Projects
- Research priorities: Diagnostic tests
- Country: India, Nepal
- Project no.: FP24\8
- Budget: €115,946
- Duration: March 2024 - February 2026
- Status: Ongoing
- Co-funding partners: Turing Foundation
Full project title:
Use of handheld ultrasound for the early detection of leprosy and evaluation of its value as compared to existing diagnostic tests.
Project coordination
American Leprosy Missions
Partners
Nireekshana ACET (AIDS Care, Education and Training)
Lalgadh Leprosy Hospital & Services Centre
Aim: This study aims to explore the utility of Philips Lumify, a handheld point-of-care ultrasonography device, with a high-resolution probe to detect changes in the nerve affected by leprosy.
Project summary
The lack of feeling in one's hands or feet common to leprosy is due to nerve damage and this is one of the major complications leading to permanent nerve function impairment and disability in leprosy. Clinical examination includes physical palpitation of nerves (clinicians feeling the patients nerves with their fingers), which is a subjective assessment and does not provide reliable results. Ultrasonography of the peripheral nerve is a dependable alternative diagnostic technique that can precisely measure the thickness of the nerves. Several research studies demonstrated the utility of ultrasonography to detect thickened nerves in leprosy in comparison to healthy nerves and a statistically significant difference was noted in the thickness (cross-sectional area of the nerve). Further, color doppler and other features of the ultrasound device enabled detection of structural changes on the surface of the nerve and changes in blood flow which is a feature of nerve inflammation (neuritis).
Ultrasonography is able to reliably detect nerve changes in leprosy. However, this technique is confined to specialized centers and radiology units far from the sites where patients seek care. With the advent of high-resolution ultrasonography, more accurate results related to nerve changes can be captured. In the last decade, several companies produced handheld and point-of-care ultrasonography devices that are capable of capturing high resolution images at the bedside of the patients or even in the field settings.
This study will explore the utility of Philips Lumify, a handheld point-of-care ultrasonography device with a high-resolution probe to detect changes in the nerve affected by leprosy. Firstly, the images and measurements from this device will be compared with the standalone device to determine accuracy. Later the same device will be used to detect nerve changes in individuals with suspect signs of leprosy. Finally, the measurements of this device will be compared with clinical and laboratory results to see if they correlate. This Philips Lumify can be used with a mobile phone app or an android tablet. This technology is promising and can be a non-invasive and an easy diagnostic tool to detect the onset of neuritis/neuropathy in leprosy or leprosy per se. This device can be used for both early and confirmatory diagnosis of leprosy. If successful, this will decrease the length of time it takes to get a diagnosis, increase access to MDT and health care, and ultimately prevent stigma and life-long disability.
- Research priorities: Diagnostic tests
- Country: Brazil
- Project no.: FP24\13
- Budget: €186,584
- Duration: 48 months
- Status: Not yet started
Full project title:
Seeking for immunological susceptibility markers for leprosy. Identification of SNPs in miRNAs binding sites and their role in immune response modulation in leprosy
Project coordination
Universidade Federal de Minas Gerais
Partners
Instituto Lauro de Souza Lima
Universidade Federal do Sergipe
Instituto Oswaldo Cruz - FioCruz Rio
Aim: This project aims to contribute to identification of host genetic risk factors for leprosy susceptibility.
Project summary
Leprosy is a disease caused by the bacteria Mycobacterium leprae. Although there is effective treatment (multidrug therapy), it is not enough to control leprosy dissemination. Leprosy transmission occurs through close contact between an untreated patient and a susceptible person. If we have an early leprosy diagnosis and transmission monitoring, we can have an early treatment, interrupt leprosy transmission between people and also prevent clinical complications of leprosy.
One way to discover the susceptibility of people to leprosy is to understand how some parts of our DNA, inside our cells, work. Scientists know that the immune response to any pathogen is controlled by the DNA and if this control is somehow altered, one can be more susceptible than others to infections such as leprosy.
Those parts of the DNA may be what we call “genetic markers” and it is very important to study these markers present in our DNA in order to allow us to identify people with higher risks to develop leprosy.
