The long-term impact of the leprosy post-exposure prophylaxis (Lpep) program on leprosy incidence: a modelling study

David J. Blok*, Peter Steinmann, Anuj Tiwari, Tanja Barth-Jaeggi, Mohammad A. Arif, Nand Lal Banstola, Rabindra Baskota, David Blaney, Marc Bonenberger, Teky Budiawan, Arielle Cavaliero, Zaahira Gani, Helena Greter, Eliane Ignotti, Deusdedit V. Kamara, Christa Kasang, Pratap R. Manglani, Liesbeth Mieras, Blasdus F. Njako, Tiara PakasiUnnati R. Saha, Paul Saunderson, W. Cairns S. Smith, René Stäheli, Nayani D. Suriyarachchi, Aye Tin Maung, Tin Shwe, Jan van Berkel, Wim H. van Brakel, Bart Vander Plaetse, Marcos Virmond, Millawage S.D. Wijesinghe, Ann Aerts, Jan Hendrik Richardus

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

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Abstract

Background The Leprosy Post-Exposure Prophylaxis (LPEP) program explored the feasibility and impact of contact tracing and the provision of single dose rifampicin (SDR) to eligible contacts of newly diagnosed leprosy patients in Brazil, India, Indonesia, Myanmar, Nepal, Sri Lanka and Tanzania. As the impact of the programme is difficult to establish in the short term, we apply mathematical modelling to predict its long-term impact on the leprosy incidence. Methodology The individual-based model SIMCOLEP was calibrated and validated to the historic leprosy incidence data in the study areas. For each area, we assessed two scenarios: 1) continua-tion of existing routine activities as in 2014; and 2) routine activities combined with LPEP starting in 2015. The number of contacts per index patient screened varied from 1 to 36 between areas. Projections were made until 2040. Principal findings In all areas, the LPEP program increased the number of detected cases in the first year(s) of the programme as compared to the routine programme, followed by a faster reduction after-wards with increasing benefit over time. LPEP could accelerate the reduction of the leprosy incidence by up to six years as compared to the routine programme. The impact of LPEP varied by area due to differences in the number of contacts per index patient included and differences in leprosy epidemiology and routine control programme. Conclusions The LPEP program contributes significantly to the reduction of the leprosy incidence and could potentially accelerate the interruption of transmission. It would be advisable to include contact tracing/screening and SDR in routine leprosy programmes.

Original languageEnglish
Article numbere0009279
JournalPLoS Neglected Tropical Diseases
Volume15
Issue number3
DOIs
Publication statusPublished - 31 Mar 2021

Bibliographical note

Funding Information:
This study is part of LPEP project, funded by Novartis Foundation (no grant number). The grant was received by Jan Hendrik Richardus. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Publisher Copyright: © 2021, Public Library of Science. All rights reserved.

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