Leprosy Post-Exposure Prophylaxis (LPEP) programme: Study protocol for evaluating the feasibility and impact on case detection rates of contact tracing and single dose rifampicin

Introduction: The reported number of new leprosy patients has barely changed in recent years. Thus, additional approaches or modifications to the current standard of passive case detection are needed to interrupt leprosy transmission. Large-scale clinical trials with single dose rifampicin (SDR) given as post-exposure prophylaxis (PEP) to contacts of newly diagnosed patients with leprosy have shown a 50-60% reduction of the risk of developing leprosy over the following 2 years. To accelerate the uptake of this evidence and introduction of PEP into national leprosy programmes, data on the effectiveness, impact and feasibility of contact tracing and PE

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

The long-term impact of the Leprosy Post-Exposure Prophylaxis (LPEP) program on leprosy incidence: A modelling study.

BackgroundThe 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.MethodologyThe 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) continuation 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 findingsIn 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 afterwards 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.ConclusionsThe 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

Leprosy post-exposure prophylaxis with single-dose rifampicin: toolkit for implementation

lNLR, Amsterdam, NetherlandsmPrivate, UKnHealth Services, Dadra and Nagar Haveli, IndiaoNLR, Jakarta, IndonesiapAnti-Leprosy Campaign, Colombo, Sri LankaqUniversidade do Estado de Mato Grosso, Ca ́ceres, BrazilrNational Tuberculosis and Leprosy Programme, Dar es Salaam,TanzaniasGerman Leprosy and Tuberculosis Relief Association, Wu ̈rzburg,GermanytDirectorate General of Health Services, MoHFW, New Delhi, IndiauNational Leprosy Elimination Program, Phnom Penh, CambodiavGerman Leprosy and Tuberculosis Relief Association,Dar es Salaam, TanzaniawSub Directorate Directly Transmitted Tropical Diseases, MoH,Jakarta, IndonesiaxErasmus MC, University Medical Center Rotterdam, Rotterdam,NetherlandsyAmerican Leprosy Missions, Greenville, USAzUniversity of Aberdeen, Aberdeen, UKaaFAIRMED, Colombo, Sri LankaabInstituto Lauro de Souza Lima, Bauru, BrazilAccepted for publication 22 July 2019SummaryObjective:Leprosy post-exposure prophylaxis with single-dose rifampicin (SDR-PEP) has proven effective and feasible, and is recommended by WHO since 2018.This SDR-PEP toolkit was developed through the experience of the leprosy post-exposure prophylaxis (LPEP) programme. It has been designed to facilitate andstandardise the implementation of contact tracing and SDR-PEP administration inregions and countries that start the intervention.Results:Four tools were developed, incorporating the current evidence for SDR-PEP and the methods and learnings from the LPEP project in eight countries. (1) theSDR-PEP policy/advocacy PowerPoint slide deck which will help to inform policymakers about the evidence, practicalities and resources needed for SDR-PEP, (2) theSDR-PEP field implementation training PowerPoint slide deck to be used to trainfront line staff to implement contact tracing and PEP with SDR, (3) the SDR-PEPgeneric field guide which can be used as a basis to create a location specific fieldprotocol for contact tracing and SDR-PEP serving as a reference for frontline fieldstaff. Finally, (4) the SDR-PEP toolkit guide, summarising the different componentsof the toolkit and providing instructions on its optimal use.Conclusion:In response to interest expressed by countries to implement contacttracing and leprosy PEP with SDR in the light of the WHO recommendation of SDR-PEP, this evidence-based, concrete yet flexible toolkit has been designed to servenational leprosy programme managers and support them with the practical means toLeprosy post-exposure prophylaxis toolkit357 translate policy into practice. The toolkit is freely accessible on the Infolep homepagesand updated as required: https://www.leprosy-information.org/keytopic/leprosy-post-exposure-prophylaxis-lpep-programm