{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,3]],"date-time":"2026-10-03T04:58:12Z","timestamp":1791003492815,"version":"4.1.0"},"reference-count":15,"publisher":"Public Library of Science (PLoS)","issue":"4","license":[{"start":{"date-parts":[[2026,4,21]],"date-time":"2026-04-21T00:00:00Z","timestamp":1776729600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100004916","name":"Funda\u00c3\u00a7\u00c3\u00a3o de Amparo \u00c3\u00a0 Pesquisa do Estado do Amazonas","doi-asserted-by":"publisher","award":["grant #010\/2023"],"award-info":[{"award-number":["grant #010\/2023"]}],"id":[{"id":"10.13039\/501100004916","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100004916","name":"Funda\u00c3\u00a7\u00c3\u00a3o de Amparo \u00c3\u00a0 Pesquisa do Estado do Amazonas","doi-asserted-by":"publisher","award":["grant #010\/2023"],"award-info":[{"award-number":["grant #010\/2023"]}],"id":[{"id":"10.13039\/501100004916","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosntds.org"],"crossmark-restriction":false},"short-container-title":["PLoS Negl Trop Dis"],"abstract":"<jats:p>\n                    Brazil has the second-highest leprosy burden worldwide, with approximately 20,000 new cases reported annually, many diagnosed with advanced disease and disability. To support earlier detection, the Ministry of Health recently approved the ML Flow rapid test for contact evaluation. ML Flow detects immunoglobulin M antibodies against phenolic glycolipid-I of\n                    <jats:italic>Mycobacterium leprae<\/jats:italic>\n                    , can be performed at the point of care using finger-prick blood, and yields results within minutes. ML Flow offers important operational advantages. It enables same-visit counseling and may support risk-stratified household-contact follow-up. However, its value is context-dependent. Because anti-phenolic glycolipid-I immunoglobulin M responses correlate with bacillary burden, positivity is more frequent in multibacillary disease, whereas many paucibacillary and pure neural cases have absent or low antibody levels. A seronegative result therefore does not exclude disease. Among asymptomatic contacts, seropositivity varies widely across studies, and in previously treated individuals antibodies may remain detectable for years. Available evidence suggests that seropositive contacts are at increased risk of incident leprosy, although predictive performance varies across settings. Serology alone is not diagnostic, and misuse may lead to stigma, anxiety, unnecessary referrals, and diversion of resources. The contribution of ML Flow is therefore implementation-dependent. In settings with standardized counseling, scheduled re-examination, and reliable referral pathways, it may support risk-stratified follow-up. In settings where these elements are weak, benefits may be limited. Brazil offers an important programmatic setting in which to evaluate this strategy, but only with safeguards: integration with dermato-neurological examination, clear protocols stating that seropositivity is not diagnostic, structured follow-up pathways, quality-controlled training, and systematic recording in the Brazilian Unified Health System information systems. Under these conditions, ML Flow may contribute to earlier diagnosis and disability reduction; without them, it risks adding workload without improving care.\n                  <\/jats:p>","DOI":"10.1371\/journal.pntd.0014238","type":"journal-article","created":{"date-parts":[[2026,4,21]],"date-time":"2026-04-21T17:42:56Z","timestamp":1776793376000},"page":"e0014238","update-policy":"https:\/\/doi.org\/10.1371\/journal.pntd.corrections_policy","source":"Crossref","is-referenced-by-count":2,"title":["Implementation of ML Flow for leprosy contacts in Brazil: Opportunities, pitfalls, and safeguards"],"prefix":"10.1371","volume":"20","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2283-069X","authenticated-orcid":true,"given":"Carolina","family":"Talhari","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cla\u00fadia dos Passos","family":"Farias","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Helio Amante","family":"Miot","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sinesio","family":"Talhari","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2026,4,21]]},"reference":[{"key":"pntd.0014238.ref001","unstructured":"Brasil. Minist\u00e9rio da Sa\u00fade. Secretaria de Vigil\u00e2ncia em Sa\u00fade e Ambiente. Departamento de HIV, Aids, Tuberculose, Hepatites Virais e Infec\u00e7\u00f5es Sexualmente Transmiss\u00edveis. Boletim epidemiol\u00f3gico: Hansen\u00edase \u2013 n\u00famero especial, janeiro 2025. Bras\u00edlia: Minist\u00e9rio da Sa\u00fade; 2025. Available from: https:\/\/www.gov.br\/saude\/pt-br\/centrais-de-conteudo\/publicacoes\/boletins\/epidemiologicos\/especiais\/2025\/boletim-epidemiologico-de-hanseniase-numero-especial-jan-2025.pdf"},{"issue":"8","key":"pntd.0014238.ref002","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pntd.0009651","article-title":"Individual and community factors determining delayed leprosy case detection: a systematic review","volume":"15","author":"Y Dharmawan","year":"2021","journal-title":"PLoS