The 19th International Leprosy Congress (ILC), held in Beijing, China from September 18 – 21, was an opportunity for leprosy experts, including the Novartis Foundation, to convene and review the progress being made in the fight against the disease.
Keynotes, posters and abstracts presented at the ILC showed progress on the main programs under the Novartis Foundation strategy toward zero transmission of leprosy. The strategy was launched in 2013 and prioritizes early detection and treatment, contact tracing and preventative treatment, strengthening of surveillance systems to become action-oriented and developing tools for faster and earlier diagnosis.
“The ILC was a great opportunity to see our leprosy strategy gaining momentum, share learnings, and highlight the research we drive and support on diagnostic development and epidemiological modelling,” said Ann Aerts, Head of the Novartis Foundation.
Progress on the Leprosy Post-Exposure Prophylaxis (LPEP) program
The LPEP program aims to evaluate the feasibility and efficiency of contact tracing and the provision of preventative treatment for leprosy under routine conditions in several countries – and to determine the impact this has on leprosy incidence.
Progress from the first 18 months of LPEP program, presented at the ILC, demonstrates the operational practicability of integrating single-dose rifampicin into routine control programs in six countries.
“I am particularly pleased that we were able to share the emerging evidence on the LPEP program, which at mid-point is already demonstrating the feasibility of integrating the strategy of contact tracing, combined with preventative therapy, in national control programs,” said Ann Aerts.
LEARNS program in the Philippines recommended for field use
In the Philippines, around 2,000 new leprosy patients are detected each year. LEARNS, implemented in collaboration with public and private partners, is the Philippines’ first mobile phone-based leprosy detection system, allowing frontline healthcare providers to send images of suspect leprosy lesions and symptoms via SMS to a specialist. This helps to reduce delays in diagnosis and treatment.
In 2015, an evaluation was carried out to determine the diagnostic concordance between LEARNS and in-person diagnosis of leprosy. LEARNS proved to be a good tool for screening, with an 83% sensitivity to correctly identify suspect lesions as leprosy; and with a 77% specificity to exclude leprosy. The accuracy of first mobile phone-facilitated leprosy detection system to help identify patients in remote areas of the Philippines has led to its recommendation for field use.
Criteria for development of a molecular diagnostic test for leprosy determined
Early diagnosis and prompt treatment with multidrug therapy for all patients remains the cornerstone of the global leprosy elimination strategy. Currently, leprosy diagnosis is almost exclusively based on clinical signs, as there is no reliable diagnostic test available.
The Novartis Foundation convened an international expert group to define the requirements for a leprosy diagnostic, and further expert meetings in 2016 reviewed user requirements and optimal technologies for such a test. The initial process was published in ‘PLOS ONE Neglected Tropical Diseases’ early in 2016, and led to the selection of a quantitative Polymerase Chain Reaction (PCR genetic test) as the optimal technology to identify people infected with leprosy as early as possible. In September, the Novartis Foundation formed a research agreement with École Polytechnique Fédérale de Lausanne (EPFL) to start the pre-clinical development of this molecular diagnostic test for leprosy.
In addition, the Novartis Foundation also supports the advancement of research in leprosy biomarkers, working with Leiden University and Erasmus in Bangladesh. The Foundation is also working to develop other laboratory tests, as well as a field-friendly test, in conjunction with the Seattle-based Infectious Disease Research Institute (IDRI) and the Cebu Skin Clinic in the Philippines. At the same time, work is ongoing with the NTD Modeling Consortium – including Warwick, UCSF and Erasmus – on modelling the epidemiology of the disease and the impact of different interventions on its incidence.