WHO Expert Committee on Leprosy.

Since the introduction of multidrug therapy for leprosy in 1981, an estimated 15 million patients have been cured of the disease and disabilities have been prevented in some 2-3 million individuals. These remarkable results have been brought about by the synergistic efforts of WHO, governmental and nongovernmental bodies, academia, industry and affected communities throughout the world. Nevertheless, much remains to be done--both to sustain this progress and to effect a further reduction in the impact of leprosy on patients and their families. This report presents the conclusions and recommendations of the WHO Expert Committee on Leprosy, whose eighth meeting reflected the recent shift in emphasis of leprosy elimination to reducing of the impairments and disabilities caused by the disease and ensuring the quality and sustainability of leprosy services. The Committee analysed the global leprosy situation, discussed elements of epidemiology, and reviewed developments in treatment of the disease and management of complications. Sociocultural issues were addressed, as was the need for community care, accessibility of health services, and effective referral systems. Indicators for monitoring and evaluation were outlined and research priorities were set out.

Control of blinding eye diseases in leprosy: strategies for India.

Over half of the people affected by leprosy worldwide are in India, many of whom are severely disabled when they present for care. Changes in policy and the integration of the leprosy programme with general health services has given rise to new challenges for the control of blinding eye disease in leprosy patients. This paper looks at the challenges posed: management, materials, manpower, money, and mobility--all of which are common barriers to the availability, access, and utilization of services--and to monitoring existing programmes. We consider strategies to overcome these challenges and fulfill the goal of VISION 2020--eliminating avoidable blindness--through the provision of comprehensive eye care and strengthening the existing infrastructure. Formal cooperation between national governments, non-governmental organisations, and International Development Agencies will need to continue, although possibly, in different roles and with plans modified to be relevant to the local needs of leprosy patients.

Brazilian policy of universal access to AIDS treatment: sustainability challenges and perspectives.

INTRODUCTION: The Brazilian AIDS Programme success is recognized worldwide, due to its integrated approach of prevention, respect for human rights and to free of charge universal access to state of the art antiretrovirals. CURRENT SITUATION: As of 2006, 180,000 people living with AIDS are on HAART with 17 drugs available, receiving medical and laboratory care through the public health system. Costs for ART drugs reached US$ 400 million in 2006 and will increase steeply if the current trends are maintained: uptake of approximately 20,000 new patients/year and the need for more expensive, patent-protected second and third line drugs. DISCUSSION: We discuss the strengths and weaknesses of the programme, budgetary pressures, the need for more intense preventive efforts, for boosting local production of new drugs, for more investment in research and development and the issue of voluntary and compulsory licensing. There are many hurdles in pursuing long-term sustainability, which depends on country driven initiatives and international collaboration and participation. CONCLUSION: We conclude that the Brazilian experience demonstrated the capability of a developing country to treat people with equity, independently of race, gender or economic power and that this equality "seed" has already spread to other countries. Internally this experience must be used to tackle other endemic diseases, such as leprosy, malaria, dengue and leishmania. The Brazilian political will has been proven but, once again, there will be the need for concerted action by civil society, researchers, health professionals, people living with HIV/AIDS and the government to convince the world that health needs should not be treated as commercial issues, and that progress in research and development must be shared throughout the world if we expect to survive as a civilization.

[Spatial analysis of leprosy cases treated at public health care facilities in Brazil]. / Análise da demanda de casos de hanseníase aos serviços de saúde através do uso de técnicas de análise espacial.

Hansen disease or leprosy is a major endemic disease in Brazil. Well-designed strategies, including decentralization of basic care, are needed to reduce its prevalence. The article begins by describing the structure and supply of services for treating leprosy cases in the country, after which it analyzes the trends in epidemiological and operational indicators, comparing the periods before and after decentralization of services to the municipal (local) level. Finally, spatial analysis allowed identifying the territorial distribution of this endemic and analyzing the pattern of geographic areas according to care provided by health facilities and its evolution. Based on the location of the geographic centers in the census tracts by place of residence, and using spatial smoothing technique based on Kernel estimation, the study constructed domain areas of care for each health facility or unit. Following municipalization of care, there was an increase in the detection and treatment by the municipalities themselves, reducing patient evasion to neighboring counties and causing changes in demand trends, with an increase in use of services by the clientele and important alterations in the epidemiological and operational indicators.