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Upcoming Event: The 16th Annual NNN Conference

The 16th Annual Neglected Tropical Diseases (NNN) Conference will take place from Tuesday 30 September to Thursday 2 October 2025, hosted by the Ministry of Health, Uganda, in Kampala and virtually. The conference will bring together NTD practitioners, government officials, community leaders, researchers, policymakers, and stakeholders from more than 50 countries to deliberate on challenges and solutions in the fight against neglected tropical diseases (NTDs).

This year’s theme, “Sustainable Innovations for Impact – Transforming the Fight Against NTDs,” highlights the importance of sustainability, innovation, and impact to ensure that technological advances and new strategies lead to long-term success in eliminating NTDs. The theme aligns strongly with the WHO NTD Road Map and global efforts to embed sustainability across programs.

The conference will feature rich discussions and case studies across six subthemes:

  • AI and Digital Health in NTD Management – Enhancing efficiency and scalability through data-driven approaches.

  • Community-Driven Innovations – Leveraging local knowledge to co-create solutions.

  • One Health Approaches to NTDs – Integrating human, animal, and environmental health.

  • Strengthening Health Systems for NTD Elimination – Embedding NTD programs into national frameworks.

  • Climate Change and NTDs – Addressing environmental drivers of disease transmission.

  • Sustainable Financing and Investment in NTD Programs – Mobilizing resources for long-term impact.

Registration is open for both in-person and virtual delegates. More details, including the full program, will be available on the official NNN Conference website.

Upcoming Event: NLR Nepal Review, Retreat, and Scientific Writing Training in Pokhara

From 09 to 13 October 2025, the entire NLR Nepal team will gather in Pokhara for the organization’s annual review and retreat. This important event will provide space for reflection, planning, and team building, while strengthening our collective vision of Driving Innovation for Health Equity and Inclusion.

The retreat will be followed by a two-day training workshop on report writing and scientific writing, aimed at enhancing staff capacity to document achievements, share research findings, and contribute to global learning. All staff members, including Research Assistants from the PEP++ project, will actively participate in the sessions.

In addition to NLR Nepal staff, a number of strategic stakeholders will join the event, including the Leprosy Focal Person from Madhesh Province, representatives from the Global Leprosy Mapping (GLM) team, and one participant each from Nepal Leprosy Trust (NLT) and The Leprosy Mission Nepal (TLMN). Their engagement will enrich discussions, ensure alignment across programs, and foster stronger collaboration.

The review and retreat will focus on:

  • Assessing progress against the 2022–2025 strategy and program outcomes.

  • Sharing experiences and lessons learned from key projects, including PEP++ and GLM.

  • Strengthening organizational culture, teamwork, and resilience.

  • Building capacity in scientific and report writing to enhance NLR Nepal’s visibility and credibility in national and international platforms.

This event marks a significant milestone in reinforcing NLR Nepal’s commitment to Zero Health Inequality from Disease, Zero Disability & Barriers, and Zero Discrimination & Exclusion, while ensuring that the organization continues to innovate and lead in inclusive development and public health.

Stay tuned for updates, highlights, and reflections from Pokhara as NLR Nepal moves forward with renewed energy and commitment.

GLM Half-Yearly Update

Global Leprosy Mapping (GLM) Expands Digital Surveillance in Nepal
Between January and June 2025, NLR Nepal reported 11,844 leprosy cases from 237 municipalities through the GLM project, using a case-based digital reporting system. The project introduced a cloud-hosted scientific dashboard with real-time maps and automated cluster analysis, strengthening Nepal’s capacity to detect hotspots and guide interventions. While some municipalities in Madhesh remain to be covered, training and digital integration are ensuring rapid progress toward a more accurate and responsive leprosy surveillance system.

Advancing the Global Leprosy Mapping (GLM) Project in Nepal

From January to June 2025, NLR Nepal made significant progress in the Global Leprosy Mapping (GLM) Project, one of the most innovative initiatives in Nepal’s national leprosy program. The project now covers 237 municipalities across 31 districts in Koshi, Madhesh, Sudurpaschim, Bagmati, and Gandaki Provinces, with 11,844 leprosy cases digitally reported using Kobo Toolbox.

