NEW DEVELOPMENT IN LEPROSY CONTROL AND THE ISSUES OF INTEGRATION

Abstract

ABSTRACT Control of leprosy has up till now depended on active case finding, early diagnosu, and lon.&r-term treatment with dapsone monotherapy of all cases, but especially of infectious (lepro matous and bordprline-lepromatousJ patients. Thu strategy u failing because of poor compliance, microbial persistence which causes relapse in patients prematurely stopping dapsone therapy, and relapses associated with a world-wide epidemic of secondary dapsone resutance. Primary dapsone resutance, occurring in any type of leprosy, u increasingly being detected. WHO now recommends that all multibacillary lepro.,.y patients should be treated ulith a three-drug regimen of rifampicin, dapsone, and pither clofazimine or ethionamide prothionamide, in a rhythm especially suitable for field superoision, for a minimal duration of two years and preferably until the patient becomes'smear ne~tive. Paucibacillary patients may be treated with short course therapy consuting of rifampicin monthly for six doses plus six months of daily dapsone. These regimens will cause a steep increase in work load, not least to the skinsmear laboratory. But after about three years, the work load should begin to reduce substantially. Then after about 10 years, it should reach well below the present level. It is suggested that integration with the TB seroices might be possible about three years after the setting-up of multidrug therapy in any area. Full integration into PHC could be possible after about 10 .years. But intewation is likely to fail unless massive health education is undertaken to lessen the stigma of leprosy.