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BACKGROUND: Case detection delay (CDD) in leprosy is defined as the period between the onset of the first signs and symptoms and the time of diagnosis. A tool, consisting of a questionnaire and a detailed guide for researchers, which includes photos of typical skin signs and notes on establishing the timing of events, was developed to determine this period of delay in months in recently diagnosed leprosy patients. The aims of the study were to determine the reliability and consistency of this CDD assessment tool. METHODS: This study was conducted in Ethiopia, Mozambique and Tanzania. Two types of consistency were considered: over time (test-retest reliability) and across different researchers (interrater reliability). A CDD questionnaire was administered to 167 leprosy patients who were diagnosed within 6 months prior to their inclusion. One month later, the same or another researcher re-administered the CDD questionnaire to the same patients. Both test-retest and interrater reliability were assessed using the intraclass correlation coefficient (ICC), where a value greater than or equal to 0.7 is considered acceptable. RESULTS: In this study, 10 participants (6.0%) were under 15 years of age, and 56 (33.5%) were women. In the test-retest assessment, the mean CDD from the first and second interviews was 23.7 months (95% CI 14.4-34.8) and 24.0 months (95% CI 14.8-33.2), respectively. The ICC for test-retest reliability was 0.99 (95% CI 0.994-0.997). For the interrater reliability assessment, the first and second interviews revealed a mean CDD of 24.7 months (95% CI 18.2-31.1) and 24.6 months (95% CI 18.7-30.5), respectively, with an ICC of 0.90 (95% CI 0.85-0.94). A standard error of measurement of 0.46 months was found in the test-retest and 1.03 months in the interrater measurement. Most answers given by participants during the first and second interviews were matching (≥86%). Most non-matching answers were

Introduction: Suboptimal doctor-patient communication drives inappropriate prescribing of antibiotics. We evaluated a communication intervention for general practitioners (GPs) in multicultural Dutch cities to improve antibiotic prescribing for respiratory tract infections (RTI). Methods: This was a non-randomized controlled before-after study. The study period was pre-intervention November 2019 – April 2020 and post-intervention November 2021 – April 2022. The intervention consisted of a live training (organized between September and November 2021), an E-learning, and patient material on antibiotics and antibiotic resistance in multiple languages. The primary outcome was the absolute number of prescribed antibiotic courses indicated for RTIs per GP; the secondary outcome was all prescribed antibiotics per GP. We compared the post-intervention differences in the mean number of prescribed antibiotics between the intervention (N = 25) and the control group (N = 110) by using an analysis of covariance (ANCOVA) test, while adjusting for the pre-intervention number of prescribed antibiotics. Additionally, intervention GPs rated the training and their knowledge and skills before the intervention and 3 months thereafter. Results: There was no statistically significant difference in the mean number of prescribed antibiotics for RTI between the intervention and the control group, nor for mean number of overall prescribed antibiotics. The intervention GPs rated the usefulness of the training for daily practice a 7.3 (on a scale from 1–10) and there was a statistically significant difference between pre- and post-intervention on four out of nine items related to knowledge and skills. Discussion: There was no change in GPs prescription behavior between the intervention and control group. However, GPs found the intervention useful and showed some improvement on self-rated knowledge and communication skills.

Background: Leprosy is an infectious disease with a slow decline in global annual caseload in the past two decades. Active case finding and post-exposure prophylaxis (PEP) with a single dose of rifampicin (SDR) are recommended by the World Health Organization as measures for leprosy elimination. However, more potent PEP regimens are needed to increase the effect in groups highest at risk (i.e., household members and blood relatives, especially of multibacillary patients). The PEP++ trial will assess the effectiveness of an enhanced preventive regimen against leprosy in high-endemic districts in India, Brazil, Bangladesh, and Nepal compared with SDR-PEP. Methods: The PEP++ study is a cluster-randomised controlled trial in selected districts of India, Brazil, Bangladesh, and Nepal. Sub-districts will be allocated randomly to the intervention and control arms. Leprosy patients detected from 2015 − 22 living in the districts will be approached to list their close contacts for enrolment in the study. All consenting participants will be screened for signs and symptoms of leprosy and tuberculosis (TB). In the intervention arm, eligible contacts receive the enhanced PEP++ regimen with three doses of rifampicin (150 − 600 mg) and clarithromycin (150 − 500 mg) administered at four-weekly intervals, whereas those in the control arm receive SDR-PEP. Follow-up screening for leprosy will be done for each individual two years after the final dose is administered. Cox’ proportion hazards analysis and Poisson regression will be used to compare the incidence rate ratios between the intervention and control areas as the primary study outcome. Discussion: Past studies have shown that the level of SDR-PEP effectiveness is not uniform across contexts or in relation to leprosy patients. To address this, a number of recent trials are seeking to strengthen PEP regimens either through the use of new medications or by increasing the d

