03839nas a2200565   4500000000100000008004100001260001200042653000800054653002300062653001300085653000800098653000800106653001200114653000800126653002400134653001300158653001700171653001200188653002600200653002900226653001500255653003000270653001500300653001600315653001600331653002700347653003400374100001400408700001100422700001300433700001200446700001200458700001300470700001400483700001400497700001200511700001600523700001500539700001500554700001300569700001300582700001400595700001500609245013100624856008600755300000800841490000700849520240300856022001403259       2023                            d  c06/202310aACF10aHansen’s disease10aKiribati10aMDA10aPEP10aPacific10aSDR10aActive case finding10aContacts10aIntervention10aleprosy10amass chemoprophylaxis10aMass drug administration10aPopulation10aPost-exposure prophylaxis10aPrevention10aProphylaxis10aRifapentine10asingle-dose rifampicin10auniversal leprosy prophylaxis1 aColeman M1 aHill J1 aTimeon E1 aRimon E1 aBauro T1 aIoteba N1 aCunanan A1 aDouglas N1 aIslam T1 aTomlinson J1 aCampbell P1 aWilliman J1 aPriest P1 aMarais B1 aBritton W1 aChambers S00aEffectiveness of population-wide screening and mass drug administration for leprosy control in Kiribati: the COMBINE protocol.  uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC10314446/pdf/bmjopen-2022-065369.pdf  a1-90 v133 a<p><strong>Introduction: </strong>Progress towards leprosy elimination is threatened by increasing incidence in 'hot-spot' areas where more effective control strategies are urgently required. In these areas, active case finding and leprosy prevention limited to known contacts is insufficient for control. Population-wide active case-finding together with universal prevention through mass drug administration (MDA) has been shown to be effective in 'hot-spot' areas, but is logistically challenging and expensive. Combining leprosy screening and MDA with other population-wide screening activities such as for tuberculosis may increase programme efficiency. There has been limited evaluation of the feasibility and effectiveness of combined screening and MDA interventions. The COMBINE study aims to bridge this knowledge gap.</p>

<p><strong>Methods and Analysis: </strong>This implementation study will assess the feasibility and effectiveness of active leprosy case-finding and treatment, combined with MDA using either single-dose rifampicin or rifamycin-containing tuberculosis preventive or curative treatment, for reducing leprosy incidence in Kiribati. The leprosy programme will run over 2022-2025 in concert with population-wide tuberculosis screening-and-treatment in South Tarawa. The primary research question is to what extent the intervention reduces the annual leprosy new case detection rate (NCDR) in adults and children compared with routine screening and postexposure prophylaxis (PEP) among close contacts (baseline leprosy control activities). Comparisons will be made with (1) the preintervention NCDR separably among adults and children in South Tarawa (before-after study) and (2) the corresponding NCDRs in the rest of the country. Additionally, the postintervention prevalence of leprosy obtained from a survey of a 'hot-spot' sub-population will be compared with prevalence documented during the intervention. The intervention will be implemented in collaboration with the Kiribati National Leprosy Programme.</p>

<p><strong>ETHICS AND DISSEMINATION: </strong>Approval has been obtained from the Kiribati Ministry of Health and Medical Services (MHMS), the University of Otago (H22/111) and the University of Sydney (2021/127) Human Research Ethics Committees. Findings will be shared with the MHMS, local communities and internationally through publication.</p>
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