The NLR SkinApp:Testing a Supporting mHealth Tool for Frontline Health Workers Performing Skin Screening in Ethiopia and Tanzania

Background: The prevalence of skin diseases such as leprosy, and limited dermatological knowledge among frontline health workers (FHWs) in rural areas of Sub-Saharan Africa, led to the development of the NLR SkinApp: a mobile application (app) that supports FHWs to promptly diagnose and treat, or suspect and refer patients with skin diseases. The app includes common skin diseases, neglected tropical skin diseases (skin NTDs) such as leprosy, and HIV/AIDS-related skin conditions. This study aimed to test the supporting role of the NLR SkinApp by examining the diagnostic accuracy of its third edition.Methods:A cross-sectional study was conducted in East Hararghe, Ethiopia, as well as the Mwanza and Morogoro region, Tanzania, in 2018–2019. Diagnostic accuracy was measured against a diagnosis confirmed by two dermatologists/dermatological medical experts (reference standard) in terms of sensitivity, specificity, positive predictive value, and negative predictive value. The potential negative effect of an incorrect management recommendation was expressed on a scale of one to four. Results: A total of 443 patients with suspected skin conditions were included. The FHWs using the NLR SkinApp diagnosed 45% of the patients accurately. The values of the sensitivity of the FHWs using the NLR SkinApp in determining the correct diagnosis ranged from 23% for HIV/AIDS-related skin conditions to 76.9% for eczema, and the specificity from 69.6% for eczema to 99.3% for tinea capitis/corporis. The inter-rater reliability among the FHWs for the diagnoses made, expressed as the percent agreement, was 58% compared to 96% among the dermatologists. Of the management recommendations given on the basis of incorrect diagnoses, around one-third could have a potential negative effect. Conclusions: The results for diagnosing eczema are encouraging, demonstrating the potential contribution of the NLR SkinApp to dermatological and leprosy care by FHWs. Further studies with a bigger sample size and comparing FHWs with and without using the NLR SkinApp are needed to obtain a better understanding of the added value of the NLR SkinApp as a mobile health (mHealth) tool in supporting FHWs to diagnose and treat skin diseases.</p

Leprosy epidemiological trends and diagnosis delay in three districts of Tanzania: A baseline study

Objectives Leprosy, also known as Hansen’s disease, is a slowly progressive and chronic infectious neglected tropical disease (NTD) caused by Mycobacterium leprae. This study was performed to assess the epidemiological trend of leprosy in the past five years in the three study districts in Tanzania in which a leprosy prevention intervention study (PEP4LEP) is implemented, and to determine the case detection delay at baseline. Methods Secondary data from the leprosy registry of the National Tuberculosis and Leprosy Program of Tanzania from 2015 to 2019 were used to describe the epidemiological trends of leprosy for the three study districts: Morogoro, Mvomero, and Lindi district council. A cross-sectional study was also conducted to assess the delay in leprosy diagnosis at baseline. The chi-square test was used to calculate statistical significance. Results Between 2015 and 2019, 657 new leprosy cases were detected in three districts. Of those cases, 247 (37.6%) were female patients, 5 (0.8%) had a grade 2 disability (G2D) and 516 (78.5%) had multibacillary (MB) leprosy. From the 50 adult leprosy patients interviewed for detection delay, 16 (32.0%) were females and 38 (76.0%) had MB leprosy. Overall, a mean case detection of 28.1 months (95% CI 21.5–34.7) and a median of 21.5 months were observed. Conclusion The three PEP4LEP study districts remain highly endemic, with long case detection delays observed that increase the risk of disabilities and contribute to ongoing leprosy transmission. Integrating activities such as contact screening and provision of post-exposure prophylaxis are therefore a necessary strategy in these endemic areas

PEP4LEP study protocol

Introduction Leprosy, or Hansen's disease, remains a cause of preventable disability. Early detection, treatment and prevention are key to reducing transmission. Post-exposure prophylaxis with single-dose rifampicin (SDR-PEP) reduces the risk of developing leprosy when administered to screened contacts of patients. This has been adopted in the WHO leprosy guidelines. The PEP4LEP study aims to determine the most effective and feasible method of screening people at risk of developing leprosy and administering chemoprophylaxis to contribute to interrupting transmission. Methods and analysis PEP4LEP is a cluster-randomised implementation trial comparing two interventions of integrated skin screening combined with SDR-PEP distribution to contacts of patients with leprosy in Ethiopia, Mozambique and Tanzania. One intervention is community-based, using skin camps to screen approximately 100 community contacts per leprosy patient, and to administer SDR-PEP when eligible. The other intervention is health centre-based, inviting household contacts of leprosy patients to be screened in a local health centre and subsequently receive SDR-PEP when eligible. The mobile health (mHealth) tool SkinApp will support health workers' capacity in integrated skin screening. The effectiveness of both interventions will be compared by assessing the rate of patients with leprosy detected and case detection delay in months, as well as feasibility in terms of cost-effectiveness and acceptability. Ethics and dissemination Ethical approval was obtained from the national ethical committees of Ethiopia (MoSHE), Mozambique (CNBS) and Tanzania (NIMR/MoHCDEC). Study results will be published open access in peer-reviewed journals, providing evidence for the implementation of innovative leprosy screening methods and chemoprophylaxis to policymakers. Trial registration number NL7294 (NTR7503). </p