The aim of this study is to develop an effective leprosy endgame strategy for low endemic settings.
Endgame strategy for leprosy in the Maldives: optimal targeting of post-exposure prophylaxis to interrupt transmission
Project coordination
Partners
- The Maldives National University
- WHO Regional Office for South-East Asia
- Health Protection Agency, Ministry of Health (Maldives)
Project summary
The Maldives have reported 80 new leprosy cases in 32 of 189 inhabited islands during 2008-2018. Only four new child cases were detected indicating that transmission of M. leprae might be close to interruption. The Maldives is committed to make the country leprosy-free in the coming decade: to interrupt transmission (zero new child cases) and achieve zero new autochthonous leprosy cases. As part of this commitment an endgame strategy should be developed. No evidence is available yet on effective endgame strategies in a low endemic setting, such as the Maldives. It has been recommended to include contact screening and prophylactic treatment with a single-dose of rifampicin (SDR) of contacts of a patient. However, it remains unclear which strategy and what the optimal profile of the target population (e.g., close contacts or high endemic community) should be in a low-endemic island setting to ensure achievement of interruption of transmission. The group’s research question is: “What would be an optimal endgame strategy to ensure interruption of transmission of M. leprae in a low endemic setting?”
To answer this question, an in-depth descriptive analysis of the leprosy epidemiology in the Maldives will be conducted. Historic and recent cases will be analysed by age, sex, clinical type, disability grade, socio-economic status and geographic distribution to inform progress made thus far and the current state of the leprosy situation. At the same time, mathematical modelling will be applied to explore which implementation strategy of single-dose rifampicin PEP would be most effective to interrupt transmission while treating as few healthy individuals as possible. Various implementation strategies of contact tracing and screening (e.g. close contacts vs community), will be considered and prophylactic treatment with SDR of contacts. Based on these findings, a strategy will be advised to the National Leprosy Programme in collaboration with WHO and local stakeholders.
Co-financer: Turing Foundation