(LML) Recurrence rate among MB patients following RFT

Leprosy Mailing List – June 7,  2019

Ref.:   (LML)  Recurrence rate among MB patients following RFT

From:  Joseph Kawuma, Kampala, Uganda

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Dear Pieter,

Joe Almeida's submission (June 2, 2019) is very well thought out and appears to be a continuation of his earlier one LML of May 12, 2019.

I wish to reflect on the submission in the context of the status of leprosy services in the African setting where there are widespread claims that the remaining leprosy issues have been integrated into primary health care services either singly or in combination with others like TB or NTDs. The claim of "integration" is in itself a problem.

• Should we use the term "cure" for LLp patients?
• What should be the duration of post-cure chemo-prophylaxis or are we again reverting to "life long"?
• Is it finally resolved that 12 months MB MDT is as good as 24 months MDT for all cases?
• Where will the diagnosis of "High BI cases" be made when skin smear services are almost non existent and where they are quality assurance is an issue? I have learnt from doing programme reviews that there are settings where skin smear results are simply recorded as "Positive" or "Negative". In any case classification of leprosy patients into PB and MB has stolen the show so going into details of the R-J classification including polar and sub-polar forms may be reserved for a few centers- of- excellence in high burden countries. The same arguments surround the actual definition of cases reported by countries as recurrences or relapses!
• There are issues with getting even small contributions to the costs of leprosy services in national or sub-national health budgets; it may be hard for many of our countries to procure the proposed medicines to be used for post-cure chemo-prophylaxis even for a few patients?
• If one were to consider going for the proposal made of continued preventive treatment after MDT, who would be included: only new recurrences and LLp cases or also the LLp treated in the past who (according to the arguments raised) contain some proportion that are "anergic"?
  
  I appreciate the difficulty with generating evidence at this stage but at the same time clear answers to these and other issues are necessary for managing the road to Zero leprosy.
  
  
  
  H Joseph Kawuma

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LML - S Deepak, B Naafs, S Noto and P Schreuder

LML blog link: http://leprosymailinglist.blogspot.it/

Contact: Dr Pieter Schreuder << editorlml@gmail.com