Research Agenda

Leprosy control achieved dramatic success in the 1980s – 1990s with the implementation of short-course multidrug therapy, which reduced the global prevalence of leprosy to less than 1 in 10,000 population. However, a period of relative stagnation in leprosy control followed this achievement. Only limited further declines in the global number of new cases reported have been achieved over the past decade.

In 2016, major stakeholders established the Global Partnership for Zero Leprosy and aligned around a shared Action Framework committed to achieving WHO targets by 2030. Research is an important pillar of the Action Framework, which also includes national leprosy programme capacity-building and resource mobilization.

More than 140 participants from more than 20 countries convened in the Research Agenda Working Group to identify key research areas to reach zero leprosy. The Zero Leprosy Research Agenda focuses on eight main research areas, briefly outlined below. The complete Zero Leprosy Research Agenda was published in Leprosy Review in September 2019.

Zero Leprosy Research Agenda

Epidemiologic modeling and socioeconomic research

  • Feasibility of global interruption of leprosy transmission
  • Potential impact of new strategies and tools
  • Geographical variation and population at risk
  • Impact of other epidemiological risk factors for transmission
  • End-game scenarios
  • Testing hypotheses
  • Available tools and their economic feasibility
  • Socioeconomic burden of leprosy
  • Financial and cost analysis of leprosy and associated illness

Digital health

  • Geolocalization of cases
  • Digital diagnostics
  • eLearning and hands-on training (with accreditation)
  • Policy research, implementation, and tracking
  • Independent evaluation of digital interventions (with scale-up plans)

Operational research

  • Mapping
  • Data management
  • Monitoring and surveillance
  • Health systems strengthening
  • Drug-resistance surveillance
  • Active case-finding

Diagnostics

  • Potential use of digital technologies to help improve clinical diagnosis
  • Nucleic acid-based tests
  • Drug-resistance surveillance
  • Reactions and relapses (including in the context of resistance)
  • Diagnostic test based on detection of host immunity
  • Testing for Infection
  • Non-human reservoirs

Post-exposure prophylaxis (PEP) and transmission

  • Leprosy prevalence and surveillance
  • Mapping of current and retrospective routine surveillance data
  • PEP intervention effectiveness
  • PEP effectiveness under routine conditions
  • Detailed cost studies
  • Quality of leprosy screening by minimally trained staff
  • Surveillance for rifampicin resistance in leprosy
  • Field-friendly diagnostic tests
  • Frequency of SDR in high endemic settings
  • Other drugs for PEP
  • PEP for high-risk contacts
  • Disturbance of gut microbiome through PEP
  • Combination of SDR and vaccines
  • Human-to-human transmission
  • Non-human reservoirs
  • Host-pathogen interactions
  • Transmission networks

Vaccines

  • Safety monitoring
  • Updates to MIP vaccine and LepVax
  • Coordination with WHO regarding criteria
  • Range of early diagnostic tests
  • Evaluation of clinical trial sites
  • Clarification for study design and evaluation parameters
  • Target Product Profiles

Disability

  • Early detection of leprosy to prevent disability
  • Pathophysiology, detection, and management of nerve function impairment and reactions
  • Number of people with disability due to leprosy
  • Prevention of disability and its worsening
  • Inclusive rehabilitation services
  • Community-based rehabilitation

Stigma

  • Interventions to reduce stigma as a barrier to zero leprosy
  • Understanding perceptions of leprosy and the reasons behind them
  • Mental wellbeing of persons affected by leprosy
  • UN principles and guidelines for the elimination of discrimination