1.7 Access to care for leishmaniasis in Africa

Barcelona Institute for Global Health (ISGlobal), Barcelona, Spain - Institute of Tropical Medicine (ITM), Antwerp, Belgium   - Médecins Sans Frontières (MSF), Geneva, Switzerland   - University of Gadarif (UoG), Gadarif (Al Qadarif), Sudan

Area of research: Diagnostic/Treatment
Research programme: Implementation

Objective:

To document the availability of care for leishmaniasis in Africa and explore novel ways of enhancing such care.

Visceral Leishmanisis late stage (courtesy of Asrat Hailu).

Expected results:

(1) Up to date estimates of burden of disease and gaps in leishmaniasis case management

(2) Tracking of uptake of innovative diagnostics and drugs

(3) Assessment of the quality of available services, drugs and diagnostics and

(4) Policy recommendations on innovative ways to enhance access to care

Summary:

Background: Visceral Leishmaniasis (VL) mainly affects poor populations in rural areas and has important socioeconomic consequences. In Sudan the estimated median total cost for one VL episode at US$45015 . Despitethe free provision of VL drugs at public hospitals, households bore 53% of the total cost of VL with one episode of VL representing 40% of the annual household income. More than 75% of households incurred catastrophic out-of-pocket expenditures. Alternative treatment regimens that reduce the duration of treatment have been developed but seem to remain out of reach of many patients in the region. In addition, there is incomplete registration and inappropriate distribution of leishmanial diagnostics and drugs in most countries.Physical access to displaced affected populations is also a major barrier. Certain NGOs have invested a lot in patient care but the coverage of needs remains unclear.

Methodology: The PhD will be articulated around a number of 4 papers in peer reviewed journals. Each will follow specific methodologies described in separate protocols. The methods will include a systematic review of the literature, a descriptive case study in each endemic country, a coverage survey, a quality assurance check, and qualitative research methods to document the community perspective.