Background Contact tracing has been a key component of COVID-19 outbreak control. Backward contact tracing (BCT) aims to trace the source that infected the index case and, thereafter, the cases infected by the source. Modelling studies have suggested BCT will substantially reduce SARS-CoV-2 transmission in addition to forward contact tracing.AimTo assess the feasibility and impact of adding BCT in practice. Methods We identified COVID-19 cases who were already registered in the electronic database between 19 February and 10 March 2021 for routine contact tracing at the Public Health Service (PHS) of Rotterdam-Rijnmond, the Netherlands (pop. 1.3 million). We investigated if, through a structured questionnaire by dedicated contact tracers, we could trace additional sources and cases infected by these sources. Potential sources identified by the index were approached to trace the source's contacts. We evaluated the number of source contacts that could be additionally quarantined. Results Of 7,448 COVID-19 cases interviewed in the study period, 47% (n = 3,497) indicated a source that was already registered as a case in the PHS electronic database. A potential, not yet registered source was traced in 13% (n = 979). Backward contact tracing was possible in 62 of 979 cases, from whom an additional 133 potential sources were traced, and four were eligible for tracing of source contacts. Two additional contacts traced had to stay in quarantine for 1 day. No new COVID-19 cases were confirmed. Conclusions The addition of manual BCT to control the COVID-19 pandemic did not provide added value in our study setting.

Background: Access to HIV testing is crucial for detection, linkage to treatment, and prevention. In less urbanised areas, reliance on general practitioners (GPs) for HIV testing is probable, as sexual health centres (SHC) are mostly located within urbanised areas. Limited insight into individuals undergoing HIV testing stems from sparse standard registration of demographics at GPs. This cross-sectional study aims (1) to assess and compare HIV testing at the GP and SHC, and (2) to assess population- and provider-specific HIV incidence. Methods: Individual HIV testing data of GPs and SHC were linked to population register data (aged ≥ 15 years, Rotterdam area, 2015–2019). We reported the proportion HIV tested, and compared GP and SHC testing rates with negative binomial generalised additive models. Data on new HIV diagnoses (2015–2019) from the Dutch HIV Monitoring Foundation relative to the population were used to assess HIV incidence. Results: The overall proportion HIV tested was 1.14% for all residents, ranging from 0.41% for ≥ 40-year-olds to 4.70% for Antilleans. The GP testing rate was generally higher than the SHC testing rate with an overall rate ratio (RR) of 1.61 (95% CI: 1.56–1.65), but not for 15-24-year-olds (RR: 0.81, 95% CI: 0.74–0.88). Large differences in HIV testing rate (1.36 to 39.47 per 1,000 residents) and GP-SHC ratio (RR: 0.23 to 7.24) by geographical area were observed. The GPs’ contribution in HIV testing was greater for GP in areas further away from the SHC. In general, population groups that are relatively often tested are also the groups with most diagnoses and highest incidence (e.g., men who have sex with men, non-western). The overall incidence was 10.55 per 100,000 residents, varying from 3.09 for heterosexual men/women to 24.04 for 25–29-year-olds. Conclusions: GPs have a pivotal role in HIV testing in less urbanised areas further away from the SHC, and among some population groups. A relatively high incidence often follows relat

