Emerging Infections Network members were surveyed to identify serum cryptococcal antigen screening practices.  215 providers (out of > 3100 members) responded, with the majority identifying as infectious disease specialists primarily caring for adults at university or teaching hospitals.  181/215 (84%) cared for adults or adolescents with HIV within the past year.  Among people with HIV newly initiating ART with CD4 < 100 cells/mm³, 63% of respondents reported always or often obtaining screening CrAg (33% reported doing so for people newly initiating ART with CD4 < 200).  Among individuals re-initiating ART with CD4 < 100, 35% reported always or often obtaining CrAg (vs. 17% if CD4 < 200).  Among people experiencing ART failure with CD4 < 100, 20% reported always or often obtaining CrAg (vs. 8% if CD4 < 200).  Among seriously ill people with CD4 < 100 regardless of ART status, 77% reported always or often obtaining CrAg (vs. 68% if CD4 < 200).  The primary barrier to screening was uncertainty about its benefit (42%) and uncertainty around recommendations (32%).  10% expressed concern about delaying ART, 2% reported test unavailability, and 42% reported none of the specified barriers.  79% indicated they would manage a positive screening result by performing lumbar puncture and ordering CSF testing, 77% would evaluate for meningitis symptoms, 69% would obtain CrAg titer, and 36% would treat with fluconazole while awaiting CSF results.

DHHS guidelines on the prevention and treatment of opportunistic infections in adults and adolescents with HIV currently recommend routine serum CrAg surveillance testing in people with newly diagnosed HIV and CD4 ≤ 200 cells/mm³, regardless of whether overt signs of meningitis are present.  Findings from this survey demonstrate moderate adherence to these recommendations, with over 40% of respondents indicating they were unsure of the benefit of this practice.  Given the continued and significant prevalence of late HIV diagnoses globally, especially among older adults with newly diagnosed HIV, these findings signal a need to raise awareness of CrAg screening and management guidelines across all providers offering HIV screening and care, especially those who may be newer to the field.