Leprosy susceptibility and severity of the disease varies among people according to immune response profile. Several types of genetic factors control host immune response and, consequently, susceptibility to disease. One of these factors are molecules called microRNAs (miRNAs). MiRNAs act by binding in specific sites in the DNA, controlling its function. If there is a variation in its binding region, it may interfere with its function and disrupt some important mechanisms such as the immune response. One important type of variation in the site of miRNA will bind is called Single Nucleotide Polymorphisms (SNPs).
Those SNPs may influence the response from DNA to an infection, such as production of protecting molecules of the immune response. So, variations on the DNA (SNPs) may increase the risk of developing leprosy or even have a protecting role. In this study, we aim to investigate those variations in the DNA (SNPs), specifically in the regions used for miRNAs to bind and control genes of the immune response, even in leprosy patients and healthy people with close contact to them. Then, we will investigate the association of these genetic variations to an increased risk of developing leprosy.
These variants are potentially useful to identify people with a high risk of developing leprosy giving to them an early diagnosis and treatment, if necessary. It is very important to control leprosy dissemination and also to prevent the clinical complications associated with leprosy progression.
- Research priorities: Operational research
- Country: India, Nigeria
- Project no.: FP24\21
- Budget: €102,520
- Duration: June 2024 - May 2026
- Status: Ongoing
- Co-funding partners: St Francis Leprosy Guild
Full project title:
Capacity Building for Leprosy
Project coordination
The Leprosy Mission Nigeria
Partners
GLRA India
NLR
LTR Nigeria
The Leprosy Mission Trust India
Aim: The primary aim of this study is to build evidence on the quality and impact of blended training packages developed as part of the Lift Leprosy Learning project and piloted in Nigeria and India based on identified learning needs of health workers (at community level, service level and supervisory level). This evidence will add to the limited body of evidence on blended learning in leprosy (and other NTDs).
Project summary
The CapaBLe (Capacity Building in Leprosy) research project aims to study the effect of updated, modernized training materials developed for those working with people affected by leprosy.
Leprosy, a neglected tropical disease caused by leprosy bacteria and affecting the nerve system, can cause paralysis and loss of sensation leading to complications such as wounds, infections and blindness. Although great progress has been made in the treatment of leprosy in past decades, over 200.000 new cases are still diagnosed each year. Missing these cases risks the disease to spread again causing more medical, social and economic suffering. Envisioning a world without this disease asks for effective early diagnosis and treatment of patients, which requires skilled project managers, supervisors, health staff and community health workers, who are the target group of our project.
Training of new people remains important. In 2021 the International Federation of Leprosy Organizations concluded that knowledge gaps exist at all levels of leprosy programs and approaches used to train people were outdated and not sustainable. Over the years, effective learning approaches and new digital developments such as telemedicine and e-learning have emerged. These new opportunities are also available in the field of leprosy. Hence, a group of leprosy organizations initiated the Lift leprosy Learning project (2023-2025) to develop and pilot modernized training approaches and materials, building on existing knowledge.
The two year CapaBle project will study the effect of these modernized training packages (a combination of on-line and face-to-face modules) in pre-selected areas in India and Nigeria. The packages are being defined based on the needs of the target group in the two countries in close collaboration with the Ministry of Health. To measure the effect the study will use different research methods: testing of knowledge (before and after trainings), interviewing trainees and trainers about their experience, observing trainees diagnosing or treating leprosy patients, and calculating the costs of these trainings. We also plan to compare and identify differences between the effect of training people in a single disease (as is the case in India) and offering training in an integrated multi-disease manner (Nigeria). Study results will provide evidence on the effect of the trainings, and insights on what does and does not work in different locations. This information will be useful for improving trainings; to convince others to use the trainings in other countries, and to add more evidence to what we already know about certain training approaches.