Negl Trop Dis"},{"issue":"6","key":"pntd.0014238.ref003","doi-asserted-by":"crossref","first-page":"640","DOI":"10.1001\/jamadermatol.2020.0653","article-title":"Incidence of and factors associated with leprosy among household contacts of patients with leprosy in Brazil","volume":"156","author":"CSS Teixeira","year":"2020","journal-title":"JAMA Dermatol"},{"key":"pntd.0014238.ref004","unstructured":"Minist\u00e9rio da Sa\u00fade. Diretrizes para vigil\u00e2ncia, aten\u00e7\u00e3o e controle da hansen\u00edase. Protocolo cl\u00ednico e diretrizes terap\u00eauticas da hansen\u00edase. Bras\u00edlia: Minist\u00e9rio da Sa\u00fade. 2022. Available from: https:\/\/www.gov.br\/conitec\/pt-br\/midias\/protocolos\/publicacoes_ms\/copy_of_20230131_PCDT_Hanseniase_2022_eletronica_ISBN.pdf"},{"key":"pntd.0014238.ref005","unstructured":"Brasil, Minist\u00e9rio da, Sa\u00fade, Secretaria de V em S. Orienta\u00e7\u00f5es sobre o fornecimento e uso do teste r\u00e1pido imunocromatogr\u00e1fico para determina\u00e7\u00e3o qualitativa de anticorpos IgM anti-Mycobacterium leprae para avalia\u00e7\u00e3o de contatos de hansen\u00edase na Aten\u00e7\u00e3o Prim\u00e1ria \u00e0 Sa\u00fade. Bras\u00edlia, DF: Minist\u00e9rio da Sa\u00fade. 2023. Available from: https:\/\/www.gov.br\/saude\/pt-br\/centrais-de-conteudo\/publicacoes\/notas-tecnicas\/2023\/nota-tecnica-no-3-2023-cgde-dedt-svsa-ms\/view"},{"issue":"1","key":"pntd.0014238.ref006","doi-asserted-by":"crossref","first-page":"8868","DOI":"10.1038\/s41598-017-07803-7","article-title":"Field-friendly serological tests for determination of M. leprae-specific antibodies","volume":"7","author":"A van Hooij","year":"2017","journal-title":"Sci Rep"},{"issue":"4","key":"pntd.0014238.ref007","doi-asserted-by":"crossref","first-page":"985","DOI":"10.1007\/s10096-025-05071-2","article-title":"A Multicenter evaluation of leprosy rapid test Fast ML Flow Hansen\u00edase in Brazil","volume":"44","author":"DP Saavedra","year":"2025","journal-title":"Eur J Clin Microbiol Infect Dis"},{"issue":"1","key":"pntd.0014238.ref008","doi-asserted-by":"crossref","first-page":"88","DOI":"10.1186\/s40249-024-01262-9","article-title":"Rapid test for Mycobacterium leprae infection: a practical tool for leprosy","volume":"13","author":"L Pierneef","year":"2024","journal-title":"Infect Dis Poverty"},{"issue":"4","key":"pntd.0014238.ref009","doi-asserted-by":"crossref","first-page":"288","DOI":"10.2471\/BLT.23.290881","article-title":"Target product profiles: leprosy diagnostics","volume":"102","author":"P Kukkaro","year":"2024","journal-title":"Bull World Health Organ"},{"issue":"1","key":"pntd.0014238.ref010","doi-asserted-by":"crossref","first-page":"22","DOI":"10.1186\/s12879-018-3653-0","article-title":"Performance of serological tests PGL1 and NDO-LID in the diagnosis of leprosy in a reference Center in Brazil","volume":"19","author":"AL Leturiondo","year":"2019","journal-title":"BMC Infect Dis"},{"key":"pntd.0014238.ref011","doi-asserted-by":"crossref","first-page":"124","DOI":"10.1590\/S0074-02762012000900019","article-title":"Comparison of two rapid tests for anti-phenolic glycolipid-I serology in Brazil and Nepal","author":"A Stefani MM de","year":"2012","journal-title":"Mem Inst Oswaldo Cruz"},{"issue":"5","key":"pntd.0014238.ref012","article-title":"Anti-PGL-1 positivity as a risk marker for the development of leprosy among contacts of leprosy cases: systematic review and meta-analysis","volume":"10","author":"MLF Penna","year":"2016","journal-title":"PLoS Negl Trop Dis"},{"issue":"12","key":"pntd.0014238.ref013","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pntd.0006083","article-title":"Longitudinal assessment of anti-PGL-I serology in contacts of leprosy patients in Bangladesh","volume":"11","author":"RA Richardus","year":"2017","journal-title":"PLoS Negl Trop Dis"},{"issue":"6","key":"pntd.0014238.ref014","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0264100","article-title":"Reaching those at risk: Active case detection of leprosy and contact tracing at Kokosa, a hot spot district in Ethiopia","volume":"18","author":"T Lema","year":"2023","journal-title":"PLoS One"},{"key":"pntd.0014238.ref015","doi-asserted-by":"crossref","first-page":"219","DOI":"10.1186\/s12879-015-0955-3","article-title":"Factors associated with anti-phenolic glycolipid-I seropositivity among the household contacts of leprosy cases","volume":"15","author":"APM Carvalho","year":"2015","journal-title":"BMC Infect Dis"}],"container-title":["PLOS Neglected Tropical Diseases"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pntd.0014238","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,21]],"date-time":"2026-04-21T17:43:00Z","timestamp":1776793380000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pntd.0014238"}},"subtitle":[],"editor":[{"given":"Anil","family":"Fastenau","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2026,4,21]]},"references-count":15,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2026,4,21]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pntd.0014238","relation":{},"ISSN":["1935-2735"],"issn-type":[{"value":"1935-2735","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,4,21]]}}}