Use of mobile technology in preventing leprosy impairments.

AIM: Rapid development in telecommunication sector across the globe has revolutionised communication networks even in rural areas. At a tertiary leprosy referral hospital in Tamil Nadu, India, leprosy treatment was started for a male patient presenting with clinical signs and symptoms suggestive of leprosy. Since the patient was from a remote area, but needed close and continuous monitoring, he was provided with a mobile phone and a 12 h toll free number. METHODS: The patient was able to provide detailed regular information of his health status to the health worker, through the toll free number from the mobile phone given to him. The patient defaulted during his treatment. Within a few days of his defaulting, a follow up call was made and the patient revealed that he did not have enough financial resources to visit the hospital and continue his treatment. RESULTS: The patient was visited by a health worker and was reassured. Arrangements were made by the hospital to reimburse his travel costs. CONCLUSION: Utilising the advancements in technology would help in solving some of the key unanswered issues existing in leprosy. The use of technology helps facilitate and complement the work of health workers in reaching out to patients living in remote areas.IMPLICATIONS FOR REHABILITATIONThe use of M (mobile) - health in treatment compliance and adherenceThe use of M-health in the prevention and management of impairments in leprosyEffective monitoring and follow up of patients with impairments through mobile.

Rapid quantitative serological test for detection of infection with Mycobacterium leprae, the causative agent of leprosy.

Leprosy remains an important health problem in a number of regions. Early detection of infection, followed by effective treatment, is critical to reduce disease progression. New sensitive and specific tools for early detection of infection will be a critical component of an effective leprosy elimination campaign. Diagnosis is made by recognizing clinical signs and symptoms, but few clinicians are able to confidently identify these. Simple tests to facilitate referral to leprosy experts are not widely available, and the correct diagnosis of leprosy is often delayed. In this report, we evaluate the performance of a new leprosy serological test (NDO-LID). As expected, the test readily detected clinically confirmed samples from patients with multibacillary (MB) leprosy, and the rate of positive results declined with bacterial burden. NDO-LID detected larger proportions of MB and paucibacillary (PB) leprosy than the alternative, the Standard Diagnostics leprosy test (87.0% versus 81.7% and 32.3% versus 6.5%, respectively), while also demonstrating improved specificity (97.4% versus 90.4%). Coupled with a new cell phone-based test reader platform (Smart Reader), the NDO-LID test provided consistent, objective test interpretation that could facilitate wider use in nonspecialized settings. In addition, results obtained from sera at the time of diagnosis, versus at the end of treatment, indicated that the quantifiable nature of this system can also be used to monitor treatment efficacy. Taken together, these data indicate that the NDO-LID/Smart Reader system can assist in the diagnosis and monitoring of MB leprosy and can detect a significant number of earlier-stage infections.

Development of a quantitative rapid diagnostic test for multibacillary leprosy using smart phone technology.

BACKGROUND: Despite efforts to eliminate leprosy as public health problem, delayed diagnosis and disabilities still occur in many countries. Leprosy diagnosis remains based on clinical manifestations and the number of clinicians with expertise in leprosy diagnosis is in decline. We have developed a new immunochromatographic test with the goal of producing a simple and rapid system that can be used, with a minimal amount of training, to provide an objective and consistent diagnosis of multibacillary leprosy. METHODS: The test immobilizes two antigens that have been recognized as excellent candidates for serologic diagnosis (the PGL-I mimetic, ND-O, and LID-1), on a nitrocellulose membrane. This allows the detection of specific IgM and IgG antibodies within 20 minutes of the addition of patient sera. Furthermore, we coupled the NDO-LID® rapid tests with a new cell phone-based test reader platform (Smart Reader®) to provide objective interpretation that was both quantifiable and consistent. RESULTS: Direct comparison of serologic responses indicated that the rapid test detected a greater proportion of leprosy patients than a lab-based PGL-I ELISA. While positive responses were detected by PGL-I ELISA in 83.3% of multibacillary patients and 15.4% of paucibacillary patients, these numbers were increased to 87% and 21.2%, respectively, when a combination of the NDO-LID® test and Smart Reader® was used. Among multibacillary leprosy the sensitivity of NDO-LID® test assessed by Smart Reader® was 87% (95% CI, 79.2-92.7%) and the specificity was 96.1% (95% CI, 91.7- 98.6%). The positive predictive value and the negative predictive value of NDO-LID® tests were 94% (95% CI, 87.4-97.8%) and 91.4% (95% CI, 85.9-95.2%), respectively. CONCLUSION: The widespread provision of rapid diagnostic tests to facilitate the diagnosis or prognosis of multibacillary leprosy could impact on leprosy control programs by aiding early detection, directing appropriate treatment and potentially interrupting Mycobacterium leprae transmission.