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The clinical management of visceral leishmaniasis in India

Boek - Dissertatie

Leishmaniasis is a neglected tropical disease that affects over 1 million people worldwide. In India, it remains one of the major neglected conditions, affecting the poorest and most vulnerable in society, and has been marked for elimination as a public health problem. One of the pillars of the elimination strategy is the use of effective treatment for patients.

The first chapter is a comprehensive literature review covering the last 10 years of evidence covering all aspects of leishmaniasis worldwide, with a focus on the clinical management. Major advances, as well as remaining lacunae are identified for both cutaneous and visceral forms of the disease.

The second chapter focuses on the use of liposomal amphotericin B (LAMB) as a treatment for visceral leishmaniasis in Bihar, the most endemic state in India. It analyses the characteristics and outcomes of 8749 patients treated under programme conditions with 20mg/kg LAMB, including the use of the regimen at PHC level through task shifting. It then describes the risk factors for relapse and also the characteristics of post-kala azar dermal leishmaniasis (PKDL) following treatment.

The third chapter examines a much under-stated aspect of treatment related studies – how patients perceive the treatments that they are receiving. It describes a qualitative study on cohorts of patients whom have received different regimens of treatment to determine the psychosocial determinants and perceptions of treatment, and how policy makers should consider these drivers when making rational treatment policy guidelines.

The fourth chapter focuses on an area that was previously considered to be an issue confined to East Africa – VL in patients co-infected with HIV. It describes the prevalence of co-infection in a cross-sectional cohort study of 2077 patients presenting with VL, and then treatment outcomes using two different treatment regimens. It then describes through a qualitative study the quality of life perceptions in patients with VL-HIV co-infection, and suggest how their experiences and perceptions can be leveraged by policy makers to improve quality, access and standards of care.

The final section of the thesis describes emerging issues in India and the sub-continent related to increasing knowledge and experience of immunosuppression in leishmaniasis.
Jaar van publicatie:2019