{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,3]],"date-time":"2026-08-03T17:53:37Z","timestamp":1785779617070,"version":"3.56.0"},"reference-count":38,"publisher":"Wiley","issue":"8","license":[{"start":{"date-parts":[[2026,4,25]],"date-time":"2026-04-25T00:00:00Z","timestamp":1777075200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2026,4,25]],"date-time":"2026-04-25T00:00:00Z","timestamp":1777075200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/501100001505","name":"Health Research Council of New Zealand","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100001505","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Tropical Med Int Health"],"published-print":{"date-parts":[[2026,8]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>\n                      Kiribati has one of the highest rates of leprosy worldwide. A nationwide screening and chemoprophylaxis program for household leprosy contacts was introduced in 2018. In 2022, population\u2010wide screening and rifamycin\u2010based treatment or chemoprophylaxis for leprosy and tuberculosis was introduced as part of the PEARL and COMBINE studies. Largescale rifamycin use theoretically risks selection of resistant\n                      <jats:styled-content style=\"fixed-case\">\n                        <jats:italic>Mycobacterium leprae<\/jats:italic>\n                      <\/jats:styled-content>\n                      strains. This study aimed to elucidate the baseline antimicrobial resistance (AMR) profile of\n                      <jats:styled-content style=\"fixed-case\">\n                        <jats:italic>M. leprae<\/jats:italic>\n                      <\/jats:styled-content>\n                      isolates in Kiribati using a novel molecular method.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      <jats:styled-content style=\"fixed-case\">\n                        <jats:italic>Mycobacterium leprae<\/jats:italic>\n                      <\/jats:styled-content>\n                      genomes from skin biopsies of patients clinically diagnosed with leprosy in Kiribati between 2017 and 2024 were analysed. We used an\n                      <jats:styled-content style=\"fixed-case\">\n                        <jats:italic>M. leprae<\/jats:italic>\n                      <\/jats:styled-content>\n                      specific repetitive element (RLEP) PCR to confirm the presence of\n                      <jats:styled-content style=\"fixed-case\">\n                        <jats:italic>M. leprae<\/jats:italic>\n                      <\/jats:styled-content>\n                      DNA. Samples with sufficient DNA (cycle threshold (CT) value &lt;\u200930) proceeded for resistance testing. A combination of nested and heminested PCR assays was used to amplify the drug resistance determining regions (DRDR's) for dapsone (\n                      <jats:italic>folP1<\/jats:italic>\n                      ), rifampicin (\n                      <jats:italic>rpoB<\/jats:italic>\n                      ) and fluoroquinolones (\n                      <jats:italic>gyrA<\/jats:italic>\n                      ) followed by DNA Sanger sequencing.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      216 skin biopsies (multibacillary [MB],\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u2009155, paucibacillary [PB],\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200961) underwent confirmatory testing. 192\/216 (89%) samples were PCR positive (median Ct value 24.5 [range 12.0\u201344.4]), including 145\u2009MB cases (median CT 21.1 [range 12.0\u201342.0]) and 47\u2009PB cases (median CT 34.0 [range 14.8\u201337.0]). Twenty\u2010four (11%) samples were PCR negative and 21 of these underwent histopathological testing, with 12 (57%) showing changes consistent with leprosy. 116 (60%) positive samples proceeded to AMR testing (MB,\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u2009106; PB,\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200910). In 10 cases (9%), dapsone resistance\u2010conferring mutations were identified in the\n                      <jats:italic>folP1<\/jats:italic>\n                      region. No mutations were identified in the\n                      <jats:italic>rpoB<\/jats:italic>\n                      or\n                      <jats:italic>gyrA<\/jats:italic>\n                      genes.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>\n                      Molecular analysis of skin biopsies revealed moderate\u2010level dapsone resistance but no rifampicin resistance in Kiribati. Establishing this baseline AMR profile will enable a before\u2010versus\u2010after intervention analysis of antimicrobial resistance in\n                      <jats:styled-content style=\"fixed-case\">\n                        <jats:italic>M. leprae<\/jats:italic>\n                      <\/jats:styled-content>\n                      isolates in Kiribati.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/tmi.70146","type":"journal-article","created":{"date-parts":[[2026,4,25]],"date-time":"2026-04-25T07:40:11Z","timestamp":1777102811000},"page":"1035-1042","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Assessment of Antimicrobial Resistance in\n                    <i>M. leprae<\/i>\n                    Strains From Kiribati"],"prefix":"10.1111","volume":"31","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8031-9852","authenticated-orcid":false,"given":"Patrick O.","family":"Campbell","sequence":"first","affiliation":[{"name":"Department of Pathology and Molecular Medicine University of Otago  Christchurch New Zealand"},{"name":"Department or Infectious Diseases, Christchurch Hospital Te Whatu Ora Waitaha  Christchurch New Zealand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Temea","family":"Bauro","sequence":"additional","affiliation":[{"name":"Government of the Republic of Kiribati Ministry of Health and Medical Services  Tarawa Kiribati"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Erei","family":"Rimon","sequence":"additional","affiliation":[{"name":"Government of the Republic of Kiribati Ministry of Health and Medical Services  Tarawa Kiribati"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nabura","family":"Ioteba","sequence":"additional","affiliation":[{"name":"Pacific Leprosy Foundation  Christchurch New Zealand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Trevor","family":"Anderson","sequence":"additional","affiliation":[{"name":"Canterbury Health Laboratories  Christchurch New Zealand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arturo","family":"Cunanan","sequence":"additional","affiliation":[{"name":"Department of Health Culion Sanatorium and General Hospital  Culion Philippines"},{"name":"Division of Programmes for Disease Control  Manila Philippines"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Taulanga","family":"Naniseni","sequence":"additional","affiliation":[{"name":"Government of the Republic of Kiribati Ministry of Health and Medical Services  Tarawa Kiribati"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jacqui","family":"Gardner","sequence":"additional","affiliation":[{"name":"Department of Pathology, Christchurch Hospital Te Whatu Ora Waitaha  Christchurch New Zealand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emma","family":"Trowbridge","sequence":"additional","affiliation":[{"name":"Mohs and Skin Cancer Specialists  Christchurch New Zealand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7214-4244","authenticated-orcid":false,"given":"Nicholas M.","family":"Douglas","sequence":"additional","affiliation":[{"name":"Department or Infectious Diseases, Christchurch Hospital Te Whatu Ora Waitaha  Christchurch New Zealand"},{"name":"Department of Medicine University of Otago  Christchurch New Zealand"},{"name":"Division of Global and Tropical Health, Menzies School of Health Research Charles Darwin University  Darwin Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0698-3285","authenticated-orcid":false,"given":"Stephen T.","family":"Chambers","sequence":"additional","affiliation":[{"name":"Department of Pathology and Molecular Medicine University of Otago  Christchurch New Zealand"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,4,25]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jgar.2022.08.021"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.3390\/ijms232012443"},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.cmi.2018.02.022"},{"key":"e_1_2_9_5_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pntd.0000328"},{"key":"e_1_2_9_6_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pntd.0002655"},{"key":"e_1_2_9_7_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pntd.0009924"},{"key":"e_1_2_9_8_1","doi-asserted-by":"publisher","DOI":"10.1128\/JCM.01924-17"},{"key":"e_1_2_9_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/S2666-5247(22)00117-3"},{"key":"e_1_2_9_10_1","volume-title":"Global Leprosy (Hansen Disease) Update, 2023: Elimiation of Leprosy Disease Is Possible\u2014Time to Act! 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