By Mary Hearty

The Drugs for Neglected Diseases initiative (DNDi) and its partners have launched a three-year project known as LeishAccess that seeks to promote access to treatments for leishmaniasis patients.

The project was launched at a community clinical trial results dissemination meeting in Kacheliba, West Pokot, Northwestern Kenya.

“This project will transform the lives of people with leishmaniasis. LeishAccess will address the access challenges which are inhibiting progress towards the elimination of this deeply neglected and deadly disease,” Dr Fabiana Alves, Director of Neglected Tropical Diseases – Leishmaniasis and Mycetoma at DNDi said in a statement.

LeishAccess seeks to increase the use of optimal diagnostics and treatment combinations to treat visceral leishmaniasis (VL), VL/HIV co-infection, and post-kala-azar dermal leishmaniasis (PKDL), a common complication that appears after visceral leishmaniasis treatment.

The project will also improve access to the treatment of uncomplicated cutaneous leishmaniasis cases with local thermotherapy and conduct operational research to improve access to VL diagnosis and treatment.

“The project aims to strengthen access to care, contributing to the global NTD Roadmap target for the control and elimination of visceral leishmaniasis and control of cutaneous leishmaniasis as a public health problem by 2030 across Eastern Africa,” Rebecca Coulborn, Epidemiologist at Epicentre/Médecins Sans Frontières, which is part of the LeishAccess project said.

Leishmaniasis is the largest parasitic killers after malaria. There are three main forms of leishmaniases: visceral (also known as kala-azar), cutaneous (the most common), and mucocutaneous.

The visceral form is the most severe and is fatal if left untreated. There are 50,000 to 90,000 new visceral leishmaniasis cases annually, with the highest number of cases reported in Eastern African countries: Eritrea, Ethiopia, Kenya, Somalia, South Sudan, Sudan, and Uganda.

The disease mostly affects people in resource-limited settings, in arid and semi-arid areas. Half of them are children under 15. Leishmaniasis is also a climate-sensitive disease: rising temperatures could affect the pathogen-carrying vectors and worsen its impact.

Since 2003, DNDi has mobilized its partners to find new treatments for leishmaniasis. In Eastern Africa, research conducted by DNDi and its partners has demonstrated the effectiveness of three combination treatments in treating the disease, including for visceral leishmaniasis patients living with HIV. Clinical trials for new, promising, all-oral treatments will begin in the coming months.

Despite progress made so far, an estimated 50% of patients still do not have access to appropriate diagnosis and treatment. A wide range of obstacles stands in the way to access: change of treatment guidelines usually takes a long time; medicines may be unaffordable for patients and health systems; production is usually insufficient and often depends on a single manufacturer; diagnosis and treatment may be unavailable where patients seek care, and at times clinicians may not be adequately trained in their use.

Other challenges also contribute to poor access, such as political instability; poor infrastructure in the visceral leishmaniasis treatment facilities; a disruptive supply chain and hyperinflation; insufficient financial resources for care-seeking (even if visceral leishmaniasis diagnostics and treatment are free, patients must pay other healthcare fees and associated costs related to the cascade of care); limited community awareness; and population movements such as nomadic practices, migratory work, conflict, and famine.

It is to respond to these challenges that DNDi initiated LeishAccess, which is implemented by a consortium of experts and key health institutions in collaboration with the Ministries of Health of Ethiopia, Kenya, South Sudan, Sudan and Uganda.

“This project is improving access to vital optimal and affordable treatments for leishmaniasis patients in Eastern Africa. Our first step is to develop, in collaboration with stakeholders, country-specific work plans that respond to the needs of the public health systems in Ethiopia, Kenya, Uganda, Sudan and South Sudan. Driving policy change is essential in ensuring patients quickly benefit from innovation from clinical research,” Simon Bolo, Head of Leishmaniasis Access, DNDi said.

This project is part of the EDCTP2 programme supported by the European Union (grant number RIA2020S-3301-LeishAccess).

Advocacy initiatives through community and stakeholder engagement for policy change are ongoing. The community dissemination meeting in Kacheliba is one such step taken to share the results of one of the new treatments that proved to be effective in treating visceral leishmaniasis.

The project will end in July 2024. Its objective is to achieve a 60% reduction in morbidity and mortality leishmaniasis cases by 2025.

Some of the key anticipated results will include a strengthened supply chain management of leishmaniasis drugs, improved disease surveillance and operational research, epidemic preparedness response, improved case management, policy advocacy and strengthened coordination, partnership, and resource mobilization.