Background: Leprosy is a public health burden in Indonesia with a high number of new cases every year and a high proportion of disability among new cases. Case detection delay (CDD) can contribute to ongoing transmission and increased disability chances among leprosy patients. This study aimed to establish the CDD of leprosy and the factors associated with detection delay in Indonesia. Method: Community-based study with a cross-sectional design. Data were collected through interviews about sociodemographic and behavioral factors, anticipated stigma, and duration of CDD. Leprosy classification and case detection methods were obtained from health service records. A random sample was taken of 126 leprosy patients registered between 1st October 2020 and 31st March 2022 in the Tegal regency in the Central Java Province. Data were analysed by descriptive and analytical statistics using multiple linear regression. Results: The mean CDD, patient delay, and health system delay were 13.0 months, 9.7 months, and 3.2 months, respectively. Factors associated with longer CDD are younger age (below 35 years), male, found through passive case detection, and not having a family member with leprosy. Factors associated with longer patient delay were being younger (below 35 years), being male, not having a family member with leprosy, and anticipated stigma of leprosy. It was not possible to reliably identify factors associated with health system delay. Conclusion: CDD in leprosy should be reduced in Indonesia. The Indonesian National Leprosy Control Program (NLCP) is advised to adopt an integrated intervention programme combining active case detection with targeted health education to reduce CDD and thereby preventing disabilities in people affected by leprosy.

Objectives Areas with high sexually transmitted infection (STI) testing rates may not require additional strategies to improve testing. However, it may be necessary to intervene in areas with elevated STI risk, but with low STI testing rates. We aimed to compare STI-related risk profiles and STI testing rates by geographical area to determine areas for improvement of sexual healthcare access. Design Cross-sectional population-based study. Setting Greater Rotterdam area, the Netherlands (2015-2019). Participants All residents aged 15-45 years. Individual population-based register data were matched with laboratory-based STI testing data of general practitioners (GPs) and the only sexual health centre (SHC). Outcome measures Postal code (PC) area-specific STI risk scores (based on age, migratory background, education level and urbanisation), STI testing rates and STI positivity. Results The study area consists of approximately 500 000 residents aged 15-45 years. Strong spatial variation in STI testing, STI positivity and STI risk was observed. PC area testing rate ranged from 5.2 to 114.9 tests per 1000 residents. Three PC clusters were identified based on STI risk and testing rate: (1) high-high; (2) high-low; (3) low, independently of testing rate. Clusters 1 and 2 had comparable STI-related risk and STI positivity, but the testing rate differed greatly (75.8 vs 33.2 per 1000 residents). Multivariable logistic regression analysis with generalised estimating equation was used to compare residents in cluster 1 and cluster 2. Compared with cluster 1, residents in cluster 2 more often did not have a migratory background, lived in less urbanised areas with higher median household income, and more distant from both GP and SHC. Conclusion The determinants associated with individuals living in areas with high STI-related risk scores and low testing rates provide leads for improvement of sexual healthcare access. Opportunities for further exploration include GP education

Background Case detection delay (CDD) is associated with grade 2 disability (G2D) in leprosy, a substantial disease burden worldwide. The standardized CDD questionnaire was developed to determine the period of CDD and its related factors. In Indonesia, the incidence of leprosy and G2D is high and an instrument to measure CDD is lacking. This study describes the translation and cross-cultural adaptation process and evaluates the CDD questionnaire in the Indonesian context. Methods We first did forward–backward translation into Bahasa Indonesia and cross-culturally adapted the CDD questionnaire. We then performed face-to-face three-step test interviews in a pilot test to evaluate the understanding of leprosy patients and the content validity of the CDD questionnaire (n = 15). Finally, the reliability and construct validity of the CDD questionnaire were tested in 50 leprosy patients in Tegal Regency, Indonesia. Results The interviews showed that leprosy patients understood the CDD questionnaire well. The content and construct validity were adequate according to linguistic validation and statistical hypothesis testing. The internal consistency test with a Cronbach alpha showed that the CDD questionnaire measures one underlying construct. The reproducibility test, including the test–retest reliability and agreement test, indicated excellent reliability. Conclusions The version of the CDD questionnaire in Bahasa Indonesia is an instrument with good validity and reliability to determine CDD in Indonesia. We recommend its implementation in the leprosy control programme of Indonesia for monitoring early case detection and thereby avoiding leprosy disability.

