Lepr Rev (2010) 81, 228–275 Review of Leprosy Research Evidence (2002 – 2009) and Implications for Current Policy and Practice ILEP Technical Commission Contributors: ITC members Wim van Brakel Hugh Cross Etienne Declercq Sunil Deepak Diana Lockwood Paul Saunderson W Cairns Smith Other contributors Jenny Batty Lenka Nahodilova Doug Soutar Valsa Augustine Bassey Ebenso 228 0305-7518/10/064053+03 $1.00 q Lepra 229 Summary ................................................................ 231 Introduction ............................................................. 231 Methods ................................................................ 231 Summary and Recommendations ............................................... 231 1. Prevention ............................................................ 231 a. Immunoprophylaxis . ................................................... 231 b. Chemoprophylaxis . ................................................... 232 2. Early diagnosis ......................................................... 232 3. Chemotherapy.......................................................... 232 4. Reactions ............................................................. 233 5. Prevention of disability ................................................... 234 6. Stigma ............................................................... 234 7. Rehabilitation .......................................................... 235 Review of Leprosy Research Evidence (2002 – 2009) and Implications for Current Policy and Practice .............................................................. 236 Introduction ............................................................. 236 Methods ................................................................ 236 1. Systematic Reviews . ................................................... 236 2. Controlled Trials....................................................... 237 3. Ongoing Trials ........................................................ 237 4. Critical appraisal, levels of evidence and strength of recommendations ............... 237 5. Presentation of findings: Review of Research Evidence .......................... 238 References .............................................................. 238 1. Prevention - Immunoprophylaxis and Chemoprophylaxis............................ 239 a. Review of recent literature on Immunoprophylaxis ............................... 239 Summary .............................................................. 239 Recent evidence ......................................................... 239 Recommendations for further research......................................... 240 References ............................................................. 241 b. Review of recent literature on Chemoprophylaxis ................................ 242 Summary .............................................................. 242 Recent Evidence......................................................... 242 Recommendations for further research......................................... 243 References ............................................................. 243 2. Early diagnosis of leprosy .................................................. 244 Summary ............................................................... 244 Recent evidence .......................................................... 244 Recommendations for further research .......................................... 245 References .............................................................. 245 3. Chemotherapy ........................................................... 246 Summary ............................................................... 246 Recent evidence .......................................................... 246 1. A common regimen for both PB and MB leprosy ............................... 246 2. Single dose ROM in PB patients ........................................... 246 3. New MDT regimens . ................................................... 247 Recommendations for further research .......................................... 247 References .............................................................. 247 4. Reactions .............................................................. 248 Type 1 Reactions ......................................................... 248 Summary ............................................................... 248 Recent Evidence on type 1 reaction ............................................ 248 230 Recommendations for further research .......................................... 251 Type 2 (ENL Reaction) ..................................................... 251 Summary . ............................................................ 251 Recent Evidence on ENL Reaction ............................................ 252 Recommendations for further research .......................................... 252 References . ............................................................ 253 5. Prevention of Disability .................................................... 254 Summary . ............................................................ 254 Self-Care . ............................................................ 254 Footwear . ............................................................ 254 Wound Care . ............................................................ 255 Nerve Decompression (Neurolysis) ............................................ 255 Bone Density ............................................................ 256 Further Perspectives on Developing POD........................................ 256 Requirements for further Research ............................................. 257 Self Care . ............................................................ 257 Footwear . ............................................................ 257 Wound Care............................................................ 257 Bone Density ........................................................... 257 Neurolysis . ............................................................ 257 References . ............................................................ 257 6. Review of recent literature on leprosy and stigma ................................. 259 Summary . ............................................................ 259 Recent evidence .......................................................... 259 Recommendations for future research........................................... 263 References . ............................................................ 264 7. Review of New Evidence on "Leprosy Rehabilitation" ............................. 265 Summary . ............................................................ 265 New Evidence. ........................................................... 265 Other research and significant documents ........................................ 265 Recommendations......................................................... 268 References . ............................................................ 268 Contributors . ............................................................ 269 Contributorship ........................................................... 269 Tribute ................................................................. 269 Acknowledgements ........................................................ 269 Table 1 - Key Recent Evidence on Prevention of Leprosy ............................. 270 a. Immunoprophylaxis...................................................... 270 b. Chemoprophylaxis....................................................... 270 Table 2 - Key Recent Evidence on Early Diagnosis of Leprosy ......................... 271 Table 3 - Key Recent Evidence on Leprosy Chemotherapy ............................ 271 Table 4 - Key Recent Evidence on Leprosy Reactions................................ 272 Table 5 - Key Recent Evidence on Prevention of Disability in Leprosy ................... 273 Table 6 - Key Recent Evidence on Leprosy Stigma.................................. 274 Table 7 - Key Recent Evidence on Community Based Rehabilitation in Leprosy ............ 274 Acronyms used in this document ............................................... 275 ILEP Technical Review 231 Summary Introduction The ILEP Technical Commission (ITC) advises ILEP member associations on technical aspects of leprosy. A major review of research evidence in leprosy was published prior to the International Leprosy Congress in 2002. This current report updates that review based on research published between 2002–2009 and focuses on interventions for prevention, early diagnosis, chemotherapy, reactions, prevention of disability, stigma measurement and reduction and rehabilitation in leprosy. Methods A systematic search of electronic databases of published literature for systematic reviews, controlled trials and ongoing trials was conducted in July 2009. The search identified 13 reviews and 21 controlled trials. The data from these studies were extracted and the references cited by these studies reviewed. Each member of the ITC took responsibility to review this evidence for each of the 7 topics and prepared a report summarising the evidence and making recommendations. These findings were presented and discussed at a Forum held in London in March 2010. The report was finalised following this Forum. The evidence was graded using a standard grading system for levels of evidence. However for some topics the evidence used qualitative and other designs which do no conform to this grading but was considered relevant