With regards to early detection, one must differentiate between active detection and passive detection of the disease. Until 2011, CIOMAL implemented a passive policy – information campaigns, staff training – by seeking to integrate its program into the National Health Service.
With the financial support of the Novartis Foundation, CIOMAL launched in 2011 “Contact Tracing” an active detection pilot project. Active detection costs about USD 120 per case. It is obviously more expensive than passive detection. However, it allows for a more systematic fight against leprosy.
In addition, this method also offers the possibility to:
Detect new leprosy cases at the start of the disease, to avoid contagion to other people and prevent severe disabilities;
Train medical staff at all levels;
Raise public awareness directly in the villages;
Ensure patient follow-up.
The methodology followed is based on systematic detection among persons in the same family or living within 300 meters of a patient affected by the disease. Each new case is listed and receives a first dose, a packet of medicine and information on potential adverse reactions.
Since 2011, the patients diagnosed between 2001 and 2010 have been contacted and visited in their homes, in districts with an endemicity rate between 1.78/10,000 and 0.5/10,000 inhabitants. The objective of the visits is to examine their relatives and neighbors.
These campaigns started in the districts with the highest rate of people affected by leprosy and ended in June 2015. The small team of CIOMAL and the National Leprosy Elimination Programme covered almost the whole country in 5 years. Over 600 new cases were identified and treated thanks to these campaigns. The data collected during this first cycle provided reliable statistics on the situation of leprosy in the country.
In October 2016, CIOMAL, the Novartis Foundation, Swiss Tropical Public Health Institute and the National Leprosy Elimination Programme started a Leprosy Post Exposure Prophilaxy (LPEP) study, which involved the distribution of a simple dose of rifampicin to the direct relatives of former patients.
Cambodia is one of the 8 countries – together with Brazil, Tanzania, Nepal, India, Sri Lanka, Myanmar and Indonesia – selected for this study aimed at demonstrating that allocating rifampicin to sensitive subjects has the potential to help prevent the disease.
These campaigns have demonstrated that active detection around known leprosy cases allows for the identification of numerous new cases, many of whom are still at an early paucibacillary stage, with no complications, and without the disease continuing to be transmitted actively, when Cambodia has met the criteria of elimination (prevalence <1/10,000). These campaigns also contribute to raising awareness among the local population and training health workers on the field. They complement the already existing activities and revitalize the fight against the disease.