Single dose treatment for visceral leishmaniasis can be effectively given in rural public hospitals
The visceral leishmaniasis (VL) elimination programme made another step forward with research published showing that a single dose treatment of liposomal amphotericin B can be effectively and safely provided in rural public hospitals. The medication had already been recommended by the World Health Organization, but it was unknown whether primary health-care facilities in the low- and middle-income countries where the disease is endemic could manage its rollout.
VL is potentially fatal, and causes substantial health problems in up to 400 000 people every year, most of whom live in the Indian subcontinent, where it is also known as “kala-azar”. The governments of Bangladesh, India and Nepal committed in 2005 to eliminate VL as a health problem by 2015.
Liposomal amphotericin B in a single, high dose proves very effective in clinical trials in specialized settings, but it requires a cold-chain to store and careful intravenous administration; the question was whether it would work also in peripheral settings in routine conditions. The study was done in a subdistrict hospital in rural Bangladesh where visceral leishmaniasis (VL) is most endemic. The researchers studied whether the facilities had the materials needed for preparing and administering the drug, as well as reliable electricity to keep the medication cool.
"The ideal drug to reduce disease burden and prevent relapse and post-kala-azar dermal leishmaniasis will need to be effective, cheap, usable at the peripheral level, and have a strong safety profile. Mondal and colleagues show for the first time that single-dose liposomal amphotericin B could meet all such expectations."
Prabhat Kumar Sinha, Rajendra Memorial Research Institute of Medical Sciences, IndiaSujit Bhattacharya, WHO South-East Asia regional office
Ninety-eight percent of the patients given the treatment achieved a final cure. As a result, the government of Bangladesh has already changed its health policy to recommend use of this treatment, which is given intravenously and provided at low cost by the pharmaceutical manufacturer.
The study was published in the Lancet Global Health, where Prabhat Kumar Sinha of the Rajendra Memorial Research Institute of Medical Sciences in India and Sujit Bhattacharya of the WHO South-East Asia regional office wrote in an accompanying commentary, “The ideal drug to reduce disease burden and prevent relapse and post-kala-azar dermal leishmaniasis will need to be effective, cheap, usable at the peripheral level, and have a strong safety profile. Mondal and colleagues show for the first time that single-dose liposomal amphotericin B could meet all such expectations.”
The study was coordinated by TDR, and managed by the International Centre for Diarrhoeal Disease Research in Bangladesh (icddr,b), with support from the Disease Control Unit of the Directorate General of Health Services, and the Government of Bangladesh. The study was funded by the World Health Organization’s Neglected Tropical Diseases department and the Agencia Española de Cooperación Internacional.