Need for, and acceptability of, rapid diagnostic tests that can facilitate the diagnosis of leprosy

New cases of leprosy indicate that M. leprae transmission is continuing. In the first half of 2015 we sequentially diagnosed new leprosy patients attending Cebu Skin Clinic, a referral and leprosy treatment centre in Cebu City, Philippines. The great majority of patients were characterised as multibacillary (145 of 147; 98·6%), most of whom had bacterial indices 3þ (86; 58·5%) or more than 20 skin lesions (94; 63·9%). Importantly, 65·3% estimated that slightly over a year had elapsed between their initial symptoms and diagnosis, while 26·5% reported a lapse of greater than 3 years. Many patients (73·8%) and their household contacts (79·2%) reported that their lives had already been adversely affected. This indicates that improvements to expedite diagnosis are required, and rapid diagnostic tests (RDT) appear suited for this. Questionnaires were conducted among various groups to ascertain the acceptability and perception of RDT. All groups responded favourably, with 95·9% patients, 93·2% contacts and 81·4% of the general population responding that RDT would be beneficial for leprosy. The vast majority of patients (88·6%) indicated that they would ‘definitely’ submit to testing, followed by 69·4% of contacts and 72·2% of the general population. The majority of patients thought their household members should also be tested, while a subset indicated that RDT use should be extended to their respective communities. We propose that, due to their ease of use, point of care applicability and acceptability within target populations, RDT could be used as an entry point to inform the diagnostic process for leprosy.