This study proposes to build a reference laboratory for AMR surveillance in Tanzania which will be used in the frame of the PEP-SDR project and beyond.
Leprosy Antimicrobial Resistance Surveillance in Post Exposure Prophylaxis Setting in Tanzania (LARS)
Project Coordination
Partners
- National program for TB and Leprosy MoH
- Universite de Paris
- German Leprosy and TB Relief Association (GLRA)
- Swiss Tropical and Public Health Institute
- Colorado State University
Project summary
In Tanzania, the prevalence of leprosy has declined over the past three decades, but the annual case detection rate remains high in over twenty high-endemic districts that show evidence of continued transmission of leprosy despite extensive leprosy elimination campaigns. Post-exposure prophylaxis (PEP) with single dose rifampicin (SDR) for close contacts of leprosy patients is among the most promising new tools to control leprosy transmission. Two post-exposure prophylaxis (PEP) with single dose rifampicin (SDR) studies are ongoing or will soon be initiated in Tanzania: one in the framework of leprosy post-exposure prophylaxis program (LPEP, 2015) and the other (PEP4LEP - EDCTP). The risk of rifampicin resistance selection by PEP-SDR is one of the key concern in the field. This fear is reinforced in Tanzania by the restriction of the rifampicin to tuberculosis patients. Beside drug resistance, another concern of PEP-SDR is its impact on strain selection. These aspects has never been investigated in leprosy neither the rapidity of positive selection under such environmental pressure. Currently, there is no local laboratory reference for drug-resistance observation of M. leprae (Mycobacterium), and no information is available regarding the current level of drug resistance in Tanzania.
Herein, this project aims to:
1) Determine the level of Anti-Microbial Resistance (AMR) in M.leprae in Tanzanian districts where Single Dose Rifampicin-Post exposure Prevention (SDR-PEP) is implemented compared to non-Single Dose Rifampicin-Post exposure Prevention (SDR-PEP) districts with identification of mutations in the drug-resistance-determining region (DRDR) in 750 newly identified leprosy patients.
2) Develop/Build local capacities for conducting Anti-Microbial Resistance (AMR) observation in M.leprae in Tanzania
This will be achieved by sequencing skin samples from 750 new diagnosed leprosy patients in three years in different districts with different PEP implementation status.
Capacity building will be done during this project in implementing a national leprosy drug resistances laboratory.
Additional 150 samples will be stored to study at a later timepoint the genetic diversity of M.leprae strain in districts with and without Single Dose Rifampicin-Post Exposure Prevention (SDR-PEP) using M.leprae whole genome (genetic makeup) sequencing.
Co-financer: German Leprosy and TB Relief Association (GLRA)