A new scoring system for operational indicators guiding leprosy monitoring and surveillance in Brazil

Objective: We aimed to develop a new score to facilitate and enhance the quantitative assessment of operational standard indicators guiding leprosy monitoring and surveillance, based on data from Brazilian hyperendemic regions, 2004-2019. Methods: We analyzed epidemiological and operational standard indicators of leprosy control from the database of the Notifiable Diseases Information System in Brazil’s North and Northeast regions. The so-called IntegraHans Operational Score (IHOS) was generated, integrating 10 indicators, with a final semi-quantitative score varying from 0 (worst scenario) to 1 (best scenario). We then applied the IHOS within an ecological and population-based study to assess temporal and spatial leprosy distributions from 2004 to 2019. Results: In total, 343,888 new leprosy cases were analyzed (61% of cases in the country). There was a significant temporal trend of the IHOS annual percentage change [-0.3; 95% confidence interval (CI): -0.5 to 0.0] during 2010-2019, with large cities showing a worsening trend (average annual percentage change -0.8, 95%CI: -1.1 to -0.4). After 2010, municipalities with low and medium social vulnerability, and those with medium human development and medium and high social prosperity, showed improved IHOS scores. Spatial patterns with the best IHOS scenarios were observed in the states of Rondônia, Tocantins, and Pernambuco. Conclusion: The IHOS combines different operational parameters and is an effective and simple tool to assess leprosy control programs in Brazil. The worst IHOS scores over time were identified in critical areas, such as large cities in hyperendemic areas and municipalities with lower endemicity.