Projects

Impact of SDR-PEP under routine programme conditions in Nepal

  • Grant: LRI Regular Grant
  • Budget round: 2022
  • Research priorities: Transmission
  • Country: Nepal
  • Project no.: FP22\19
  • Budget: €143,803
  • Duration: March 2022 – August 2025
  • Status: Completed

Full project title:
How effective is ongoing SDR-PEP implementation under routine programme conditions – a retrospective cohort study in Nepal

Project coordination
NLR Nepal

Partners
FAIRMED Foundation Nepal
Rehabilitation Empowerment and Development Nepal (READ)

Aim: The study provided scientific evidence on the effectiveness of single-dose rifampicin post-exposure prophylaxis (SDR-PEP) in preventing leprosy among contacts under routine programme conditions. It also generated valuable insights into the impact of ongoing SDR-PEP implementation on new case detection rates at the district level.

Final project summary:
Leprosy remains an important public health challenge in several low- and middle-income countries. Beyond its physical effects, the disease can contribute to poverty through the stigma, discrimination, and social exclusion experienced by affected individuals and their families. Nepal continues to be among the countries with the highest burden of leprosy worldwide. 

Since the introduction of multidrug therapy (MDT) in 1982, leprosy control efforts have focused primarily on early case detection and treatment. While MDT is highly effective in curing the disease, it does not fully prevent ongoing transmission. This has led to increased interest in preventive interventions that can reduce the risk of developing leprosy among people who have been in contact with newly diagnosed patients.

Evidence from studies in Indonesia, Bangladesh, and other countries has shown that combining contact tracing with single-dose rifampicin post-exposure prophylaxis (SDR-PEP) can significantly reduce the risk of developing leprosy among contacts. The Leprosy Post-Exposure Prophylaxis (LPEP) programme, implemented in several countries including Nepal, demonstrated that SDR-PEP is both feasible and effective within routine health services. These findings contributed to the World Health Organization's recommendation to use SDR-PEP as part of leprosy prevention strategies.

Despite the successful implementation of SDR-PEP, questions remained about its longer-term effectiveness and the continued detection of new leprosy cases in some districts. This study was therefore conducted to assess the incidence of leprosy among contacts who had received SDR-PEP and to better understand why new cases continued to occur despite preventive treatment.

The study evaluated approximately 28,200 contacts who received SDR-PEP between 2015 and 2019, alongside an equal number of contacts who did not receive preventive treatment in comparison districts. In addition, all newly diagnosed leprosy cases detected among contacts during the study period were assessed.

The findings demonstrated that SDR-PEP provided substantial protection against the development of leprosy. Contacts who received SDR-PEP had a 72% lower risk of developing leprosy compared with those who did not receive preventive treatment. This protective effect was equally evident among blood relatives and household contacts, who are considered to be at highest risk of infection and are therefore the main target group for post-exposure prophylaxis programmes.

The study also found that the proportions of multibacillary (MB) and paucibacillary (PB) leprosy among newly diagnosed cases were similar in both groups. This suggests that SDR-PEP does not selectively prevent one type of leprosy over another but instead provides broad protection against disease development.

While the study design did not allow definitive conclusions about the impact of SDR-PEP on leprosy transmission at the population level, the results clearly demonstrated its strong protective effect for individuals at risk. The findings suggest that sustained implementation of SDR-PEP over several years could reduce the number of contacts progressing to disease and, over time, contribute to lower transmission within communities.

Impact

Banstola, N. L., Hasker, E., Mieras, L., Gurung, D., Baral, B., Mehata, S., Prasai, S., Ghimire, Y., Das, B. K., Napit, P., & van Brakel, W. H. (2024). Effectiveness of ongoing single dose rifampicin post-exposure prophylaxis (SDR-PEP) implementation under routine programme conditions—An observational study in Nepal. PLOS Neglected Tropical Diseases, 18(12), e0012446.