Acceptability and feasibility of chemoprophylaxis with single-dose rifampicin in four leprosy-endemic districts in Benin

TL;DR

This study evaluated how acceptable and feasible it is to use single-dose rifampicin to prevent leprosy in Benin, finding that education and awareness are key to increasing acceptance.

Contribution

The study provides real-world data on the feasibility and acceptability of leprosy chemoprophylaxis in endemic regions, highlighting factors influencing acceptance.

Findings

58.6% of leprosy contacts agreed to receive single-dose rifampicin chemoprophylaxis.

Lack of education and low leprosy knowledge significantly increased the likelihood of refusing chemoprophylaxis.

6,416 contacts received SDR, and 8 new leprosy cases were identified and treated.

Abstract

Chemoprophylaxis with single-dose rifampicin (SDR) is a preventive measure recommended by the World Health Organization to limit leprosy transmission. This study was carried out to assess the acceptability and feasibility of this measure in Benin.

This intervention-oriented study, including contacts of people affected by leprosy (PALs), was conducted in two linear phases from September 2019 to August 2020 in Benin. In the first phase, we assessed contacts’ knowledge of leprosy and their perceptions of SDR through interviews conducted after their informed consent. In the second phase, contacts were educated about leprosy and the importance of SDR in leprosy control. Eligible contacts were clinically examined, and new leprosy patients were treated with multidrug therapy while consented healthy contacts received the SDR.

9,941 contacts were registered around 197 PALs. After interviewing 394 contacts, the majority (88.8%) had insufficient leprosy knowledge. Of these contacts, 58.6% agreed to receive chemoprophylaxis. They were willing to take the necessary time for treatment (74.5%), travel long distances (83.1%) and take the drug as often as possible (90.0%). Marital status (p = 0.008), education level (p = 0.000) and knowledge of leprosy (p = 0.000) were statistically linked to chemoprophylaxis acceptance. Contacts who lived alone, who weren’t educated and had little knowledge of leprosy were respectively 2.18, 2.75 and 43.13 times more likely to refuse chemoprophylaxis.

Of the 9,941 sensitized contacts, 6,798 were clinically examined, and 6,416 received SDR. The average age of contacts who received chemoprophylaxis was 27.3 years (±19.8), with a predominance of women (52.7%). Eight (8) new patients were identified and treated with multidrug therapy.

It is important to increase awareness to improve knowledge of leprosy to contribute to chemoprophylaxis acceptance.

Despite the decline in leprosy cases in recent years, the incidence rate has stagnated, indicating that the transmission has not yet been broken. New approaches to reducing the number of cases and curbing disease transmission, such as early case detection, clinical contact examination and chemoprophylaxis, are now being recommended. In leprosy control, rifampicin chemoprophylaxis for contacts of patients is a preventive intervention that can prevent the transmission of infection among household members. We report here the experience of an intervention-oriented study in four leprosy-endemic localities in Benin. We first assessed the leprosy contacts knowledge of the disease, the acceptability and feasibility of single-dose rifampicin (SDR) before administering it to those who gave informed consent. Of these contacts, 58.6% agreed to receive chemoprophylaxis and were willing to take the necessary time for treatment and travel long distances to take the drug as often as possible. However, contacts who lived alone who weren’t educated and had little knowledge of leprosy were more likely to refuse chemoprophylaxis with SDR. It is therefore important to improve education and knowledge of the disease to contribute to the acceptance of chemoprophylaxis.

Figures