The study aims to provide this scientific evidence of the effectiveness of SDR-PEP in preventing leprosy among contacts in a routine programme setting. It also aims to provide a better understanding of the impact of ongoing SDR-PEP implementation on new case detection rate at district level.
How effective is ongoing SDR-PEP implementation under routine programme conditions – a retrospective cohort study in Nepal
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Project summary
Leprosy, a neglected tropical disease, continues to disrupt the lives of people. The disease burden is higher in low-income countries. The affected people often face stigma and discrimination due to its disabling factor which leads the persons and their families to further poverty. Nepal is one of the top ten countries in the world where leprosy is a burden.
The current control strategy of leprosy, based on case detection and treatment with multidrug therapy (MDT), was introduced in 1982. MDT is an effective treatment, but it has insufficient impact on the leprosy incidence rate, as leprosy transmission is not interrupted.
It has been shown that contact tracing combined with the provision of post-exposure prophylaxis (PEP) with single-dose rifampicin (SDR) may reduce the risk of developing leprosy in contacts by 60%. Findings from different studies, such as, the PEP trial in Indonesia, the ‘COLEP’ study in Bangladesh and the LPEP study has shown its effectiveness and the feasibility of integrating chemoprophylaxis into routine leprosy control. SDR-PEP therefore is a promising new leprosy elimination strategy and recommended by the World Health Organization (WHO) Guidelines for the Diagnosis, Treatment and Prevention of Leprosy in 2018, as preventive treatment for contacts of leprosy patients. Additional practical evidence is needed to demonstrate the impact of SDR-PEP when this strategy is implemented as part of routine leprosy control.
The research question this project aims to address is therefore: How effective is contact screening and SDR-PEP implementation, as part of routine leprosy control, in preventing leprosy among contacts who received SDR-PEP, 4-7 years post intervention?
During the project period, 14,100 contacts who received SDR-PEP and same number who did not receive SDR-PEP between 2015 and 2019 in cohort and control districts will be assessed for leprosy. Similarly, all new leprosy cases detected during the same period among contacts in all these districts will be assessed.