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 PEP for leprosy are required. The leprosy post-exposure prophylaxis (LPEP) programme was designed to obtain those data. Methods and analysis: The LPEP programme evaluates feasibility, effectiveness and impact of PEP with SDR in pilot areas situated in several leprosy endemic countries: India, Indonesia, Myanmar, Nepal, Sri Lanka and Tanzania. Complementary sites are located in Brazil and Cambodia. From 2015 to 2018, contact persons of patients with leprosy are traced, screened for symptoms and assessed for eligibility to receive SDR. The intervention is implemented by the national leprosy programmes, tailored to local conditions and capacities, and relying on available human and material resources. It is coordinated on the ground with the help of the in-country partners of the International Federation of Anti-Leprosy Associations (ILEP). A robust data collection and reporting system is established in the pilot areas with regular monitoring and quality control, contributing to the strengthening of the national surveillance systems to become more action-oriented. Ethics and dissemination: Ethical approval has been obtained from the relevant ethics committees in the countries. Results and lessons learnt from the LPEP programme will be published in peer-reviewed journals and should provide important evidence and guidance for national and global policymakers to strengthen current leprosy elimination strategies

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

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

Leprosy post-exposure prophylaxis with single-dose rifampicin (LPEP): an international feasibility programme

Background Innovative approaches are required for leprosy control to reduce cases and curb transmission of Mycobacterium leprae. Early case detection, contact screening, and chemoprophylaxis are the most promising tools. We aimed to generate evidence on the feasibility of integrating contact tracing and administration of single-dose rifampicin (SDR) into routine leprosy control activities. Methods The leprosy post-exposure prophylaxis (LPEP) programme was an international, multicentre feasibility study implemented within the leprosy control programmes of Brazil, India, Indonesia, Myanmar, Nepal, Sri Lanka, and Tanzania. LPEP explored the feasibility of combining three key interventions: systematically tracing contacts of individuals newly diagnosed with leprosy; screening the traced contacts for leprosy; and administering SDR to eligible contacts. Outcomes were assessed in terms of number of contacts traced, screened, and SDR administration rates. Findings Between Jan 1, 2015, and Aug 1, 2019, LPEP enrolled 9170 index patients and listed 179 769 contacts, of whom 174782 (97·2%) were successfully traced and screened. Of those screened, 22 854 (13·1%) were excluded from SDR mainly because of health reasons and age. Among those excluded, 810 were confirmed as new patients (46 per 10 000 contacts screened). Among the eligible screened contacts, 1182 (0·7%) refused prophylactic treatment with SDR. Overall, SDR was administered to 151 928 (86·9%) screened contacts. No serious adverse events were reported. Interpretation Post-exposure prophylaxis with SDR is safe; can be integrated into different leprosy control programmes with minimal additional efforts once contact tracing has been established; and is generally well accepted by index patients, their contacts, and health-care workers. The programme has also invigorated local leprosy control through the availability of a prophylactic intervention; therefore,

Costs and revenue of health care in a rural Zimbabwean district

The District Health Executive of Tsholotsho district in south-west Zimbabwe conducted a health care cost study for financial year 1997-98. The study's main purpose was to generate data on the cost of health care of a relatively high standard, in a context of decentralization of health services and increasing importance of local cost-recovery arrangements. The methodology was based on a combination of step-down cost accounting and detailed observation of resource use at the point of service. The study is original in that it presents cost data for almost all of the health care services provided at district level. The total annualized cost of the district public health services in Tsholotsho amounted to US$10 per capita, which is similar to the World Bank's Better Health in Africa study (1994) but higher than in comparable studies in other countries of the region. This can be explained by the higher standards of care and of living in Zimbabwe at the time of the study. About 60% of the costs were for the district hospital, while the different first-line health care facilities (health centres and rural hospitals together) absorbed 40%. Some 54% of total costs for the district were for salaries, 20% for drugs, 11% for equipment and buildings (including depreciation) and 15% for other costs. The study also looked into the revenue available at district level: the main source of revenue (85%) was from the Ministry of Health. The potential for cost recovery was hardly exploited and revenue from user fees was negligible. The study results further question the efficiency and relevance of maintaining rural hospitals at the current level of capacity, confirm the soundness of a two-tiered district health system based on a rational referral system, and make a clear case for the management of the different elements of the budget at the decentralized district level. The study shows that it is possible to deliver district health care of a reasonable quality at a cost that is by no means exorbitant, albeit unfortunately not yet within reach of many sub-Saharan African countries today

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