Yaws is a chronic, highly contagious skin and bone infection caused by Treponema pallidum subspecies pertenue, usually affecting children in impoverished and remote communities. Yaws lesions have thick yellow crusts on pink papillomas that ulcerate and leave deep scars. Yaws cases were confirmed in the Liguasan Marsh, Mindanao Island group, Southern Philippines, in 2017, but there were no cases confirmed in the Luzon and Visayas Island groups. We aimed to detect at least one active or latent yaws case in the island groups of Luzon and Visayas. Active yaws surveillance was conducted by inviting healthcare providers to report yaws suspects. Five remote villages were included in the case detection surveys: three in Luzon and two in the Visayas Island groups. Two indigenous peoples communities were included: Aetas of Quezon and Dumagat/Remontados of Rizal provinces. Trained field personnel conducted free skin check-ups of children, household contacts, and community members. Yaws suspects underwent point-of-care serologic tests for T. pallidum and nontreponemal antibodies. A total of 239 participants were screened for skin diseases, and 103 had serologic tests. Only the Aetas of Quezon province, Luzon, had confirmed yaws cases. Nineteen cases (54.3%) were detected among 35 Aetas: five active yaws (four children, one adult), two latent yaws (adults), and 12 past yaws (1 child, 11 adults). An 8-year-old boy had yaws with skeletal deformities. We report the first yaws cases among the Aetas of Quezon, Luzon Island group. Active yaws surveillance and case detection in remote areas and among indigenous peoples should continue.

SETTING: India has the highest number of new TB cases worldwide. The participation of private providers (PPs) in the National TB Elimination Programme (NTEP) has remained suboptimal. OBJECTIVE: To explore the experiences, barriers and facilitators about their participation in the NTEP as perceived by PPs working in varied settings. DESIGN: Focus group discussions and in-depth interviews were used to engage PPs to obtain their views on participation in the NTEP. Framework and thematic content analysis was used to analyse qualitative data. RESULTS: Non-availability of a comprehensive range of diagnostics and lack of flexibility in the NTEP were barriers to participation in NTEP. PPs were predisposed to think that NTEP was for those who could not afford to purchase medications. Attitudes and previous experiences with NTEP made them sceptical about the NTEP regimen. Although more frequent interactions were sought with NTEP, some bitterness about previous interactions was perceived. CONCLUSION: Challenges identified by PPs for the NTEP include improvement of the quality of TB care, especially at the lower levels of care, availability of a comprehensive range of diagnostics, being friendly to PPs and patients, more frequent interactions with PPs, and more caring conversations with patients at NTEP centres.

Tegal Regency in Central Java Province, Indonesia, is a leprosy endemic area. In 2021, the leprosy prevalence was 0.82 per 10,000 population. The total number of new cases was 133, of whom 11% had Grade 2 disability (G2D). The high number with G2D indicates substantial case detection delay (CDD). This delay can be caused by personal, societal and health service-related factors. The aim of this study was to describe the association of disability grade with health-seeking behavior. We employed a cross-sectional research design involving 126 patients with leprosy selected by random sampling among 171 patients with leprosy registered from the 4th quarter of 2020 until the 1st quarter of 2022. Data were collected using a structured questionnaire translated from an international standardized questionnaire (ie, CDD questionnaire) through interviews with leprosy patients. Data were analyzed by descriptive and inferential statistics. We found nearly half (46.8%) of the patients aged 35-50 years, and almost two-thirds were male. Of all, 75.4% had completed primary or secondary education. At diagnosis, more than half had no disability at all, and 10.3% had G2D. Nearly half (45.2%) had used ‘self-medication’ and did not seek appropriate health care services before being diagnosed with leprosy. There was a statistically significant association between health-seeking behavior and the disability grade at diagnosis (p=0.01). In summary, disability caused by leprosy constitutes a significant public health burden in Tegal Regency, which could be lowered through supporting appropriate health seeking behavior.

Summary Objective Although elimination of leprosy was achieved in Nepal at national level in 2009, around 3000 new cases are still detected every year and 5% of these cases have Grade 2 disability (G2D). This study aims to describe the geographical distribution of leprosy new case detection (NCD) and G2D from 2010 to 2021 in two leprosy endemic provinces in Nepal. Methods We collected the geolocations and leprosy-related data of patients registered from 2010 to 2021 in Provinces 1 and 7. The geographical distribution of NCD and G2D was analysed in Quantum Geographic Information Systems (QGIS) at district, municipality and ward level, and we calculated the trends in Eye Hand Foot (EHF) impairment scores among cases with disabilities. Results From 2010 to 2021, a decrease in NCD and G2D cases was identified in Province 1, and an increase in NCD and G2D cases in Province 7. Geographical variations were visible between wards within highly endemic districts in both provinces. The mean EHF score in cases with disability increased from 1.7 in 2017 to 2.5 in 2020 in Province 1 and fluctuated between 2.3 and 4.5 in Province 7. Conclusions This study shows that the leprosy problem is still current in Nepal. Geographic variations in case detection and disability indicators are seen best when mapping at ward level. Leprosy programme managers can use the maps to develop long-term strategies at district, municipality or ward level that include intensified active case finding, preventive treatment and disability services, while considering costs and efficient use of resources.

