Leprosy and Buruli ulcer patients in low-income countries will test a community-led self-care programme designed to prevent recurring, disabling ulcers. The problem is not that self-care works—it does, much like for diabetic foot ulcers—but that people in poverty with weak health services struggle to sustain it. This project adapts a proven model: women’s groups that cut perinatal deaths in Asia and Africa will now support ulcer patients to care for their own feet and wounds. If the self-care intervention succeeds, it could slash the rate of recurrent ulcers without expensive medical equipment, keeping people mobile and out of hospital. Separately, the team will run the first efficacy trial of a cheap tissue-regenerating treatment for leprosy ulcers that do occur, and assess the neglected clinical needs of Buruli ulcer patients—a rare condition that often requires extensive surgery. The programme also builds a lasting research community across three countries, producing protocols for future trials. This is implementation science in a difficult context: the goal is not a new drug, but a scalable, locally adaptable system that makes existing knowledge work for the people who need it most.
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This application is directed towards leprosy ulcers and Buruli Ulcer (BU). Preventing the problem of recurrent leprosy ulcers. We tackle the problem of recurrent ulcers caused by repeated injury and progressive anatomical changes. As with diabetes, self-care can greatly reduce the rate of recurrence of ulcers. The problem is how to make self-care happen; how to support it in communities. This is an implementation science problem in a difficult context; that of poverty and underdeveloped services. However, self-care is not expensive and we will develop and evaluate a scalable intervention. The intervention will be based on a set of principles designed to encourage local adaptation and innovation; our model is women s groups that have been used successfully to reduce perinatal death in Asia and Africa. We shall evaluate this intervention by means of a step-wedge cluster trial across three countries. Promoting healing of leprosy ulcers. Even with good prevention ulcers will still occur and they take a long time to heal. While the clinical trajectory and quality of life of people with leprosy have been studied this is not the case for people with ulcers. We will therefore establish a cohort of participants with ulcers sufficiently severe to bring them to hospital. This cohort will serve as a sampling frame for trials of treatments to overcome the problem of slow ulcer healing. We will establish an efficacy trial of a promising yet inexpensive tissue regenerative treatment in a hospital which has experience of the method. At the same time we will identify and prioritise promising treatments to promote ulcer healing through an iterative process of literature review, modelling and consensus development. We will produce protocols for evaluation of these treatments and conduct feasibility studies as appropriate. These activities will form the basis for applications for follow-on grants thereby perpetuating the academic collaborations we shall foster. Improving care for Buruli Ulcer (BU). One of our centres for leprosy care is also a referral centre for the rare condition of BU. While the clinical sequelae of BU have been studied the clinical needs of patients have not been assessed. We shall fill this gap in the literature in order to generate affordable plans to better manage this condition in context where it occurs. Likewise large BU ulcers require extensive surgery. We shall therefore identify promising new treatments to promote healing of BU ulcers and to reduce the need for surgery. As with leprosy, we will conduct feasibility studies and prepare applications for external funding. Developing a community of research practice. We will deliver the implementation of the self-care support intervention and study priorities within 18 months. At completion we will deliver the evaluation of the support intervention, the costed health needs assessment and recommendations for BU, the efficacy trial and at least three protocols for external funding. Throughout this programme we will develop a community of scientific practice, including public and communities, to advise the programme, assimilate and disseminate its outputs and to engage in the production and delivery of follow-on studies.
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