{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,25]],"date-time":"2026-04-25T18:26:33Z","timestamp":1777141593244,"version":"3.51.4"},"reference-count":30,"publisher":"BMJ","issue":"6","license":[{"start":{"date-parts":[[2023,6,29]],"date-time":"2023-06-29T00:00:00Z","timestamp":1687996800000},"content-version":"unspecified","delay-in-days":28,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/100017714","name":"Turing Foundation","doi-asserted-by":"publisher","award":["N\/A"],"award-info":[{"award-number":["N\/A"]}],"id":[{"id":"10.13039\/100017714","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Pacific Leprosy Foundation","award":["N\/A"],"award-info":[{"award-number":["N\/A"]}]},{"DOI":"10.13039\/501100021734","name":"Leprosy Research Initiative","doi-asserted-by":"publisher","award":["FP_22\\21"],"award-info":[{"award-number":["FP_22\\21"]}],"id":[{"id":"10.13039\/501100021734","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2023,6,16]]},"published-print":{"date-parts":[[2023,6]]},"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Progress towards leprosy elimination is threatened by increasing incidence in \u2018hot-spot\u2019 areas where more effective control strategies are urgently required. In these areas, active case finding and leprosy prevention limited to known contacts is insufficient for control. Population-wide active case-finding together with universal prevention through mass drug administration (MDA) has been shown to be effective in \u2018hot-spot\u2019 areas, but is logistically challenging and expensive. Combining leprosy screening and MDA with other population-wide screening activities such as for tuberculosis may increase programme efficiency. There has been limited evaluation of the feasibility and effectiveness of combined screening and MDA interventions. The COMBINE study aims to bridge this knowledge gap.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and analysis<\/jats:title>\n                    <jats:p>This implementation study will assess the feasibility and effectiveness of active leprosy case-finding and treatment, combined with MDA using either single-dose rifampicin or rifamycin-containing tuberculosis preventive or curative treatment, for reducing leprosy incidence in Kiribati. The leprosy programme will run over 2022\u20132025 in concert with population-wide tuberculosis screening-and-treatment in South Tarawa. The primary research question is to what extent the intervention reduces the annual leprosy new case detection rate (NCDR) in adults and children compared with routine screening and postexposure prophylaxis (PEP) among close contacts (baseline leprosy control activities). Comparisons will be made with (1) the preintervention NCDR separably among adults and children in South Tarawa (before\u2013after study) and (2) the corresponding NCDRs in the rest of the country. Additionally, the postintervention prevalence of leprosy obtained from a survey of a \u2018hot-spot\u2019 sub-population will be compared with prevalence documented during the intervention. The intervention will be implemented in collaboration with the Kiribati National Leprosy Programme.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Ethics and dissemination<\/jats:title>\n                    <jats:p>Approval has been obtained from the Kiribati Ministry of Health and Medical Services (MHMS), the University of Otago (H22\/111) and the University of Sydney (2021\/127) Human Research Ethics Committees. Findings will be shared with the MHMS, local communities and internationally through publication.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2022-065369","type":"journal-article","created":{"date-parts":[[2023,6,29]],"date-time":"2023-06-29T14:10:20Z","timestamp":1688047820000},"page":"e065369","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":6,"title":["Effectiveness of population-wide screening and mass drug administration for leprosy control in Kiribati: the COMBINE protocol"],"prefix":"10.1136","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4414-5645","authenticated-orcid":false,"given":"Mikaela","family":"Coleman","sequence":"first","affiliation":[{"name":"Sydney Infectious Diseases Institute (Sydney ID), The University of Sydney, Sydney, New South Wales, Australia"},{"name":"Tuberculosis Research Program, The Centenary Institute at the University of Sydney, Sydney, New South Wales, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3749-6519","authenticated-orcid":false,"given":"Jeremy","family":"Hill","sequence":"additional","affiliation":[{"name":"Sydney Infectious Diseases Institute (Sydney ID), The University of Sydney, Sydney, New South Wales, Australia"},{"name":"Tuberculosis Research Program, The Centenary Institute at the University of Sydney, Sydney, New South Wales, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Eretii","family":"Timeon","sequence":"additional","affiliation":[{"name":"Government of the Republic of Kiribati Ministry of Health and Medical Services, Tarawa, Kiribati"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Erei","family":"Rimon","sequence":"additional","affiliation":[{"name":"Government of the Republic of Kiribati Ministry of Health and Medical Services, Tarawa, Kiribati"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Temea","family":"Bauro","sequence":"additional","affiliation":[{"name":"Government of the Republic of Kiribati Ministry of Health and Medical Services, Tarawa, Kiribati"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nabura","family":"Ioteba","sequence":"additional","affiliation":[{"name":"Pasifika Futures Ltd, Christchurch, New Zealand"},{"name":"Pacific Leprosy Foundation, Christchurch, New Zealand"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Arturo","family":"Cunanan","sequence":"additional","affiliation":[{"name":"Pacific Leprosy Foundation, Christchurch, New Zealand"},{"name":"Department of Health, Culion Sanatorium and General Hospital, Culion, Philippines"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7214-4244","authenticated-orcid":false,"given":"Nicholas M","family":"Douglas","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases, Christchurch Hospital, Christchurch, New Zealand"},{"name":"Department of Medicine, University of Otago, Christchurch, New Zealand"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tauhid","family":"Islam","sequence":"additional","affiliation":[{"name":"Division of Programmes for Disease Control, Manila, Philippines"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jill","family":"Tomlinson","sequence":"additional","affiliation":[{"name":"Pacific Leprosy Foundation, Christchurch, New Zealand"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Patrick O","family":"Campbell","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases, Christchurch Hospital, Christchurch, New Zealand"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5080-4435","authenticated-orcid":false,"given":"Jonathan","family":"Williman","sequence":"additional","affiliation":[{"name":"Biostatistics and Computation Biology Unit, University of Otago, Christchurch, New Zealand"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Patricia","family":"Priest","sequence":"additional","affiliation":[{"name":"University of Otago, Dunedin, New Zealand"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3404-2690","authenticated-orcid":false,"given":"Ben J","family":"Marais","sequence":"additional","affiliation":[{"name":"Sydney Infectious Diseases Institute (Sydney ID), The University of Sydney, Sydney, New South Wales, Australia"},{"name":"Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Warwick J","family":"Britton","sequence":"additional","affiliation":[{"name":"Tuberculosis Research Program, The Centenary Institute at the University of Sydney, Sydney, New South Wales, Australia"},{"name":"Department of Clinical Immunology, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Stephen T","family":"Chambers","sequence":"additional","affiliation":[{"name":"Pacific Leprosy Foundation, Christchurch, New Zealand"},{"name":"Department of Pathology and Biomedical Science, University of Otago, Christchurch, New Zealand"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2023,6,29]]},"reference":[{"key":"2025121223375813000_13.6.e065369.1","unstructured":"World Health Assembly . 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