BACKGROUND: Preventive interventions with post-exposure prophylaxis (PEP) are needed in leprosy high-endemic areas to interrupt the transmission of Mycobacterium leprae. Program managers intend to use Geographic Information Systems (GIS) to target preventive interventions considering efficient use of public health resources. Statistical GIS analyses are commonly used to identify clusters of disease without accounting for the local context. Therefore, we propose a contextualized spatial approach that includes expert consultation to identify clusters and compare it with a standard statistical approach. METHODOLOGY/PRINCIPAL FINDINGS: We included all leprosy patients registered from 2014 to 2020 at the Health Centers in Fatehpur and Chandauli districts, Uttar Pradesh State, India (n = 3,855). Our contextualized spatial approach included expert consultation determining criteria and definition for the identification of clusters using Density Based Spatial Clustering Algorithm with Noise, followed by creating cluster maps considering natural boundaries and the local context. We compared this approach with the commonly used Anselin Local Moran's I statistic to identify high-risk villages. In the contextualized approach, 374 clusters were identified in Chandauli and 512 in Fatehpur. In total, 75% and 57% of all cases were captured by the identified clusters in Chandauli and Fatehpur, respectively. If 100 individuals per case were targeted for PEP, 33% and 11% of the total cluster population would receive PEP, respectively. In the statistical approach, more clusters in Chandauli and fewer clusters in Fatehpur (508 and 193) and lower proportions of cases in clusters (66% and 43%) were identified, and lower proportions of population targeted for PEP was calculated compared to the contextualized approach (11% and 11%). CONCLUSION: A contextualized spatial approach could identify clusters in high-endemic districts more precisely than a standard statistical approach. Therefore

Background: Yaws is a chronic, non-venereal, highly contagious skin and bone infection affecting children living in impoverished, remote communities and caused by Treponema pallidum subspecie pertenue. Social stigma and economic losses due to yaws have been reported anecdotally in the Southern Philippines but have not been well-documented. Objective: To describe and compare the psychological, social, and economic effects of yaws from the perspective of patients, contacts, and key informants in two areas of the Philippines. Materials and methods: Yaws and contacts were identified through clinicoseroprevalence surveys conducted in the Liguasan Marsh area, Mindanao, Southern Philippines in 2017 and among the Aetas, an indigenous people community in Quezon province, Luzon region in 2020. Skin examinations and serologic tests confirmed the diagnosis of active, latent, or past yaws among the children and adults. Trained health personnel conducted in-depth interviews of those affected by yaws and their guardians, household contacts, and key informants, such as health workers regarding their perceptions, feelings, health-seeking behaviors, and effects of yaws on their lives. Results: A total of 26 participants were interviewed: 17 from Mindanao and 9 from Luzon. Aside from the physical discomforts and embarrassment, yaws was considered stigmatizing in Mindanao, because positive non-treponemal tests or treponemal antibody tests were associated with syphilis and promiscuity. These have led to loss of employment and income opportunities for adults with latent or past yaws. In contrast, the Aetas of Luzon did not perceive yaws as stigmatizing, because it was a common skin problem. Plantar yaws interfered with the Aeta’s gold panning livelihood due to the pain of wounds. Conclusions: Yaws is not merely a chronic skin and bone disease. It can lead to significant psychosocial and economic problems as well. Yaws is a generally forgotten disease in the Philippines. There is no ya

