Ongoing Projects

This project seeks to ascertain the feasibility, acceptability and effectiveness of combining both mental health and self-care interventions in an integrated approach to improve quality of life, social inclusion and reduce disability and average cost of healthcare by families affected by leprosy, BU and LF. Additionally, the project seeks to explore sustainable approaches to improve quality of care. The approaches include:

1. Identification, capacity building and engagement of eligible NTD Champions. These are persons affected by NTDs who are willing and able to share their lived experience on volunteer basis to serve as skilled local trainers and project team leaders.
2. Use of integrated self-help groups (SHGs) of persons affected by leprosy, LF and BU to provide peer counselling, mental health and self-care. The project seeks to explore the effectiveness of the integrated approach and compare the outcomes of mental health and self- care practices between SHGs of persons affected groups facilitated by NTD Champions and those facilitated by HCWs.

This study seeks to improve self-care in the community for Leprosy patients who are at risk of recurring ulceration based on the 'implementation science' approach, and to develop new and improved methods of clinical care for both Leprosy and BU patients when they are in hospital. The project is designed to create an international Community of Practice involving researchers, community and public contributors, clinicians and policy makers.

This research involves:

• WP1: INSTIL: This study aims to improve self-care in the Community for patients who are at risk of recurring leprosy ulcers.
• WP2: HABU: This study has 2 components (Retrospective and Prospective). This project assesses the health needs of Buruli Ulcer patients
• WP3: Feasibility Studies: There are also 2 components here:
  1. Feasibility Study 1: SUSTAIN: This evaluates the continuity of donor funded self- help groups
  2. Feasibility Study 2: Scoping review of the role of traditional healers in the management of Leprosy and Buruli ulcers

Integrated service delivery (ISD) is imperative because fragmented delivery of single-disease services is not cost-efficient. With dwindling financial resources and associated poor health funding, fragmented services delivery is no longer sustainable. Nigeria’s fragile health system requires a service delivery model that will improve access, equity and patient outcomes. Overdependence on the few and inequitably distributed MH experts, and the huge MH treatment gap of >80% all point to the need for ISD that expands equitable access to quality care, including the poorest and marginalized population groups.

Overall goal of the project is to expand coverage and access to person-centered, quality comprehensive Tuberculosis, Common Mental Disorders (CMD) and Substance Use Disorders (SD)care through an innovative integrated Services Delivery model in three states (Anambra, Enugu and Nasarawa) in Southeastern and Northcentral Nigeria. The project’s interventions for TB, CMD (especially Depression) and SD integrated services delivery, ISD, will be achieved through strengthening of the following Health System Strengthening building blocks:

1. Strengthening Leadership, Governance, & Accountability for equitable health care
2. Capacity building for health workforce
3. Strengthening patient-centered service delivery
4. Enhancing the health information system for multiple disease management
5. Improving access to essential medicines for CMD & SD.
6. Engagement of the community

The project targets a 20% increase in TB cases diagnosed in the intervention LGAs, 25% of TB cases with CMD identified and managed and 10% of TB cases with SD identified and managed

Integrated service delivery of the 3 health conditions, has the potential to mutually contribute to improving case detection, management and treatment outcomes for all 3 conditions. Furthermore, it will considerably reduce diagnostic delay as well as eliminate hindrances to access posed by program fragmentation, maximize utilization of human and material resources, and significantly improve access to services, thereby broadening coverage for the target populations.

This study seeks to assess the burden of mental disorders among persons affected by leprosy or BU in southern Nigeria and determine the effect of community-oriented, holistic approach on reducing burden of mental disorders on the persons affected by leprosy/BU. The study is a cluster randomized trial in 10 local government areas (LGAs) with the highest number of notified leprosy or BU cases in southern Nigeria (2014-2018). Before and after the intervention, burden of mental disorders among persons affected by leprosy or Buruli ulcer will be assessed using identical tools. Appropriate intervention will be designed to reduce the mental disorders through advocacy, training (for community opinion leaders and healthcare workers) and formation of self-help groups among patients.

The current study will use a mixed-methods exploratory study design, comprising:

1. Baseline assessments of KAP and fears of community members in order to develop the audio- delivered content and written material.
2. Baseline assessment of self-esteem and internalized stigma of persons affected by leprosy.
3. Participatory development of the audio-delivered content and written material by persons affected by leprosy.
4. Pilot and implementation of the interventions in Nigeria. This will be done among different groups who will be compared. Groups will be selected by cluster randomization.
5. Evaluation of the interventions and the impact of developing the intervention on persons affected, using the same methods as the baseline study.

Neglected tropical Diseases (NTDs) and TB continue to be diseases of public health importance in Nigeria. While progress has been made in their control, many problems still persist. These require the use of innovative strategies to surmount the dwindling resources available for control activities. This project seeks to provide comprehensive support in an integrated manner for control of skin NTDs (especially leprosy and BU) using innovative and cost-effective strategies. The project seeks to continue bridging gaps in in the country's TB response as well as providing general programmatic support to the national programmes (NTBLCP and NTD).

Governments need support and technical advice on how to best integrate SDR-PEP administration into their existing national leprosy control programmes. The implementation has to be carefully planned and designed to ensure quality and sustainability.

1. Optimize time to enrolment by expanding GxAlert notification to include TBls and patients.
2. Leveraging existing GFCBOs to improve patient tracking.
3. Improving counselling of patient and HWs.
4. Decentralize baseline investigations to LGA level by supporting the NTP to engage more pre- qualified labs, and TBls to collect and transport samples.
5. Providing transport support to patient for baseline investigations.
6. Employing mobile connectivity solution to improve TAT of baseline investigations.
7. Verifying reported pretreatment deaths using verbal autopsy and
8. Decentralized treatment initiate by empowering TBls and HWs to initiate treatment. Furthermore, the project will conduct an operational research to investigate reasons for treatment refusal by DRTB patient in Nigeria.