Improving experiences and outcomes for individuals with severe stigmatizing skin diseases Developing an integrated case finding and management intervention in Ghana and Ethiopia. (SHARP Project)

Abstract

Severe stigmatising skin diseases (SSSDs) - including leprosy, yaws, Buruli ulcer (BU) and cutaneous leishmaniasis (CL) - are major causes of morbidity and are associated with disability, psychological distress and social isolation which can lead to stigmatisation, especially when treated late. As the different SSSDs share common characteristics, integration of programme activities may generate synergistic effects, especially when individuals living with SSSDs are engaged through the social structures most relevant to them. We plan to develop, implement and evaluate the feasibility, impact and cost-effectiveness of an integrated case finding and management SSSD intervention on outcomes for individuals living with SSSDs. We will work in Atwima Mponua District in Ghana, focussing on BU, yaws and leprosy and South Wollo in Ethiopia focussing on leprosy and CL. Atwima Mponua Municipal is one of the 260 Metropolitan, Municipal and District Assemblies (MMDAs) in Ghana, and forms part of the 43 MMDAs in the Ashanti Region, situated in the south-western part of the region. To inform the complex intervention design and strengthen implementation and evaluation, we propose formative work, outlined in this protocol. We will combine desk reviews, stakeholder workshops, surveys, ethnographic and qualitative research to understand the current context and organisational processes within the formal healthcare and local care systems from the provider, patient and community perspectives. We will explore with stakeholders’ strengths and challenges in areas including case-finding, management and stigma reduction for SSSDs, and the range of intervention possibilities and priorities for addressing these. Findings will inform interactive co-creation workshops with stakeholders to draft and refine the intervention package. Simultaneously, evaluation tools will be developed and validated. Subject to international and national COVID-19 guidelines, this research will take 9 months from September 2020