This study formed part of a larger multicentre study “Development of a Population Based Leprosy Registry (PBLR) and New Case Detection Strategies (NCDS) to Eradicate Leprosy in Urban Areas” which was conducted by The Leprosy Mission Trust India and funded by the Indian Council for Medical Research. The aim of the study was to identify the effectiveness of a ‘Tent Awareness Program’ as a strategy to increase new case detection in an urban setting. The leprosy tent awareness programme was carried out in Kolkata Metropolitan City, in identified areas near densely populated places where many people congregate. On a market day or local ‘haat’, a tent was set up in a public area by the roadside, in a place which was designated by the local authorities. Posters along with banners were placed around the tent to catch the attention of the people and leaflets giving basic facts about leprosy were distributed. Loudspeaker announcements were also made from the tent by the staff about the disease, concerning early symptoms, the importance of early treatment, the treatment centres near the area and other relevant information. 13 such programmes were conducted, which covered approximately 21,000 people. From this effort, 14 new untreated leprosy cases were identified through voluntary reporting, among whom nine were of multi-bacillary and five of pauci-bacillary type. The Leprosy Tent Programme can be carried out on a regular basis by a small number of staff with minimal expense. This increases awareness as well as case detection and could be a good tool in the battle against leprosy.

Background: Single-dose rifampicin as post-exposure prophylaxis (SDR-PEP) for leprosy given to contacts of leprosy patients was proven to reduce their risk by 57%.1 The Leprosy Post-Exposure Prophylaxis (LPEP) program evaluates the feasibility of integrating SDR-PEP distribution into leprosy control programmes in eight leprosy endemic countries, among which India is one. Acceptability by the main stakeholders is an important component of feasibility and essential for sustainability and scale-up of health interventions. This study looked at the acceptability of the introduction of SDR-PEP in the LPEP project area in India. Study design: The acceptability of the implementation of the LPEP project was assessed in the Union Territory of Dadra and Nagar Haveli (DNH) in India. This was done through a qualitative cross-sectional study using semi-structured interviews and focus group discussions with the main stakeholders of the intervention. A quantitative component of the study was the compliance rate of index patients and their contacts in accepting contact screening and SDR-PEP administration. Results: The intervention was generally regarded as beneficial. Participants understood that SDR-PEP prevents the development of leprosy. Disclosure of the leprosy status of patients was needed to approach their close contacts. This was not a barrier for the administration of SDR-PEP. The trust in the health services, health staff and the gender sensitive approach contributed importantly to the high level of acceptability. The compliance rate was 99.0% among leprosy patients and 98.6% among contacts. Conclusion: Contact screening and SDR-PEP distribution in DNH, India, has been very well accepted by the main stakeholders: index patients, contacts, health workers and supervisors.

Objective: To study the level of access to general and specific entitlements for people affected by leprosy and to compare the level of access available to those living in leprosy colonies and general communities, among the four states Uttar Pradesh (UP), Chhattisgarh (CG), Andhra Pradesh (AP) and Tamil Nadu (TN) within India. Methods: This is a cross-sectional descriptive study. A total sample size of 379 included 100 from UP, 100 from CG, 101 from AP and 78 from TN, of which 161 were from leprosy colonies and 218 from the general community. The study is the outcome of the baseline survey carried out from 2016 to 2017 for the CREATE Project. Results: The study clearly shows that the largest difference in accessibility to general schemes between leprosy colonies and the general community was found in the state of UP (4 schemes) and is comparatively less in CG (3 schemes) with the lowest difference being found in the states of AP (2 schemes) and TN (1 scheme). With regards to specific schemes, UP once again had the greatest difference in accessibility (7 schemes) followed by AP (5 schemes) with the least difference being found in the states of CG (3 schemes) and TN (1 Scheme). Conclusions: The study concludes that accessibility differences among the four states from maximum to minimum in order is UP, CG, AP and TN, indicating the influence of local demographic and cultural factors on the accessibility process required for state specific approaches. Overall the colony dwellers have better access to both the general and specific schemes when compared to those living in the general community.

An 18 year old male on multibacillary multidrug therapy (MBMDT) for 7 months with the diagnosis of borderline tuberculoid (BT) leprosy, presented with gradually progressive and massive right ulnar nerve abscess and radial cutaneous nerve abscess. He also had mobile complete claw hand of the right side. High resolution ultrasonography (HR USG) of the right ulnar nerve showed markedly thickened ulnar nerve with loss of normal fascicular pattern. It also showed heteroechoic collection, with central anechoic lesion suggestive of ulnar abscess, measuring about 145cc in volume. In addition to MBMDT, the patient was started on tapering oral prednisolone starting 40 mg daily. The ulnar nerve abscess was decompressed by percutaneous aspiration on three occasions every 3–4 weeks. Serial HR USG of nerves was carried out throughout the treatment period. No surgical intervention was required. After 24 months of MBMDT, complete resolution of nerve abscess with improvement in right ulnar nerve motor function was noted. The patient underwent corrective surgery for right claw hand.

Introduction: Trophic ulcers in leprosy are a therapeutic challenge. Various treatment options have been tried, but none is found to be universally effective. The search for better treatment continues. Methods: Leprosy patients with long standing trophic ulcers treated with platelet rich fibrin (PRF) dressings were identified in this retrospective review. PRF was prepared by centrifuging autologous blood at 2800 rpm for 15 minutes. The PRF dressings were repeated at weekly intervals and treatment response was assessed using the National Pressure Ulcer Advisory Panel (NPUAP) staging. Results: Ten patients (7 males) treated with PRF dressings were identified. The mean age of the study patients was 45.4 years. Three patients had NPUAP stage II, six patients had NPUAP stage III and one patient had NPUAP stage IV ulcers. Eight patients showed complete healing after 2–4 PRF dressing sessions. Complications were limited to localised infection in one patient. Conclusion: PRF dressings are a promising therapeutic option for treatment of nonhealing trophic ulcers in leprosy patients.

Objective: The ‘Prevention of Disability (POD) project for persons affected by leprosy’ was designed to strengthen early diagnosis through community empowerment in high endemic districts in Tanzania and to reduce occurrence of leprosy related Grade 2 disabilities. Methods: The project activities were implemented in leprosy high endemic districts with prevalence rates above 1/10,000 population between 2012–2015. 12 districts were involved and 12 new POD Committees with 236 POD members were trained to be trainers. The POD committees trained 100 village health committees with 1,300 members using the POD training manual under the supervision of District Social Welfare Officers [SWOs] and District Tuberculosis and Leprosy Coordinators [DTLCs]. Results: A total of 134,104 people were reached with 65,827 school children from 225 schools and 68,277 adults from 248 villages. Through sensitisation activities involving district POD committees, village health committees, drama groups and community members, 3,483 leprosy suspects were identified and 531 were confirmed by DTLCs as new leprosy cases. Through active case finding activities in household contacts 1399 contacts were reached and 73 new leprosy cases were confirmed. Conclusions: Statistics over the last 14 years showed that there was a decreasing of new leprosy cases notifications during routine passive cases finding period. With start of empowerment of community and household screening activities, the numbers of new cases in the districts increased tremendously. This suggests that there is a high presence of hidden cases. The numbers of new detected cases were in some districts more than doubled by the interventions. The relative low percentage of Grade 2 disability of 9% in the project compared to a current national average of over 12% support the effectiveness of the intervention ‘empowerment of communities’ for early case detection.