Early detection of leprosy and LF is one of the cornerstones of Lepra’s work. It’s not a new concept by any means; we have been striving for better ways to detect and diagnose cases for years. But it is an important concept, and one which we are going to dedicate more time, resources and attention to in the coming years.
Traditionally, a new case of leprosy or LF is only diagnosed when someone presents themselves at a health centre. Maybe they are worried about their emerging signs and symptoms. Maybe they have been encouraged by a family member or friend to go and get checked. Whatever the reason, it relies on people taking a decision to go to the clinic themselves, with no direct role of the health care system. We call this ‘passive case detection’: diagnosis without direct intervention.
But there are many barriers to someone deciding to go to the clinic to get checked out.
It may be a long way away, so you have to organise transport, which comes at a cost when maybe you can’t afford to, and even if you could, maybe you had more pressing things that you needed to buy. Or maybe you don’t have the time to go.
Or maybe you don’t have faith in the service you would get if you did go. Or maybe you’re not even that concerned – your symptoms are only minor and don’t affect your day-to-day life. Or maybe you want to keep your potential diagnosis a secret, or simply aren’t ready to accept the truth.
Maybe your position in your family – your age or your gender – means you don’t have the freedom or independence to go.
Any of these barriers could delay your decision to seek health advice. And this could be critical, for as we know, the earlier you detect and treat a case of leprosy or LF, the better the health outcomes and the more likely you can minimise the lifelong impact. Often, by the time even the earliest signs of infection become apparent, lifelong disability and discrimination are already factors.
This is where ‘active case finding’ comes in. Instead of waiting for someone to decide to come to you, you go to them. Lepra teams in India and Bangladesh do this through community outreach – going village to village, door-to-door and person-to-person. It is a time-consuming approach, but we know it is highly effective.
In Jamui District in Bihar State, India, the ASPIRE project takes this exact approach. Working with our partners, Effect Hope, the five-year project was launched in 2022, with the aim to integrate health and community responses to address leprosy LF, PKDL, CL and scabies.
Working with the government health system, the project visited and screened every single village in the district, reaching 86% of all households. The result was more than three times the usual number of leprosy and LF cases being diagnosed. It is an impressive and important achievement.
Most importantly, the ASPIRE approach reaches the hidden cases, the people who would otherwise go undiagnosed. The people for whom the barriers to go to a clinic themselves prove too much: children, the elderly, the economically, socially, culturally and geographically marginalised - The people who need support the most. Active case finding reaches them and enables them to get the support they need.
So, at Lepra, we are looking to scale up our work on the ASPIRE project in the coming years, taking the approach to other districts and communities.
We see it as a much-needed and high-impact approach – an opportunity to reach the people who otherwise do not get the care and support which is so vitally needed.
In autumn, Lepra launches its ambitious new 2024 - 2030 Global Strategy. We hope you can join our special event, click here to learn more.
