The impact of COVID-19 on persons affected by leprosy and leprosy control in the North and Northeast of Brazil

Introduction & Aim: Brazil, ranking second globally in newly detected leprosy (Hansen's disease) patients, has encountered obstacles in advancing leprosy control amidst the Covid-19 pandemic, particularly in more vulnerable regions. This study aims to characterize the psychosocial as well as health status and needs of individuals affected by leprosy during the Covid-19 pandemic in the North and Northeast regions of Brazil.

Method: This is a descriptive cross-sectional study examining the health status and needs of persons affected by leprosy during the Covid-19 pandemic throughout the years 2019 and 2020. Adults receiving multidrug therapy (MDT) who were registered in the National System of Notifiable Diseases during this period and lived in the North and Northeast regions of Brazil were included. After obtaining consent, data collection involved conducting telephone surveys. Referrals to additional care were provided to study participants in need. Data collected were entered into REDCap, with subsequent data extracted using TabWin® software from the Department of Informatics of the Brazilian Unified Health System. We conducted a descriptive analysis of sociodemographic, clinical-epidemiological, and psychosocial variables using STATA. Logistic regression analysis was used to estimate the odds ratio (OR) with 95% confidence intervals (95% CI).

Results: The study included 346 persons affected by leprosy who were receiving leprosy treatment. Interruption of MDT occurred in 31.8%, among these patients, 22.5% reported that the interruption had a relationship with the pandemic. Of the included participants, 35.3% reported that their household contacts were not screened for leprosy, although 14.2% recognized skin lesions with loss of sensitivity in their contacts. When assessing mental wellbeing, sadness was reported by 32.4%, fear by 35.3%, sleep deprivation by 34.7%, and depression by 9.8% of the participants. We observed an association between loss of income and sadness (OR 1.61; 95%CI 1.02–2.54; p-value 0.040) and reported depression (OR 2.35; 95%CI 1.11–4.98; p-value 0.026). Social distancing had an additional financial impact on 32.3% of persons affected by leprosy in this study.

Discussion & Conclusion: The pandemic had significant economic, social, and health impacts on the lives of persons affected by leprosy, further complicating leprosy control efforts. Medication availability, medical and psychological patient follow-up, as well as contact screening, were hindered during the pandemic, making the control of leprosy even more challenging. Recognizing the weaknesses of the leprosy control program is crucial for enhancing services both presently and in preparation for future crises like pandemics. Brazil could enhance leprosy control services by implementing novel disease control strategies, including additional prevention measures for contacts. In addition to the necessary improvements needed at the clinical health system level, addressing social vulnerability and enhancing individual mental wellbeing are urgent priorities. This could be achieved through initiatives such as offering counseling and establishing peer-support groups.