A major highlight has been the launch of a scientific dashboard hosted on HEROKU, featuring automated cluster analysis, heat maps, and real-time alerts. This tool provides decision-makers with powerful insights into transmission dynamics and helps target interventions more efficiently. Integration of SDR-PEP tracking into the system has further strengthened the link between case detection and preventive action.

Despite challenges such as partial coverage in Madhesh and connectivity limitations, progress has been reinforced through multiple levels of training (MTOT, TOT, and field coaching), ensuring health workers are equipped to manage case-based data and use geospatial tools effectively.

The GLM project continues to serve as a model of innovation in digital surveillance, bringing Nepal closer to its goal of interrupting leprosy transmission and achieving Zero Health Inequality from Disease, Zero Disability & Barriers, and Zero Discrimination & Exclusion.

PEP++ 24-Month Follow-Up in Nepal

NLR Nepal has completed screening of 23,961 contacts during the 24-month follow-up of the PEP++ study, detecting 20 new leprosy cases across 25 municipalities in Madhesh Province. This milestone demonstrates the importance of preventive treatment and active surveillance in the journey towards zero leprosy.

PEP++ 24-Month Follow-Up Activities in Nepal

NLR Nepal is continuing the 24-month follow-up of the PEP++ study, a groundbreaking international trial being implemented in Nepal, India, Brazil, and Bangladesh. The project is testing an enhanced preventive regimen to stop the transmission of leprosy in highly endemic areas.

As of this phase, 23,961 contacts have been screened out of 23,842 medicated contacts. Through these follow-up activities, 20 new leprosy cases have been detected—highlighting both the importance of active surveillance and the value of preventive chemoprophylaxis in interrupting transmission.

The activities have so far reached 25 municipalities across 42 targeted areas in Dhanusha, Mahottari, and Sarlahi districts of Madhesh Province. Local governments, health workers, and community volunteers have been closely engaged, ensuring strong ownership and effective implementation at the grassroots level.

This follow-up is a crucial step in evaluating the long-term effectiveness of the PEP++ regimen compared to standard SDR-PEP, and it provides vital evidence for Nepal’s progress toward Zero Health Inequality from Disease, Zero Disability & Barriers, and Zero Discrimination & Exclusion.

The PEP++ study protocol: a cluster-randomised controlled trial on the effectiveness of an enhanced regimen of post-exposure prophylaxis for close contacts of persons affected by leprosy to prevent disease transmission

Abstract

Background: Leprosy is an infectious disease with a slow decline in global annual caseload in the past two decades. Active case finding and post-exposure prophylaxis (PEP) with a single dose of rifampicin (SDR) are recommended by the World Health Organization as measures for leprosy elimination. However, more potent PEP regimens are needed to increase the effect in groups highest at risk (i.e., household members and blood relatives, especially of multibacillary patients). The PEP++ trial will assess the effectiveness of an enhanced preventive regimen against leprosy in high-endemic districts in India, Brazil, Bangladesh, and Nepal compared with SDR-PEP.

Methods: The PEP++ study is a cluster-randomised controlled trial in selected districts of India, Brazil, Bangladesh, and Nepal. Sub-districts will be allocated randomly to the intervention and control arms. Leprosy patients detected from 2015 – 22 living in the districts will be approached to list their close contacts for enrolment in the study. All consenting participants will be screened for signs and symptoms of leprosy and tuberculosis (TB). In the intervention arm, eligible contacts receive the enhanced PEP++ regimen with three doses of rifampicin (150 – 600 mg) and clarithromycin (150 – 500 mg) administered at four-weekly intervals, whereas those in the control arm receive SDR-PEP. Follow-up screening for leprosy will be done for each individual two years after the final dose is administered. Cox’ proportion hazards analysis and Poisson regression will be used to compare the incidence rate ratios between the intervention and control areas as the primary study outcome.

Discussion: Past studies have shown that the level of SDR-PEP effectiveness is not uniform across contexts or in relation to leprosy patients. To address this, a number of recent trials are seeking to strengthen PEP regimens either through the use of new medications or by increasing the dosage of the existing ones. However, few studies focus on the impact of multiple doses of chemoprophylaxis using a combination of antibiotics. The PEP++ trial will investigate effectiveness of both an enhanced regimen and use geospatial analysis for PEP administration in the study communities.

Trial registration: NL7022 on the Dutch Trial Register on April 12, 2018. Protocol version 9.0 updated on 18 August 2022 https://www.onderzoekmetmensen.nl/en/trial/23060.

