Four steps to ending leprosy
Aim: The Leprosy Mission's aim is to achieve zero transmission of leprosy by 2035. This means that we need to detect and treat cases of leprosy early.
Detecting new cases of leprosy means that healthcare workers need to visit towns and villages in order to examine people who have leprosy symptoms (active case finding). It can also requires individuals to travel to health centres or leprosy hospitals to receive diagnosis and treatment.
In 2021, both of these things were more difficult than normal because of pandemic restrictions.
Just like in 2020, fewer people were diagnosed with leprosy in 2021 than we would expect.
This does not mean there are fewer leprosy cases, but that fewer people were diagnosed and started treatment. We now have a two-year backlog of cases.
If a person is diagnosed late and if they are infectious, they will continue to transmit the bacteria in their community.
Although the Covid pandemic has been a big setback in our efforts to stop leprosy transmission, we have a plan to make up for lost time.
As you will see in the coming pages, the data we have collected in recent years demonstrates that our plan will work.
(Cover photo credit: Ala Kheir)
Active case finding, contact tracing, and preventative medicines
Strengthening national health systems
Improving leprosy health information systems
Improved leprosy diagnostic tools
There is more to ending leprosy transmission than this, but if we get these four things right, we will go a long way to achieving our goal.
© Ricardo Franco
Active case finding means visiting communities and actively looking for new cases of leprosy.
How effective is active case finding?
In 2021, TLM Timor-Leste worked with government health workers to conduct active case finding in five municipalities. They spent between 14 and 24 days in each municipality, visiting homes and schools.
In previous years, these municipalities had fewer than 20 cases of leprosy. In 2021, 58 people were diagnosed with leprosy.
Leprosy is not a highly infectious disease. Most people who develop the disease have been in close contact with an infectious person over a prolonged period.
In order to find new cases of leprosy, one of the best places to start looking is amongst the people who are close contacts of a newly diagnosed person. Contact screening is key to identifying and treating new cases of leprosy.
For any close contacts who do not display symptoms of leprosy, we can provide them with a preventative antibiotic (known as post-exposure prophylaxis, or PEP for short). This reduces the risk of developing leprosy by 60 percent.
Health systems in leprosy endemic countries are under-resourced and the health workers have to manage many diseases, so have less time for leprosy.
This is why TLM is working with governments to help them strengthen their health systems for early detection and treatment of leprosy.
In 2021 we provided 40,894 days of training on leprosy to medical & para medical staff.
Proyash translates as 'ambition'. The Proyash project in Bangladesh has been able to strengthen government health systems in 12 districts across Bangladesh by:
Improving quality of leprosy services through a more responsive health care system
Improving efficiency in surveillance, monitoring and evaluation through an improved health management information system
Improving health seeking behaviour among those affected by and at risk of leprosy
Improving social and financial protection by reducing stigma, discrimination & promoting social inclusion of persons affected by leprosy
TLM's Global Strategy commits us to tackling leprosy in key endemic areas.
Currently, much of the data we have focuses on national-level leprosy cases. The sub-national data shows us the new case trends, identifies where community transmission is ongoing and therefore tells us what specific interventions are needed in that district.
This means we need to identify which districts, towns, and even villages are responsible for the highest numbers of leprosy cases.
© Ollivier Girard
Leprosy diagnosis today is conducted by checking for skin and nerve signs and symptoms, and is backed up by slit skin smears in the laboratory. This can take several days, or even longer for the laboratory confirmation.
In short, diagnosing leprosy today is a long and difficult process.
Our scientists are currently working on diagnostic tools that would allow us to identify leprosy within minutes. This could be done in communities and would not require a health centre or lab.
Investing in research will also allow us to better understand how leprosy is transmitted and how this transmission can be stopped.
Our scientists are responsible for monitoring people who relapse of symptoms and instances where the antibiotics used to treat leprosy are not working (anti-microbial resistance).
Three types of diagnostic tools that our teams are working on:
We can be the generation to end a disease that has harmed humanity for more then 4,000 years.
