Barriers to Early Diagnosis and Strategies for Early Detection of Leprosy in Endemic Settings: A Narrative Literature Review

Leprosy is a chronic infection of the skin and peripheral nerves, and delayed diagnosis sustains transmission and causes preventable grade 2 disability (G2D) in endemic settings. This review examines which barriers delay the diagnosis of leprosy and which strategies and tools can help detect it earlier, with particular attention to Indonesia. PubMed was searched on 25 September 2026 for English-language records first published online in 2021–2025 (531 records), and ten studies were purposively selected and synthesised narratively. Systematic reviews reported median detection delays of 12–36 months and G2D at diagnosis in 5.6–43.2% of cases. In Tegal, Indonesia, the mean delay was 13.0 months, mostly (9.7 months) before patients reached health services, and was longer with passive detection (16.5 compared with 6.9 months), while misdiagnosis and repeated consultations contributed to delay within health services. In Brazil, 1.3% of notified cases were later found to be misdiagnoses. Point-of-care serology was sensitive in multibacillary disease (0.83–0.92) but not in paucibacillary disease (0.36–0.38), and artificial-intelligence tools remained at an early stage. Contact screening in Cambodia detected 33 new cases among 7,496 contacts, and a cluster-randomised post-exposure prophylaxis (PEP) trial found no significant reduction in incidence in its primary analysis. No included primary study tested whether these strategies shorten detection delay or reduce G2D. Delayed diagnosis arises mainly from patient-level factors such as stigma and care-seeking behaviour, with a contribution from health services. Early detection strategies appear promising, but their effect on delay and G2D is unproven and should be evaluated using these outcomes.