Introducing leprosy post-exposure prophylaxis into the health systems of India, Nepal and Indonesia: a case study

Abstract

BackgroundLeprosy has a wide range of clinical and socio-economic consequences. India, Indonesia and Nepal contribute significantly to the global leprosy burden. After integration, the health systems are pivotal in leprosy service delivery. The Leprosy Post Exposure Prophylaxis (LPEP) program is ongoing to investigate the feasibility of providing single dose rifampicin (SDR) as post-exposure prophylaxis (PEP) to the contacts of leprosy cases in various health systems. We aim to compare national leprosy control programs, and adapted LPEP strategies in India, Nepal and Indonesia. The purpose is to establish a baseline of the health system’s situation and document the subsequent adjustment of LPEP, which will provide the context for interpreting the LPEP results in future.MethodsThe study followed the multiple-case study design with single units of analysis. The data collection methods were direct observation, in-depth interviews and desk review. The study was divided into two phases, i.e. review of national leprosy programs and description of the LPEP program. The comparative analysis was performed using the WHO health system frameworks (2007).ResultsIn all countries leprosy services including contact tracing is integrated into the health systems. The LPEP program is fully integrated into the established national leprosy programs, with SDR and increased documentation, which need major additions to standard procedures. PEP administration was widely perceived as well manageable, but the additional LPEP data collection was reported to increase workload in the first year.ConclusionsThe findings of our study led to the recommendation that field-based leprosy research programs should keep health systems in focus. The national leprosy programs are diverse in terms of organizational hierarchy, human resource quantity and capacity. We conclude that PEP can be integrated into different health systems without major structural and personal changes, but provisions are necessary for the additional monitoring requirements.Electronic supplementary materialThe online version of this article (10.1186/s12913-017-2611-7) contains supplementary material, which is available to authorized users.

Leprosy services in primary health care in India: comparative economic cost analysis of two public‐health settings

“… MB, multibacillary; NCDR, new case detection rate; PB, paucibacillary; Source: Tiwari et al . 2017 . …”

Current situation of leprosy in India and its future implications

“…It is designed to complement and be integrated into the NLEP rather than operating vertically. [ 12 ]…”

Leprosy post-exposure prophylaxis in the Indian health system: A cost-effectiveness analysis

“…SDR-PEP was field-tested in the Union Territory of Dadra and Nagar Haveli (DNH) between 2015 and 2018 as part of the Leprosy Post-Exposure Prophylaxis (LPEP) program [9]. The LPEP program was designed to assess the feasibility and impact of contact tracing and SDR-PEP to asymptomatic contacts of leprosy cases [10].…”

“…The necessary complementary activities to the routine leprosy programme were contact listing, screening, and follow-up. Additionally, LPEP also increased the awareness of leprosy in the community [9]. In DNH a total of 30,295 contacts received SDR-PEP between 2015 and 2018.…”