Immigrants constitute large proportions of the population in many high-income countries. Knowledge about their perceptions of antibiotics, in comparison to native populations, is limited. We explored these perceptions by organizing nine homogeneous focus group discussions (FGDs) with first-generation immigrant and native Dutch participants (N = 64) from Rotterdam and Utrecht, who were recruited with the assistance of immigrant (community support) organizations. The FGDs were audio-recorded and transcribed verbatim. Inductive thematic analyses were performed with the qualitative analysis software Atlas.ti, using open and axial coding. We did not find noteworthy differences between immigrants and native Dutch participants; all participants had an overall reluctant attitude towards antibiotics. Within-group differences were larger than between-group differences. In each FGD there were, for instance, participants who adopted an assertive stance in order to receive antibiotics, who had low antibiotic-related knowledge, or who used antibiotics incorrectly. Native Dutch participants expressed similar difficulties as immigrant participants in the communication with their GP, which mainly related to time constraints. Immigrants who encountered language barriers experienced even greater communicational difficulties and reported that they often feel embarrassed and refrain from asking questions. To stimulate more prudent use of antibiotics, more attention is needed for supportive multilingual patient materials. In addition, GPs need to adjust their information, guidance, and communication for the individual's needs, regardless of the patient's migration background.

Background Yaws is a chronic, highly contagious skin and bone infection affecting children living in impoverished, remote communities. It is caused by Treponema pallidum subsp. pertenue. We report the prevalence of active yaws among elementary schoolchildren based on clinical and serological criteria in selected municipalities of Southern Philippines. Methods From January to March 2017, exploratory cross-sectional surveys and screening of skin diseases were conducted in the Liguasan Marsh area of the provinces Maguindanao, Sultan Kudarat, and Cotabato. We included 9 municipalities and randomly selected one public elementary school per municipality. Members of students’ households and the communities were also examined and treated. Yaws suspects and contacts had blood tests for trepone-mal and non-treponemal antibodies using Dual Pathway Platform and Treponema pallidum particle agglutination (TPPA) tests. Results A total of 2779 children and adults were screened for any skin disease: 2291 students, 393 household members, and 95 community members. Among 210 yaws suspects and con-tacts, 150 consented to serologic tests. The estimated prevalence of active yaws among schoolchildren screened was 1 out of 2291 (0.04%). Among 2532 children who were 14 years old and younger, 4 (0.2%) had active yaws. Eight adult household contacts and community members had latent yaws and 2 had past yaws. Five out of 9 municipalities were endemic for yaws. Conclusions This study confirmed that the Philippines is endemic for yaws but at a low level in the schools surveyed. This is an under-estimation due to the limited sampling. The lack of proper disease surveillance after the eradication campaign in the 1960’s has made yaws a forgotten disease and has led to its resurgence. Yaws surveillance is needed to determine the extent of yaws in the Philippines and to help develop a strategy to eradicate yaws by 2030.

Objectives Leprosy is a chronic infectious disease caused by Mycobacterium leprae and one of the world’s most neglected tropical diseases. The post-exposure prophylaxis for leprosy study (PEP4LEP) compares two integrated skin-screening approaches combined with single dose rifampicin administration to contacts of leprosy patients. The aim of this baseline survey was to describe the epidemiological trends of leprosy and estimate case detection delay in the Ethiopian study districts before the start of the intervention. Methods The study was conducted in three districts of East Hararghe zone, Oromia Region, Ethiopia. We applied descriptive retrospective study design to describe epidemiological trends of leprosy between 2010 and 2019. Fifty patients diagnosed in the six months prior to their inclusion in the study were interviewed to establish the case detection delay at baseline. The healthcare delivery system and National Leprosy Control Program are also described. Results Trends in the number of new leprosy patients detected decreased slightly over the past ten years, although the number of new child cases increased overall, suggesting ongoing transmission. The mean case detection delay was 22.4 months (95% CI: 18.6–26.3), while the median was 19.5 months. The mean patient and health system delay were 19.6 months (95% CI: 15.8–23.4) and 2.6 months (95% CI: 1.5–3.6), respectively. Conclusion Considerable leprosy case detection delays were found in the PEP4LEP study districts in Ethiopia. Efforts to reduce delay and interrupt the transmission should focus on integrating prevention and active case finding, contact tracing and providing post-exposure prophylaxis to contacts of leprosy patients.

