NIHR RIGHT: Transforming the Treatment and Prevention of Leprosy and Buruli ulcers in Low and Middle-Income Countries (LMICs)

Transforming the Treatment and Prevention of Leprosy and Buruli ulcers in Low and Middle-Income Countries (LMICs), was awarded by the NIHR in the UK through its Research and Innovation for Global Health Transformation (RIGHT) call.

We are working across three countries - Nigeria, Nepal and India. Our overall aim is to improve self-care in the community for leprosy patients who are at risk of recurrent ulceration and further disfigurement and disability and to better understand the needs of Buruli ulcer patients and the barriers to meeting those needs.

World Map Leprosy

NIHR | National Institute for Health Research

University of York

The Leprosy Mission

The Leprosy Mission England and Wales

Key researchers

Professor Richard Lilford

Institute of Applied Health Research
Director of National Institute for Health Research (NIHR) Applied Research Centre West Midlands (ARC WM)

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Site Leads

Dr Indra Bahadur Napit

Nepal Site Lead

Dr Joydeepa Darlong

India Site Lead

Dr Anthony Meka

Nigeria SE Site Lead

Dr Sunday Udo

Nigeria NC Site Lead

Current projects

NIHR200132_FIGURE 2- Organogram of studies_11.10.2022

Nepal

WP1 INSTIL: (Self Help Evaluation for lepRosy and other conditions in NePAl (SHERPA) Study)

The SHERPA study aims to evaluate a service intervention called Integrated Mobilization of People for Active Community Transformation (IMPACT). This is a programme funded by the government of Australia to encourage self-care and self-help. We plan to evaluate the IMPACT intervention by following a cohort of 18 self-help clusters from around the time of inception to 24 months. The study is a prospective, cluster-based, non-randomised controlled study. The IMPACT intervention will be rolled-out to 36 clusters in total, of which we will study the final 18 clusters.

WP3: TABLE Trial

We are running a clinical trial titled ‘Trial of Autologous Blood products to promote ulcer Healing in LEprosy (TABLE)'. This is a randomised clinical trial (RCT) to evaluate the efficacy of Leukocyte and Platelet-Rich Fibrin (L-PRF) on healing rates for leprosy ulcers and on duration of hospital stay.

WP4: Sustainability of Self-Help Groups

This is one of four studies on sustainability of Self-Help Groups (SHG) once funding ceases. The broad aim of the Nepal study is to evaluate the sustainability of program activities of PACED (Participatory Action for Community Empowerment and Development) and CEDAR (Community Empowerment, Development, Disability & Rehabilitation), projects run by TLMN and of perceptions any short-term benefits.

India

WP1 INSTIL (Replicability Model Evaluation)

The Leprosy Mission Trust India (TLMTI) recently proposed the replicable model project (intervention) to enhance leprosy care within the existing government health system, with the goal of reducing the rate of leprosy related disability (WHO classifications Grade I and II) below 5% in newly diagnosed children and adults in Janjgir Champa, Chhattisgarh by 2024. We will also evaluate this intervention.

WP4: Sustainability of Self-Help Groups

This is one of four studies on sustainability of Self-Help Groups (SHG) once funding ceases. We aim to evaluate the sustainability of program activities of the Self-Help Community Development Project (SHCDP) and perceptions of any short-term benefits.

Review on customised protective footwear in prevention of recurrence of ulcer in insensitive feet due to leprosy

This study aims to review the literature on customised footwear and answer the following question: Does footwear with customised insole reduce the recurrence of ulcer in person affected by leprosy and diabetes at risk of ulcer as compared current standard Micro-Cellular Rubber (MCR) footwear?

Nigeria (SE)

In South East Nigeria, we are working with the German Leprosy and TB Relief Association (DAHW).

WP1 INSTIL

We aim to support self-care for people in the community who are at risk of recurring leprosy ulcers, based on an ‘implementation science’ approach. We aim to Identify people at risk of ulcers from registers held in our study centres; carry out baseline assessment in ulcer prevalence and severity, and quality of life and wellbeing; build on our internationally agreed principles to design local interventions in collaboration with communities, patients, clinicians and policy-makers; pilot, refine, roll out and evaluate intervention.

WP2 health needs assessment for Buruli ulcer (HABU)

HABU Cohort: we will conduct a cohort study to better understand the needs of BU patients and the barriers to meeting those needs;
HABU Retrospective: a retrospective study of those who have had surgery or who complain of any symptom that can be ascribed to the treatment. Clinical observations will be made and participants will complete questionnaires. We aim to interpret our findings with respect to the literature to examine for improving prognosis with time.

WP4: Sustainability of Self-Help Groups

This is one of four studies on sustainability of Self-Help Groups (SHG) once funding ceases. The aim is to evaluate post-implementation of SHG projects that were implemented in SE Nigeria in order to identify barriers and facilitators to SHG implementation/effectiveness, and the feasibility of sustaining SHG in Southern Nigeria.

Scoping study of traditional healers in prevention and management of leprosy and buruli ulcer

This study aims to explore the literature to determine the scope of practice and involvement of traditional healers in the prevention and management of Leprosy and Buruli ulcers.

Nigeria (NC)

WP4: Sustainability of Self-Help Groups

In North Central Nigeria, we are working with the Leprosy Mission Nigeria. This is one of four studies on sustainability of Self-Help Groups (SHG) once funding ceases. We will interview different groups of people who were involved or have knowledge of the community-based self-care/self-help interventions in North Central Nigeria. The interviews will aim to explore the impact of the community-based interventions on the targeted communities.