Analysis of the abandonment of cutaneous leishmaniasis treatment in the southern Amazon region of Brazil

• DOI: 10.1016/j.ijid.2024.107486
• Publication Date: 2025-02-28T19:44:30Z
• Authors: Mrs Gabriella Fer...; Mr João Eduardo C...; Dr Amanda Gabriel...; Dr Letícia Silvei...; Dr Ludiele Souza ...; Dr João Gabriel Luz
• Keywords: Infectious and parasitic diseases; RC109-216

Introduction: Cutaneous leishmaniasis (CL) is a parasitic disease highly endemic in Brazil, especially in the Amazon region. Although CL is fully treatable within the Brazilian public health system, the therapeutic regimens present limitations that may hinder adherence, such as significant adverse effects, parenteral route of administration, and long duration. Despite these limitations, few studies have addressed treatment abandonment by CL patients. This study identified the magnitude of abandonment of CL treatment in the state of Mato Grosso, located in the southern Brazilian Amazon. We also described the spatial distribution of this event at the municipality level. Methods: Data on new confirmed cases of CL reported over 16 years (2007-2022) among residents of Mato Grosso were extracted from the national reporting system. The global and annual coefficient of abandonment of CL treatment was calculated for the whole state and for each municipality by dividing the number of CL patients who abandoned treatment by all CL patients. Moreover, we used the Global Moran's Index (I) and the Local Indicators of Spatial Association to investigate the spatial autocorrelation between municipal coefficients and to detect hotspots for the abandonment (i.e., High-High areas), respectively. Results: From 2007 to 2022, Mato Grosso reported 35,538 new cases of CL. Of these, 565 abandoned the treatment, which amounted to an overall coefficient of abandonment of 1.6% (95% confidence interval=1.5-1.7%). The annual coefficients ranged from 1.0% (2014) to 3.1% (2018). A total of 83% (117/141) of the municipalities registered at least one case with abandonment. The highest cumulative abandonment coefficients were observed in municipalities located in the Central mesoregion of the state, with a peak of 33.3%. Indeed, we detected a positive spatial autocorrelation of the cumulative coefficients of abandonment per municipality (I=0.112; p=0.009) and one hotspot for the abandonment composed of four central municipalities. Discussion: We observed a considerable occurrence of abandonment of CL treatment. It is likely that the high impact that therapeutic regimens have on patients' lives underlies this outcome, as already suggested in Brazil. Public policies aimed at adherence to treatment should be performed in Mato Grosso, as drug therapy plays a crucial role in preventing physical deformities due to CL relapses with mucosal involvement. Although drug resistance in leishmaniasis is not yet a major concern in Brazil, such policies can also prevent the eventual emergence of resistant strains. These policies should be prioritized in central municipalities of the state, which comprise a hotspot for the event. For better policy design, additional investigations addressing the topic at the individual level must be performed. Conclusion: This was the first study addressing the abandonment of CL treatment in Brazil. We concluded that 1.6% of CL patients of Mato Grosso abandon treatment, mainly those living in central municipalities.