The long-term impact of the Leprosy Post-Exposure Prophylaxis (LPEP) program on leprosy incidence: A modelling study.
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Blok David J, Steinmann Peter, Tiwari Anuj, Barth-Jaeggi Tanja, Arif Mohammad A, Banstola Nand Lal, Baskota Rabindra, Blaney David, Bonenberger Marc, Budiawan Teky, Cavaliero Arielle, Gani Zaahira, Greter Helena, Ignotti Eliane, Kamara Deusdedit V, Kasang Christa, Manglani Pratap R, Mieras Liesbeth, Njako Blasdus F, Pakasi Tiara, Saha Unnati R, Saunderson Paul, Smith W Cairns S, Stäheli René, Suriyarachchi Nayani D, Tin Maung Aye, Shwe Tin, van Berkel Jan, van Brakel Wim H, Vander Plaetse Bart, Virmond Marcos, Wijesinghe Millawage S D, Aerts Ann, Richardus Jan Hendrik
Аннотация
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) continuation 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 afterwards 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.