Kenya ‘FIP-Kenya’
2018-2021

28. FIP-Kenya
2 teaching hospitals
11 major referral hospitals
Focus on improving hospital diagnostic capacity and
medical practice
Where in Kenya?

29. FIP-Kenya

30. FIP-Kenya project
AMREF
Medical and
radiographer education
delivery
JICA
Funding
GAFFI
Co-ordination
Finance
Educational materials
Research
Scholarships
Monitoring/evaluation
MoH
Hospital co-ordination
Equipment procurement
IT infrastructure
Procurement of diagnostic
reagents (KEMSA)
KEMRI
Research implementation
Cancer registry
Fungal disease registry
www.GAFFI.org
National Public
Health Lab
Technician training
National lab
QA program

31. OUR VISION IS TO REDUCE ILLNESS AND DEATH
ASSOCIATED WITH FUNGAL DISEASES WORLDWIDE.
GAFFI
Global Action Fund for Fungal Infections
LEAVE NO ONE BEHIND: Too many people
have no access to life-saving fungal diagnostics
and antifungal medicine. This has to change!
www.gaffi.org/Roadmap
May 2015

32. • Drug access program – team to ensure
licensing and purchase of generic antifungals
drugs everywhere
• NTD program – mapping, training, prevention,
rapid diagnosis of skin and fungal eye disease
• Facilitating faster point of care diagnostics
• Advocacy program for leading problems –
children with fungal pneumonia, blindness,
diagnostic training in each country (reference
labs).
GAFFI’s next phase
www.GAFFI.org

33. ‘Leave no one behind’
www.GAFFI.org
Too many people have no access to life-saving
diagnostics and antifungal medicine
This has to change