Objectives Leprosy, also known as Hansen’s disease, is a slowly progressive and chronic infectious neglected tropical disease (NTD) caused by Mycobacterium leprae. This study was performed to assess the epidemiological trend of leprosy in the past five years in the three study districts in Tanzania in which a leprosy prevention intervention study (PEP4LEP) is implemented, and to determine the case detection delay at baseline. Methods Secondary data from the leprosy registry of the National Tuberculosis and Leprosy Program of Tanzania from 2015 to 2019 were used to describe the epidemiological trends of leprosy for the three study districts: Morogoro, Mvomero, and Lindi district council. A cross-sectional study was also conducted to assess the delay in leprosy diagnosis at baseline. The chi-square test was used to calculate statistical significance. Results Between 2015 and 2019, 657 new leprosy cases were detected in three districts. Of those cases, 247 (37.6%) were female patients, 5 (0.8%) had a grade 2 disability (G2D) and 516 (78.5%) had multibacillary (MB) leprosy. From the 50 adult leprosy patients interviewed for detection delay, 16 (32.0%) were females and 38 (76.0%) had MB leprosy. Overall, a mean case detection of 28.1 months (95% CI 21.5–34.7) and a median of 21.5 months were observed. Conclusion The three PEP4LEP study districts remain highly endemic, with long case detection delays observed that increase the risk of disabilities and contribute to ongoing leprosy transmission. Integrating activities such as contact screening and provision of post-exposure prophylaxis are therefore a necessary strategy in these endemic areas.

Introduction: Engagement is essential to achieve intended outcomes of online interventions, but achieving such engagement is a key challenge for many researchers and practitioners. This systematic literature review aims to identify strategies and tools to promote the use of online health interventions for early detection and raising awareness of chronic diseases among the public, and to investigate the evidence regarding the effectiveness of such strategies. Materials and methods: We performed a systematic search of seven electronic databases: Embase, Medline All Ovid, Web of Science, Cochrane Central Register of Controlled Trials, PsycINFO, CINAHL and Google Scholar. The study protocol is registered in PROSPERO (CRD42020200471). Results: The database search identified 8,526 articles, 47 were included in the review. Thirty-two studies reported strategies to promote the use of their online intervention, including online advertisements on social media (n = 17), a dating application (n = 10), and a website (n = 3). Social media were not only used for promotion of the intervention, but also as main intervention platform (n = 18). Seven studies reported traditional promotion methods such as printed advertisement and (offline) campaigns. Twenty-seven studies reported strategies to keep users engaged, including reminders (n = 12), sharing of posts on social media (n = 4), rewards (n = 3), weekly group discussions (n = 2), follow-up phone calls (n = 2), interactive games (n = 1), monthly quizzes (n = 1), links to provision of a test kit (n = 1), and a deposit-return system (n = 1). Conclusions: No study conducted a formal evaluation of the effectiveness of the engagement strategies. Examining the effectiveness of engagement strategies is an important area for further research.

Objectives Leprosy is a chronic infectious disease caused by Mycobacterium leprae. The PEP4LEP project will compare two integrated skin-screening interventions combined with the distribution of a single dose of rifampicin as post exposure prophylaxis (SDR-PEP) for contacts of leprosy patients. To implement the study in Mozambique, it was necessary to assess recent epidemiological indicators of leprosy and to estimate case detection delay as a main outcome indicator at baseline. Methods This was a descriptive study to establish the trend of epidemiological indicators of leprosy in the Nampula province districts Murrupula, Meconta and Mogovolas in Mozambique, between 2015 and 2019; and to calculate the average delay to diagnose leprosy cases in these districts. The National Leprosy Control Programme was also described. For the estimation of the case detection delay, 81 recently diagnosed patients were interviewed. Results There were 939 new leprosy cases detected in the three districts from 2015 to 2019, with a high proportion of disability (17.0%). The mean diagnosis delay was 26.6 months (95% CI: 18.4–34.7), while the median was 17.0 months. Multibacillary cases had an average delay of 27.9 months (95% CI: 18.6–37.1), while those with grade 2 disability had an average delay of 47.8 months (95% CI: 15.4–80.2). Conclusion The long case detection delay and high grade 2 disability rates indicate that there is a need for active case finding and chemoprophylaxis with SDR-PEP to help interrupt the chain of Mycobacterium leprae transmission in Nampula province.

