Background It is unknown whether persons with symptomatic cryptococcal meningitis detected during routine blood cryptococcal antigen (CrAg) screening have better survival than persons presenting with overt meningitis. Methods We prospectively enrolled HIV-infected Ugandans with cryptococcal meningitis from December 2018 to December 2021. Participants were treated with amphotericin-based combination therapy. We compared outcomes between persons who were CrAg screened then referred to hospital versus those presenting directly to the hospital with symptomatic meningitis. Results Among 489 participants with cryptococcal meningitis, 40% (194/489) received blood CrAg screening and were referred to hospital (median time to referral 2 days, IQR 1-6). CrAg screened persons referred to hospital had lower 14-day mortality than non-CrAg screened persons who presented directly to hospital with symptomatic meningitis (12% vs. 21%; Hazard Ratio = .51; 95%CI, .32–.83; p = .006). Fewer CrAg screened participants had altered mental status versus non-CrAg screened participants (29% vs. 41%; p = .03). CrAg screened persons had lower quantitative CSF culture burden (median 4,570 CFU/mL [IQR, 11–100,000] vs. 26,900 CFU/mL [IQR, 182–324,000]; p = .01) and lower CSF opening pressures (median 190 mmH2O [IQR, 120–270] vs. 225 mmH2O [IQR, 140–340]; p = .004) compared with non-CrAg screened persons. Conclusions Survival from cryptococcal meningitis was higher in persons with prior CrAg screening than those without CrAg screening. Altered mental status was the most potent predictor for mortality in a multivariate model. We suggest that CrAg screening detects cryptococcal meningitis at an earlier stage, as evidenced by a favorable baseline risk profile and notably fewer persons with altered mental status.