On Tuesday September 14, 2021, NLR organized the launch of the PEP4LEP research project on implementing leprosy prevention methods in Nampula province, Mozambique. The Provincial Governor's representative and the PEP4LEP implementing parties – NLR, Lúrio University and the Ministry of Health – witnessed the first hand out of a, for Mozambique, new preventive medicine for contacts of leprosy patients. This medicine is proven to contribute to the interruption of leprosy, a disease which can have devastating effects.
Leprosy is an infectious disease, mainly affecting the skin, nerves and eyes. When not detected and treated in time, the disease can lead to disabilities, stigma and discrimination. Actively searching for leprosy patients and treating the disease at an early stage is important to reduce transmission. Last week, the World Health Organization (WHO) reported that a 37% reduction in global new leprosy cases was seen in 2020 compared with 2019. This change is thought to be caused by decreased detection and reporting due to the COVID-19 pandemic. Innovative and intensified methods are urgently needed for leprosy control.
A single dose of the antibiotic rifampicin has been proven to reduce the risk of developing leprosy by nearly 60% when administered to contacts of leprosy patients. The WHO incorporated this preventive treatment in their guidelines since 2018. However, little is known about the best implementation method, especially when focusing on the sub-Sahara African context.
PEP4LEP is a research project that aims to identify the best approach for screening people at risk of developing leprosy and administering preventive treatment in Mozambique, Ethiopia, and Tanzania. During this randomized implementation trial, two methods are compared. The first method is community based in which 'skin camps' are set up to screen around 100 community members who live in the surroundings of a leprosy patient. The second method focuses on health facilities, with household contacts of a leprosy patient being invited to receive skin screening. All eligible contacts of leprosy patients in this project will be offered rifampicin aimed at preventing them from developing and spreading leprosy.
Participants in the PEP4LEP study are not only screened for leprosy, but also for other skin diseases and neglected tropical diseases (NTDs) affecting the skin. This integrated screening approach is an evidence based and WHO supported method for leprosy detection. The approach is expected to help overcome the stigma that often hinder participation in specific leprosy interventions.
The PEP4LEP project aims to provide policymakers with relevant information on the effectiveness of the two methods for improved leprosy control. It will also explore acceptability, cost-effectiveness and health workers' capacity in detecting leprosy and other skin diseases. The project is funded by the European & Developing Countries Clinical Trials Partnership (EDCTP), supported by the European Union, and by the Leprosy Research Initiative.
30,000 people screened and treated
In all three PEP4LEP research countries, a total of 30,000 contacts of leprosy patients will be screened for skin diseases and treated preventively for leprosy. About 90 percent of the participants will be screened in a community-based setting and 10 percent via health centers. In Mozambique, an expected total of 10,000 people will receive a single dose of rifampicin. Of course, COVID-19 preventive measures are taken into account during the execution of PEP4LEP project activities.