BACKGROUND: In new leprosy cases, grade 2 disability (G2D) is still a public health burden worldwide. It is often associated with the delayed leprosy diagnoses that healthcare systems should play a crucial role in preventing. The aim of this systematic review was to identify healthcare factors related to delays in case detection in leprosy. METHODS: PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) was used as a guideline in this research. The study protocol was registered in the PROSPERO (International Prospective Register of Systematic Reviews) with reference code CRD42020189274. Data was collected from five electronic databases: Embase, Medline All Ovid, Web of Science, Cochrane CENTRAL, and the WHO Global Health Library. RESULTS: After applying the selection criteria for original empirical studies, and after removing duplicates, we included 20 papers from 4313 records. They had been conducted in ten countries and published between January 1, 2000, and January 31, 2021. We identified three categories of healthcare factors related to delayed case. 1) Structural factors, such as i) financial and logistic issues, and geographical circumstances (which we classified as barriers); ii) Health service organization and management including the level of decentralization (classified as facilitators). 2) Health service factors, such as problems or shortages involving referral centers, healthcare personnel, and case-detection methods. 3) Intermediate factors, such as misdiagnosis, higher numbers of consultations before diagnosis, and inappropriate healthcare services visited by people with leprosy. CONCLUSIONS: Delays in leprosy case detection are due mainly to misdiagnosis. It is crucial to improve the training and capacity of healthcare staff. To avoid misdiagnosis and reduce detection delays, national leprosy control programs should ensure the sustainability of leprosy control within integrated health services.

Background In India, leprosy clusters at hamlet level but detailed information is lacking. We aim to identify high-incidence hamlets to be targeted for active screening and post-exposure prophylaxis. Methodology We paid home visits to a cohort of leprosy patients registered between April 1st, 2020, and March 31st, 2022. Patients were interviewed and household members were screened for leprosy. We used an open-source app(ODK) to collect data on patients’ mobility, screening results of household members, and geographic coordinates of their households. Clustering was analysed with Kulldorff’s spatial scan statistic(SaTScan). Outlines of hamlets and population estimates were obtained through an open-source high-resolution population density map(https://data.humdata.org), using kernel density estimation in QGIS, an open-source software. Results We enrolled 169 patients and screened 1,044 household contacts in Bisfi and Benipatti blocks of Bihar. Median number of years of residing in the village was 17, interquartile range (IQR)12-30. There were 11 new leprosy cases among 658 household contacts examined (167 per 10,000), of which seven had paucibacillary leprosy, one was a child under 14 years, and none had visible disabilities. We identified 739 hamlets with a total population of 802,788(median 163, IQR 65–774). There were five high incidence clusters including 12% of the population and 46%(78/169) of the leprosy cases. One highly significant cluster with a relative risk (RR) of 4.7(p<0.0001) included 32 hamlets and 27 cases in 33,609 population. A second highly significant cluster included 32 hamlets and 24 cases in 33,809 population with a RR of 4.1(p<0.001). The third highly significant cluster included 16 hamlets and 17 cases in 19,659 population with a RR of 4.8(p<0.001). High-risk clusters still need to be screened door-to-door. Conclusions We found a high yield of active household contact screening. Our tools for identifying high

Background: The Public Health Services in the Rotterdam region, the Netherlands, observed a substantial decrease of non-COVID-19 notifiable infectious diseases and institutional outbreaks during the first wave of the COVID-19 epidemic. We describe this change from mid-March to mid-October 2020 by comparing with the pre-COVID-19 situation. Methods: All cases of notifiable diseases and institutional outbreaks reported to the Public Health Services Rotterdam-Rijnmond between 1st January and mid-October 2020 were included. Seven-day moving averages and cumulative cases were plotted against time and compared to those of 2017–2019. Additionally, Google mobility transit data of the region were plotted, as proxy for social distancing. Results: Respiratory, gastrointestinal, and travel-related notifiable diseases were reported 65% less often during the first wave of the COVID-19 epidemic than in the same weeks in 2017–2019. Reports of institutional outbreaks were also lower after the initially imposed social distancing measures; however, the numbers rebounded when measures were partially lifted. Conclusions: Interpersonal distancing and hygiene measures imposed nationally against COVID-19 were in place between mid-March and mid-October, which most likely reduced transmission of other infectious diseases, and may thus have resulted in lower notifications of infectious diseases and outbreaks. This phenomenon opens future study options considering the effect of local outbreak control measures on a wide range of non-COVID-19 diseases. Targeted, tailored, appropriate and acceptable hygiene and distancing measures, specifically for vulnerable groups and institutions, should be devised and their effect investigated.