- Research priorities: Disability
- Country: India
- Project no.: FP24\19
- Budget: €206,665
- Duration: July 2024 - October 2026
- Status: Ongoing
Full project title:
Establishing the effectiveness of a peer support approach based Basic Psychological Support for NTDs (BPS-N) to address mental wellbeing, stigma and social participation of persons affected by leprosy and lymphatic filariasis in Jharkhand, India
Project coordination
NLR India Foundation
Partners
GLRA India
Central Institute of Psychiatry, Ranchi, Jharkhand
NLR
Association of Persons Affected by Leprosy (APAL)
LEPRA Society
Aim: This study aims to evaluate the effectiveness of BPS-N-based peer support for addressing stigma, mental well-being and social and work participation of persons affected by leprosy or LF.
Project summary
India is home to a large proportion of the global burden of leprosy and lymphatic filariasis (LF), two neglected tropical diseases (NTDs). Both leprosy and LF can cause life-long and irreversible disabilities which can lead to serious problems . The fact that these affected people are not participating in important aspects of life can be explained by the stigma that exist. Together, the disabilities, limited participation and negative environment can cause people affected by leprosy or LF to experience poor mental health, depression and/or anxiety.
In 2020 and 2021, NLR India Foundation developed Basic Psychological Support for persons affected by NTDs (BPS-N) guide. This is an intervention that aims to reduce the psychological consequences by providing support to people affected by leprosy or LF. The intervention is delivered by peers, other people who have (had) leprosy or LF who provide support. The first results from the BPS-N implementation when piloted in India, showed promising results. However, the actual effectiveness of this tool has not been studied yet. This research proposal aims to develop a project to test the effectiveness of peer support based on BPS-N, for addressing issues related to stigma, mental well-being and participation among persons affected by leprosy or LF. In this study we will compare the mental wellbeing of people affected by leprosy or LF who will receive the BPS-N intervention with a group of people affected by leprosy or LF who will not receive this. This will hopefully provide additional evidence on the potential of this intervention to improve the (mental) well-being of persons living with NTDs.
The study will be conducted in two districts in Jharkhand state, India (Garhwa and Palamu. Our study will consist of three phases:
1) During the first phase, we will prepare all study material, we will also train the peer-supporters on the use of the BPS-N guideline, and collaborate with local government departments. Further, we will identify all participants for the study, these include the peer supporters, people receiving the peer-support intervention, and the people who will not receive the intervention. Who belongs to which group, will be randomly decided based on their geographical location.
2) During the implementation phase, the peer-supporters will receive a training and then provide the BPS-N intervention to the people affected by leprosy or LF. Meanwhile, the researchers will collect information about the mental wellbeing, participation and stigma of the study participants. They will also be interviewed and asked how they experienced the intervention. In addition, the local health and social services will be involved. The researchers will also collect information about how the BPS-N intervention can be integrated with their services.
3) The last phase will focus on evaluating the effects of the intervention, by comparing all collected information stigma, mental wellbeing and participation with the initial levels and between the groups. Recommendation will be written up and offered to the health and social services in Jharkhand state how to integrate the BPS-N intervention in their existing programmes.
- Grant: Research Capacity Strengthening Grant
- Budget round: 2023
- Research priorities: Diagnostic tests
- Country: Nepal
- Project no.: FP23_CS.6
- Budget: € 19,750
- Duration: October 2023 – September 2025
- Status: Ongoing
The study aims to further validate the use of thermography in leprosy diagnosis and monitoring of nerve impairment.
Thermographic assessment of autonomic innervation in Leprosy
Project coordination
Project summary
Leprosy affects the nerve function of the affected body parts. The changes can be felt as weakness in muscles, unable to feel, touch, and dryness mainly in hands and feet. It is easy to monitor muscle weakness and loss of sensation but not the dryness in hands and feet. There are previous studies that correlate skin temperature and skin nerve activity. There have been great advances in infrared thermography in recent years and has been used in various clinical diagnoses.
We can use thermography or electric conductance of the skin to quantify neurological function. Research has proven that thermography can measure disruptions in skin temperature and can be used as an assessment tool for diagnosing neuropathy. The study is designed and aims to further validate the use of thermography in leprosy diagnosis and monitoring of nerve impairment. Thermography is an easy and noninvasive tool that aids in the diagnosis and early detection of nerve impairment in leprosy.