Dr. H. Joseph Kawuma
Medical Advisor, German Leprosy and TB Relief Association
Chair, Technical Advisory Group for Leprosy, WHO
Knowing about the presence of infection in time would provide a timely opportunity to employ preventive measures in a better defined population. Increasing proportions of newly detected cases are contacts of known present or past patients and tend to arise from "leprosy pockets". Having a simple test for leprosy would make it easier to define the at-risk population.
This becomes more relevant in the context of diminishing clinical skills and the integration of leprosy services into the general health services. The test should be one that guides the decision on the diagnosis and the need to treat, and preferably also justifies the end point of the treatment. The end point of current multidrug therapy (MDT) regimens is based on completion of the prescribed number of MDT blister packs.
When compared to the pre-MDT era, the present treatment is much shorter but it still demands too much time from both the patient and the health services. Managing separate regimens for PB and MB cases demands additional skills training and makes logistics management more complicated. Overall adherence to treatment would probably be better with shorter regimens.
The MDT regimens in use at the moment are simple and robust, but do not address the problems of reactions and nerve damage that are the cause of most leprosy-related impairments and disabilities. If these did not occur, leprosy would be a much easier condition to deal with. Among other reasons, this would lead to a significant reduction in the need to maintain referral services. Most probably, there would also be a significant reduction in the psychosocial problems that accompany the disease.