Studies on the use and impact of single-dose rifampicin (SDR) as post-exposure prophylaxis (PEP) have been and are being carried out under routine national programs in many countries, including India, Nepal, Indonesia, and Cambodia. Drawing upon these studies and my experiences in India, I have summarized some key findings below.

Following the success of the COLEP study (the first large-scale study of SDR-PEP in an endemic setting), a feasibility study of implementation and acceptance of SDR-PEP was carried out in Dadra & Nagar Haveli (D&NH), India. All contacts of cases detected from April 1, 2013, to March 31, 2018, were included to be screened and given SDR-PEP. Qualitative data were collected to find out acceptance/rejection and challenges faced by community and health care staff.

A total of 30,295 eligible contacts of 1,662 new cases detected over the five-year period received SDR. No untoward effects or complications were reported. SDR-PEP was well accepted by 99.3% of individuals, and there was no hesitation in swallowing one capsule of rifampicin¹

Auxiliary Nurse Midwives (ANM) were asked about whether the project had increased their workload. They answered that it had, but they see the increase as temporary; they know that SDR-PEP will lead to fewer cases in the future. Their response upholds the conclusion of a 2017 study: “PEP can be integrated into different health systems without major structural and personal changes, but provisions are necessary for the additional monitoring requirements.”²

The effectiveness of providing SDR-PEP to eligible contacts was assessed by the decline in the number of cases over the five-year period: 261 (2018–2019); 200 (2019–2020); 144 (2020–2021); 109 (2021–2022); 92 (2022–2023). The prevalence rate declined in corresponding years from 3.25 (2018–2019) to 0.96 (2022–2023) per 10,000 population.³

Also in India, there is an example of the effectiveness of a “blanket approach” in which SDR-PEP is administered, with consent, to the entire healthy population of a community, instead of establishing eligibility according to contact tracing. In 2017, the district leprosy officer of Varanasi, Uttar Pradesh, decided to initiate this approach after two patients were diagnosed with multibacillary leprosy in the district hospital and subsequent village-wide screening identified 12 additional new cases. All healthy residents above two years of age, a total of 156 out of 172 persons, were given SDR. In six years of follow-ups, there were no new cases of leprosy found in this village.⁴

In Nepal, a retrospective cohort study looked at the effectiveness of SDR‑PEP when implemented under routine program conditions. Two areas, one with SDR‑PEP and one without, were compared. In a follow up of 74 months, districts where contacts received SDR‑PEP showed around 72% reduction in case detection compared to areas where SDR‑PEP was not used.⁵

To address challenges related to availability of rifampicin and in drug formulations, WHO has initiated the supply of rifampicin alongside MDT in more than 40 countries. The current context provides a timely opportunity to introduce systematic contact management for early case detection and protection of those at highest risk through SDR-PEP administration.

Based on the studies introduced in this article and other available evidence, SDR-PEP can be considered a promising intervention that can and should be implemented within routine leprosy control programs, at least to begin with in low-endemic areas.

References

¹ Richardus JH, Tiwari A, Barth-Jaeggi T, Arif MA, et al. Leprosy post-exposure prophylaxis with single-dose rifampicin (LPEP): an international feasibility programme. Lancet Glob Health. 2021;9(1):e81–e90. doi:10.1016/S2214-109X(20)30396-X.

² Tiwari A, Mieras L, Dhakal K, et al. Introducing leprosy post-exposure prophylaxis into the health systems of India, Nepal and Indonesia: a case study. BMC Health Serv Res. 2017;17:684. doi:10.1186/s12913-017-2611-7.

³ “Innovations/Best practices under NLEP in Dadra & Nagar Haveli.” Unpublished report. Available at: https://www.nitiforstates.gov.in/public-assets/Best_Practices/Compendiums/Leprosy%20Eradication%20Initiatives%20DNHDD%20_%20Best%20Practices%20%20(1).pdf. Accessed February 20, 2026.

⁴ Singh R, Agarwal A. Experience with administering single-dose rifampicin as post-exposure prophylaxis (SDR-PEP) for leprosy through blanket approach in Uttar Pradesh, India. Indian J Lepr. 2024;96:159–161. Available at: https://nlrindia.org/wp-content/uploads/2024/07/changing-perception-and-improving-knowledge-on-leprosy.pdf. Accessed March 24, 2026.

⁵ Banstola NL, Hasker E, Mieras L, Gurung D, et al. Effectiveness of ongoing single-dose rifampicin post-exposure prophylaxis (SDR-PEP) implementation under routine program conditions—An observational study in Nepal. PLoS Negl Trop Dis. 2024;18(12):e0012446. doi:10.1371/journal.pntd.0012446.