Abstract
BackgroundThe country of Kiribati is a small Pacific island nation which had a new case detection rate of 191 per 100,000 in 2016, and is one of the few countries yet to reach the WHO leprosy elimination goal. Chemoprophylaxis of household contacts of new cases, or to the whole population in a highly endemic areas have been found to be effective in reducing new case rates. This study investigated the potential impact of different chemoprophylaxis strategies on future cases in South Tarawa, the main population centre of Kiribati.MethodologyThe microsimulation model SIMCOLEP was calibrated to simulate the South Tarawa population and past leprosy control activities, and replicate annual new cases from 1989 to 2016. The impact of six different strategies for delivering one round of single dose rifampicin (SDR) chemoprophylaxis to household contacts of new cases and/or one or three rounds of SDR to the whole population was modelled from 2017 to 2030.Principal FindingsOur model predicted that continuing the existing control program of high levels of public awareness, passive case detection, and treatment with multidrug treatment would lead to a substantial reduction in cases but this was less effective than all modelled intervention scenarios. Mass chemoprophylaxis led to a faster initial decline in cases than household contact chemoprophylaxis alone, however the decline under the latter was sustained for longer. The greatest cumulative impact was for household contact chemoprophylaxis with three rounds of mass chemoprophylaxis at one-year intervals.ConclusionsThe results suggest that control of leprosy would be achieved most rapidly with a combination of intensive population-based and household chemoprophylaxis. These findings may be generalisable to other countries where crowding places social contacts as well as household contacts of cases at risk of developing leprosy.
Highlights
Despite being one of the most ancient diseases, there are annually still around 200,000 newly diagnosed leprosy cases worldwide [1]
The results suggest that control of leprosy would be achieved most rapidly with a combination of intensive population-based and household chemoprophylaxis. These findings may be generalisable to other countries where crowding places social contacts as well as household contacts of cases at risk of developing leprosy
We found that all chemoprophylaxis strategies were predicted to be more effective than the current control strategy, a combination of household contact chemoprophylaxis alongside three rounds given to the entire population in consecutive years
Summary
Despite being one of the most ancient diseases, there are annually still around 200,000 newly diagnosed leprosy cases worldwide [1]. To reduce the high rates, the Kiribati MHMS has partnered with the Pacific Leprosy Foundation (PLF) to improve several aspects of the programme, including resourcing, database management, diagnostic skills, intensive case finding, improved publicity campaigns, and follow-up of patients and contact tracing. This has led to an increase in reported cases in recent years. The country of Kiribati is a small Pacific island nation which had a new case detection rate of 191 per 100,000 in 2016, and is one of the few countries yet to reach the WHO leprosy elimination goal. This study investigated the potential impact of different chemoprophylaxis strategies on future cases in South Tarawa, the main population centre of Kiribati
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