Single-Dose Rifampicin Leprosy Chemoprophylaxis for Household Contacts in Kiribati: An Audit of a Combined Retrospective and Prospective Approach

Patrick O Campbell; Temea Bauro; Erei Rimon; Eretii Timeon; Caitlin Bland; Nabura Ioteba; Nicholas M Douglas; Arturo Cunanan; Stephen T Chambers

doi:10.3390/tropicalmed9030058

Single-Dose Rifampicin Leprosy Chemoprophylaxis for Household Contacts in Kiribati: An Audit of a Combined Retrospective and Prospective Approach

Trop Med Infect Dis. 2024 Mar 1;9(3):58. doi: 10.3390/tropicalmed9030058.

Authors

Patrick O Campbell^{1

2}, Temea Bauro³, Erei Rimon³, Eretii Timeon³, Caitlin Bland⁴, Nabura Ioteba⁵, Nicholas M Douglas^{2

6

7}, Arturo Cunanan^{8

9}, Stephen T Chambers¹

Affiliations

¹ Department of Pathology and Biomedical Science, University of Otago, Christchurch 8011, New Zealand.
² Department of Infectious Diseases, Christchurch Hospital, Te Whatu Ora Waitaha, Canterbury 8011, New Zealand.
³ Government of the Republic of Kiribati Ministry of Health and Medical Services, Tarawa P.O. Box 268, Kiribati.
⁴ Otago Medical School, University of Otago, Christchurch 8011, New Zealand.
⁵ Pasifika Medical Association, Christchurch 8011, New Zealand.
⁶ Department of Medicine, University of Otago, Christchurch 8011, New Zealand.
⁷ Division of Global and Tropical Health, Menzies School of Health Research, Charles Darwin University, Darwin, NT 0811, Australia.
⁸ Department of Health, Culion Sanatorium and General Hospital, Culion 5315, Philippines.
⁹ Division of Programmes for Disease Control, Manila 1003, Philippines.

Abstract

Kiribati is a Pacific Island nation with a widely dispersed population and one of the highest rates of leprosy worldwide. Single-dose rifampicin post-exposure prophylaxis (SDR-PEP) of leprosy contacts has reduced new case detection rates in controlled trials. In 2018, an SDR-PEP programme was introduced in Kiribati that included screening and chemoprophylaxis of household contacts of leprosy cases retrospectively (2010-2017) and prospectively (2018-2022). We conducted a retrospective audit to determine the comprehensiveness, timeliness and feasibility of the SDR-PEP programme. Overall, 13,641 household contacts were identified (9791 in the retrospective and 3850 in the prospective cohort). In the retrospective cohort, 1044 (11%) contacts were absent, 403 (4%) were ineligible for SDR, and 42 new cases were detected (0.4%) Overall, SDR coverage was 84.7%. In the prospective cohort, 164 (4%) contacts were absent, 251 (7%) were ineligible for SDR, and 23 new cases were diagnosed (0.6%). Overall, SDR coverage was 88.1%. Across both cohorts, there were 23 SDR refusals. The median time to SDR administration was 220 days (IQR 162-468) and 120 days (IQR 36-283) for the retrospective and prospective cohorts, respectively. SDR was readily accepted in both cohorts. The new case detection rate (0.5%) is consistent with that in other studies. Overall SDR coverage in both the retrospective and prospective phases met programmatic expectations.

Keywords: Mycobacterium leprae; feasibility studies; household contacts; leprosy; post-exposure prophylaxis; single-dose rifampicin.

Grants and funding

CB received Health Research Council of New Zealand (HRC) funding for a summer studentship (Ref no: 22/441). This research received no other external grant funding.