India is in the last mile to sustainably eliminate visceral leishmaniasis, also known as kala-azar. Cases have plummeted 98% in the past 14 years. 44,533 people were diagnosed with visceral leishmaniasis in 2007, but in 2022, only 834 cases were reported. This dramatic reduction is largely the result of a national programme to control the disease that began in the early 90s. The programme has constantly pushed the adoption of shorter, safer treatments, such as single-dose liposomal amphotericin B, introduced into the country by DNDi in 2014.
Although India is on the cusp of wiping out the deadly parasitic disease for good, new cases continue to emerge – and these are the hardest to eliminate. In 2019, an independent World Health Organization (WHO) mission identified gaps in the country’s elimination programme and gave recommendations to remedy these, including strengthening testing and treatment facilities at medical colleges as well as district and sub-divisional hospitals.
To give effect to these recommendations, DNDi partnered with the National Centre for Vector Borne Disease Control, the Bihar Health Department, and the Rajendra Memorial Research Institute of Medical Sciences (RMRIMS) in Patna to establish Centres of Excellence in Bihar’s Saran (Chapra) and Purnea districts in January 2023 and August 2023 respectively. Made possible with funding from Takeda Pharmaceutical Company Limited’s Global CSR Program, the Centres of Excellence have been created by refurbishing the laboratories and leishmaniasis wards in these hospitals.
Providing diagnosis, treatment, and acting as focal points for managing complicated visceral leishmaniasis cases – such as post-kala-azar dermal leishmaniasis (PKDL), visceral leishmaniasis relapse, and HIV-VL – the Centres of Excellence bring cutting-edge medical advances closer to the homes of people most at risk. ‘Earlier, all patients had to go to Patna, but now patients from Saran and Purnea districts can be diagnosed and treated at the Centres of Excellence at their respective district hospitals,’ says Dr Krishna Pandey, Director of RMRIMS. ‘This is excellent news for patients.’
Manoj Kumar, Deputy Superintendent, Sub-Divisional Hospital, Dhamdaha, Purnea notes that DNDi’s leadership and guidance have been invaluable in completing this ambitious project. ‘Top-notch diagnostic facilities in the Centres of Excellence labs are critical for elimination because we can’t treat patients if we can’t diagnose them,’ he says. This is especially true of PKDL, which complicates elimination of visceral leishmaniasis. PKDL can present years after visceral leishmaniasis has been cured, with the skin lesions acting as a reservoir of disease that can then be transmitted by sandflies.
Importantly, the Centres of Excellence also preserve and advance knowledge and skills in the diagnosis and treatment of leishmaniasis. Dr Rajesh Pandey, State Coordinator for Neglected Tropical Diseases with WHO, says this is vital to sustaining the elimination of visceral leishmaniasis. ‘When the prevalence of the disease slowly comes down, our skilled doctors, nurses, and field-level staff will rarely see the cases and their complications. The Centres of Excellence will help retain the expertise and technical knowledge among our health staff.’
Built as part of a pilot phase, the Centres of Excellence will be assessed for their impact later in 2023. Based on this learning, new Centres of Excellence will be established in Nepal and Bangladesh to further support sustainable elimination in the region. Learnings and recommendations from the impact assessment will also be available to policymakers and stakeholders to inform the establishment of similar centres in visceral leishmaniasis endemic regions around the world.
Photo credit: Ranjan Rahi