The long-term impact of the leprosy post-exposure prophylaxis (Lpep) program on leprosy incidence:a modelling study

Background The Leprosy Post-Exposure Prophylaxis (LPEP) program explored the feasibility and impact of contact tracing and the provision of single dose rifampicin (SDR) to eligible contacts of newly diagnosed leprosy patients in Brazil, India, Indonesia, Myanmar, Nepal, Sri Lanka and Tanzania. As the impact of the programme is difficult to establish in the short term, we apply mathematical modelling to predict its long-term impact on the leprosy incidence. Methodology The individual-based model SIMCOLEP was calibrated and validated to the historic leprosy incidence data in the study areas. For each area, we assessed two scenarios: 1) continua-tion of existing routine activities as in 2014; and 2) routine activities combined with LPEP starting in 2015. The number of contacts per index patient screened varied from 1 to 36 between areas. Projections were made until 2040. Principal findings In all areas, the LPEP program increased the number of detected cases in the first year(s) of the programme as compared to the routine programme, followed by a faster reduction after-wards with increasing benefit over time. LPEP could accelerate the reduction of the leprosy incidence by up to six years as compared to the routine programme. The impact of LPEP varied by area due to differences in the number of contacts per index patient included and differences in leprosy epidemiology and routine control programme. Conclusions The LPEP program contributes significantly to the reduction of the leprosy incidence and could potentially accelerate the interruption of transmission. It would be advisable to include contact tracing/screening and SDR in routine leprosy programmes.</p

Leprosy post-exposure prophylaxis with single-dose rifampicin

_Objective:_ Leprosy post-exposure prophylaxis with single-dose rifampicin (SDRPEP) has proven effective and feasible, and is recommended by WHO since 2018. This SDR-PEP toolkit was developed through the experience of the leprosy postexposure prophylaxis (LPEP) programme. It has been designed to facilitate and standardise the implementation of contact tracing and SDR-PEP administration in regions and countries that start the intervention. _Results:_ Four tools were developed, incorporating the current evidence for SDRPEP and the methods and learnings from the LPEP project in eight countries. (1) th

A single dose of rifampicin to prevent leprosy: Qualitative analysis of perceptions of persons affected, contacts, community members and health professionals towards chemoprophylaxis and the impact on their attitudes in India, Nepal and Indonesia

Introduction: The purpose of this study is to investigate the impact of post-exposure prophylaxis (PEP) and the education given along with PEP on knowledge about leprosy and the attitudes and reported behaviour towards people affected by leprosy. This study is a sub-study of the Leprosy Post-Exposure Prophylaxis (LPEP) programme. Methods: Seventy-two semi-structured interviews and five Focus Group Discussions (FGDs) were conducted in India, Nepal and Indonesia. The study population consisted of i) index patients, ii) contacts, iii) community members and iv) health professionals. The participants were selected purposively. A team of four social scientists analysed the data using a thematic analysis. Results: The participants in this study were mostly positive and sometimes very positive about the possibility to prevent leprosy in close contacts through a single dose of rifampicin. Most respondents reported that there were no changes in their views towards leprosy or people affected by leprosy after the intervention. The study revealed that the incorrect health information that was retained and the wish of some people affected to conceal the illness poses challenges for a PEP programme. Conclusion: The LPEP programme was perceived positively and no negative effects were reported. In this analysis, PEP did not appear to have an effect on the way leprosy or people affected by leprosy were perceived. More research is needed on providing health information that is accurate and understandable for contacts, and on approaches in which disclosure of the index patient is not required

The Impact of Leprosy and Physical Disability on Marital and Sexual Relationships of Married Nepali Men

Purpose: Both leprosy and disability can have a negative impact on a person’s relationships. This study aimed to gain insight into the impact of leprosy and disability on marital and sexual relationships of married Nepali men. Method: The study used a cross-sectional design with a qualitative approach. Thirty participants were selected using purposive sampling and put in 3 groups (10 in each group): (1) men with impairments due to leprosy, (2) men without leprosy but with physical disabilities, and (3) men without leprosy or disabilities (control group). Data were collected during semi-structured interviews and two focus group discussions, and analysed with the software programme NVivo using structured coding. Results: The majority of the men indicated they were satisfied with their marital and sexual relationships. However, some leprosy-affected men and some men with disabilities experienced friction in their marital relationships. Fighting between husband and wife was reported by half of the men affected by leprosy. Leprosy and disability had a negative influence on the sexual relationships of some of the men, because of physical limitations, pain, or decreased sex drive. Furthermore, many participants appeared to lack knowledge about the cause of leprosy and about sexual health. Conclusion and Implications: Men affected by leprosy or disabilities seemed to face more problems in their marital relationships than men from the control group. This was primarily related to physical limitations which resulted in the inability to work; this threatened their personal and social identity. Findings show that there may be a problem in accessibility or availability of sex education. In addition, some marital problems could be related to lack of knowledge of leprosy. These point to the importance of providing education on leprosy and sexual health at the time of diagnosis

Four hypotheses per instrument to confirm construct validity and its study outcome.

Four hypotheses per instrument to confirm construct validity and its study outcome.</p

Three subgroups to check interpretability of the WEMWBS and PHQ-9 in Province 1 and 7, Nepal.

Three subgroups to check interpretability of the WEMWBS and PHQ-9 in Province 1 and 7, Nepal.</p

Adaptation of item statements of WEMWBS and PHQ-9 in Nepalese culture.

Adaptation of item statements of WEMWBS and PHQ-9 in Nepalese culture.</p

Characteristics of persons affected by leprosy (n = 90) and controls not affected by leprosy (n = 50) in the quantitative part of the cross-cultural validation study.

Characteristics of persons affected by leprosy (n = 90) and controls not affected by leprosy (n = 50) in the quantitative part of the cross-cultural validation study.</p

Four pre-defined hypotheses per instrument to confirm construct validity and the results of testing these.

Four pre-defined hypotheses per instrument to confirm construct validity and the results of testing these.</p