Strategies for leprosy services in low-endemic areas and countries

Most leprosy-endemic countries have a national leprosy programme working to achieve ‘zero leprosy’ guided by a zero leprosy roadmap, national leprosy strategy or similar document. In July 2023, WHO published new Technical Guidance on interruption of transmission and elimination of leprosy disease. The key tool is the Leprosy Elimination Framework that specifies 3 phases of elimination with indicators and cut-offs for when one phase transitions to the next. Now that interruption of transmission and elimination of leprosy are on the horizon for many countries or, indeed, have already been achieved, there is a need for detailed guidance on what strategies are appropriate for leprosy control under low-endemic circumstances (Phase 2 and 3 of the Leprosy Elimination Framework). It is important to realise that strategies for providing services to persons with leprosy-related disabilities, eliminating stigma and discrimination and implementing inclusion measures have a different horizon and will still be needed for decades to come. The International Federation of Anti-Leprosy Associations (ILEP) Technical Commission (ITC) organised a symposium and a workshop during which strategies for leprosy control were discussed under five headings that covered all operational aspects of a leprosy programme: Prevention, case detection and diagnostics; Treatment and case management; Disability prevention, management and rehabilitation (including mental health); Stigma reduction, inclusion and human rights; and Surveillance and data management. Strategies were recommended under each heading, with reference to the phase of elimination for which they are deemed appropriate.