Experiences and perceptions on diagnostic delay of leprosy by affected people in Colombia: A qualitative study

Leprosy, also known as Hansen's disease, is an infectious neglected tropical disease that requires a timely diagnosis and onset of multi-drug therapy to cure, halt transmission and prevent irreversible disabilities. Although Colombia shows a relatively low incidence of leprosy, the disease remains endemic in certain parts of the country. In addition, high rates of leprosy-related disability are observed due to diagnostic delay. Patients' experiential knowledge and expertise are crucial to further understand the reasoning behind this delay in diagnosis. Therefore, our study aimed to explore the experiences and perceptions of people affected by leprosy with diagnostic delays in the departments Cesar and Valle del Cauca in Colombia where the disease is endemic. We conducted 24 semi-structured in-depth interviews with people affected by leprosy in Colombia and used thematic analysis to analyse the interview results. Based on our analysis, we mapped out the patient pathway towards diagnosis and treatment, and highlighted the individual-level, community-level, and health system-level challenges leading to potential delays. Main reasons for delay included perceived limited leprosy training and expertise among healthcare workers, challenges related to the organisation of leprosy care, accessibility and affordability barriers, limited awareness about leprosy and stigmatisation of people diagnosed with leprosy. A multifactorial approach to leprosy diagnostic delay is necessary to tackle current challenges, including investing in integral leprosy care centres and prioritising active case detection. Implementing leprosy awareness strategies among healthcare workers and communities are necessary to tackle the stigmatisation of the disease and improve overall leprosy knowledge and expertise.