Introducing Single Dose Liposomal Amphotericin B for the Treatment of Visceral Leishmaniasis in Rural Bangladesh: Feasibility and Acceptance to Patients and Health Staff

Background. For the treatment of visceral leishmaniasis in Bangladesh, single dose liposomal amphotericin B (ambisome) is supposed to be the safest and most effective treatment. Specific needs for application and storage raise questions about feasibility of its implementation and acceptance by patients and health staff. Methods. The study was carried out in the most endemic district of Bangladesh. Study population includes patients treated with ambisome or miltefosine, hospital staff, and a director of the national visceral leishmaniasis program. Study methods include direct observation (subdistrict hospitals), open interviews (heath staff and program personnel), structured questionnaires, and focus group discussions (patients). Results. Politicalcommitment for ambisome is strong; the general hospital infrastructure favours implementation but further strengthening is required, particularly for drug storage below 25°C (refrigerators), back-up energy (fuel for generators), and supplies for ambisome administration (like 5% dextrose solution). Ambisome created high satisfaction in patients and hospital staff, less adverse events, and less income loss for patients compared to miltefosine. Conclusions. High political commitment, general capacities of subdistrict hospitals, and high acceptability favour the implementation of ambisome treatment in Bangladesh. However, strengthening of the infrastructure and uninterrupted supplies of essential accessories is mandatory before introducing sLAB in Bangladesh. 1. Background Visceral leishmaniasis (VL), also called Kala-azar (KA), is a vector borne neglected disease ranked by the WHO as the infectious disease with the ninth highest burden worldwide [1]. More than 70？per cent of the cases worldwide occur in India, Bangladesh, and Nepal [2]. The annual incidence for Bangladesh has recently been estimated to be between 12,400 and 24,900 cases [2]. Out of the 64 districts and 493 subdistricts of Bangladesh, 45 districts and 105 subdistricts are affected [3]. L. donovani causing VL in the region has no other reservoir than humans and no other vector other than Phlebotomus argentipes. There are new rapid diagnostic tests [4] and different treatment options so that the elimination of the disease was envisaged. In 2005 a Memorandum of Understanding was signed by Bangladesh, India, and Nepal to eliminate VL from the Indian subcontinent aiming for less than one case per 10,000 people in the endemic districts by 2015 [5]. One important element in the elimination strategy is early diagnosis and complete treatment. Within the