Keywords: Blanket campaigns; Clarithromycin; High-endemic areas; Leprosy; Post-exposure prophylaxis; Rifampicin.

Effectiveness of ongoing single-dose rifampicin post-exposure prophylaxis (SDR-PEP) implementation under routine programme conditions—An observational study in Nepal

Banstola NL*1; Hasker E2, Mieras L3, Gurung D4, Baral B4, Mehata S5, Prasai S6, Ghimire Y7, Kumar Das B8, Napit P9, van Brakel WH3

1NLR Nepal; 2 Institute of Tropical Medicine Antwerp; 3NLR IO Netherlands; 4FAIRMED Nepal; 5Health office Morang, 6Health office Sunsari, 7Health office Jhapa, 8Health office Udayapur, 9Leprosy Control and Disability Management Section, Nepal 

*Corresponding author

Banstola NL

ORCID: 0000-0002-8115-7661

Biratnagar, Koshi province

NLR Nepal 

nbastola123@gmail.com

nandlalbanstola@nlrnepal.org.np

Abstract

Background/Introduction

Leprosy control remains a challenge in Nepal. Single-dose rifampicin post-exposure prophylaxis (SDR-PEP) shows promise in reducing leprosy incidence among contacts of index cases, contributing to reducing the transmission of Mycobacterium (M.) leprae. This study evaluates the effectiveness of routine SDR-PEP implementation in Nepal in addition to contact screening, focusing on its impact on reducing leprosy risk among contacts and potential population-level effects.

Methodology

We conducted a retrospective cohort study to compare leprosy case notification rates and leprosy risk among close contacts. We compared two districts implementing SDR-PEP (the intervention group) and two without (the control group). Data from 2015 onwards included demographics, index case types, and contact relationships. Statistical analyses, including hazard ratios (HR) and Kaplan-Meier survival curves, assessed the impact of SDR-PEP implementation.

Findings

All four districts showed a decrease in case notification rates since 2015, with the steepest decline in the intervention districts. The risk of developing leprosy among contacts was significantly lower in the intervention districts (HR 0.28, 95% CI 0.18-0.44). SDR-PEP offered 72% protection, consistent over time, as shown in Kaplan-Meier plots. The interaction between intervention and blood-related contact was non-significant (0.29 versus 0.27, p=0.32), and the proportion of MB cases among incident cases was not significantly different post-PEP (51.4% vs. 53.6%, p=0.82).

Conclusions

This study demonstrates the substantial protective effect of integrating SDR-PEP in routine leprosy control programs with contact screening, significantly lowering leprosy risk among contacts. SDR-PEP is equally effective for blood-related contacts and does not preferentially prevent PB cases. While suggesting potential population-level impact, the study design does not allow for firm conclusions at this level. Further research is needed to fully assess SDR-PEP’s effectiveness in diverse contexts and optimize its implementation. Integrating SDR-PEP within well-organized contact screening programs is effective and is expected to reduce leprosy transmission when applied as a rolling intervention.

Keywords: Routine leprosy Control, Single-dose Rifampicin (SDR), Post-exposure Prophylaxis (PEP), SDR-PEP Implementation, Contact Screening, 

Annual Reports

Please view all our Annual Progress Reports

ANNUAL REPORT 2024 LEPROSY CONTROL NLR NEPAL
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ANNUAL REPORT 2024 INCLUSION NLR NEPAL
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ZERO EXCLUSION EVALUATION NLR RIH 2020-2023
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NB ARTICLE PUBLISHED IN PLOS NTDs
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DISABILITY FRIENDLY VILLAGES NEPAL EVALUATION REPORT 2017
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ANNUAL REPORT NLR NEPAL 2023 FINAL
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RESULTS CHAIN EXAMPLES OUTCOMES 2022
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ANNUAL REPORT NLR NEPAL 2022 FINAL
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ANNUAL PROGRESS REPORT 2021
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ANNUAL PROGRESS REPORT 2020
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ANNUAL PROGRESS REPORT 2019
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ANNUAL PROGRESS REPORT 2018
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ANNUAL PROGRESS REPORT 2017
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ANNUAL PROGRESS REPORT 2016
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ANNUAL PROGRESS REPORT 2014
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ANNUAL PROGRESS REPORT 2012
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