Background & objectives: Detection and treatment of post-kala-azar dermal leishmaniasis (PKDL) cases is considered important for kala-azar elimination. The objective of our study was to find out the proportion of different forms of lesions, interruption of treatment and rate of treatment completion, cure rates of PKDL, risk factors for developing severe forms of PKDL and utilization of services offered by the kala-azar elimination program.
Methods: A cross-sectional survey of PKDL patients registered for treatment at all levels of care during 2015 and 2016 was done.
Results: 576 PKDL patients who had started treatment in 2015 and 2016 were studied. Three-fourths of all patients were found to be clinically cured after a year of follow-up. Around 90% lesions were of macular type. Interruption of treatment was observed in one-fourth of PKDL patients. Median duration between kala-azar treatment and development of PKDL was 4.5 years. Around 79% patients had past history of kala-azar treatment. Discontinuation of treatment during earlier kala-azar episode was significantly associated with the development of papular and nodular forms of lesion. 43% of patients had received the incentive of INR 2000 after completion of treatment. Around three-fourths women in the reproductive age group were found not to use any contraceptive method during PKDL treatment.
Interpretation & conclusion: PKDL treatment interruption should be reduced through ensuring drug supply and timely retrieval of patients. Directly observed treatment should be implemented and combination regimen should be explored to improve final cure rate. Delivery of financial incentive to PKDL patients and counselling and contraception to women of reproductive age group should be improved.

中文翻译：

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印度黑热病后皮肤利什曼病 (PKDL) 的临床流行病学变化：四个流行州的调查结果

背景和目标：黑热病后皮肤利什曼病 (PKDL) 病例的检测和治疗被认为对消除黑热病很重要。我们研究的目的是找出不同形式病变的比例、治疗中断和治疗完成率、PKDL 的治愈率、发展为严重形式的 PKDL 的危险因素以及消除黑热病提供的服务的利用情况。程序。
方法：对 2015 年和 2016 年在各级医疗机构登记接受治疗的 PKDL 患者进行了横断面调查。
结果：研究了 2015 年和 2016 年开始治疗的 576 名 PKDL 患者。经过一年的随访，四分之三的患者被发现临床治愈。约90%的病变为黄斑型。在四分之一的 PKDL 患者中观察到治疗中断。黑热病治疗和 PKDL 发展之间的中​​位持续时间为 4.5 年。大约 79% 的患者有黑热病治疗史。在早期黑热病发作期间停止治疗与丘疹和结节形式病变的发展显着相关。43% 的患者在完成治疗后获得了 2000 印度卢比的奖励。发现大约四分之三的育龄妇女在 PKDL 治疗期间未使用任何避孕方法。
解读与结论：应通过确保药物供应和及时接回患者来减少 PKDL 治疗中断。应实施直接观察治疗，探索联合用药方案，以提高最终治愈率。应改进对 PKDL 患者的经济激励以及对育龄妇女的咨询和避孕。