A joint project, Pacific Leprosy Foundation (implementing partner) and the Ministries of Health in Samoa and Kiribati

A joint project, Pacific Leprosy Foundation
(implementing partner) and the Ministries of Health
               in Samoa and Kiribati

(PEP-SDR)-Kiribati
 An operational intervention using single-dose
  rifampicin (SDR) annually for 2 consecutive years as
  preventive measure among household contacts (using
  2010 -2017 index cases as reference) and followed by 3
  years successive monitoring and follow – up as a cohort
  population.
 Retrospective 2010-2017
 Prospective-all new cases

WHY
 Kiribati-approx. 200 cases p.a. in pop of 115,ooo
 Research-60-70% reduction of cases in hhc
 Modelling shows this is an effective strategy- and more
  so when combined with other strategies
 Opportunity to revitalize/enhance leprosy program
 Improved community awareness
 Reduce stigma

Predicting the impact of household contact and mass
chemoprophylaxis on future new leprosy cases in South Tarawa,
Kiribati: A modelling study.
Gilkison C, Chambers S, Blok DJ, Richardus JH, Timeon E, Rimon E, et al. (2019) PLoS Negl Trop Dis 13(9)

Staged Implementation
 4 stages
➢ 1 Planning and development
➢ 2 Intensive case finding and contact tracing
➢ 3 Pilot
➢ 4 Implement country wide

1 Planning
                               Decisions:
   Develop protocol                              Prospective (all new
                          Retrospective? (2010
     and policies                                      cases)
                               onwards)

  Develop definition
     of household                                  How to involve
                          Training-who/when
  contact appropriate                               community
      for location

    Develop and field
                            Data recording-          Monitoring
  test material- primer
                            robust database          rifampicin
   and FAQs for index
                               needed.               resistance?
   cases and contacts

Communty involvement
 Improved awareness a great by -product
 Gain community acceptance by involving community
 groups

2 Intensive case finding
 Aim is to diagnose cases in the community before PEP
  implemented
 Get consent of index cases- provide information
➢ Contact tracing
➢ School screenings
➢ Skin camps

3 Pilot
 Opportunity to try out processes
 Feedback from nurses implementing pilot
 Review and make changes before rolling out
 countrywide

Wider community-awareness
 Posters, billboards
 Song competition
 Radio spots
 Drama
 Dance
 Community meetings
 Puppet shows

4 Implement countrywide
 Aim-Complete first round in 3 months
 Examination of every contact and provision of SDR
 Issues with movement of contacts
 Remote outer islands- took longer to get coverage
 100% commitment of national program staff
 Idea of eradicating leprosy captured the imagination
  of health workers
 Results: 90% coverage in round one – examination of
  every contact and SDR
 Downward trend in case numbers being seen

Summary of results to date
                   Cohort of over
  Household                                 SDR readily
                   12,000 contacts
contacts >10% of                         accepted – 20 in
  population       • Unevenly spread       total refused
                     across population

                     SDR coverage
  No reported                            Took 6 months to
                       about 90%
 adverse effects                         get this coverage
                      (increasing)

Results cont.
 PEP became part of a larger program to improve quality
  and effectiveness
   Improved diagnostic skills by training program
   Improved communication between central leprosy unit and
      medical clinics.
     Improved communication of nursing clinics with community
     Gave attention and status to leprosy programme at national
      level
     Improved public awareness through publicity
     Focused attention on ensuring patients completed treatment-
      reduced defaulters

Summary for Partners

                       Most effective when
Do not see PEP as a                          Becomes business as
                        integrated into
 one off project                                   usual
                          overall NLP

           Take the opportunity      Immense added
           to work with team to     value-community
             review the whole      awareness, reduced
                programme                stigma