Scaling Up Task-Shifted Epilepsy Care (SHIFT)

Vanderbilt University Medical Center, Nashville TN

Investigators

Abstract

Abstract: Scaling Up Task-Shifted Epilepsy Care (SHIFT) has the potential to benefit half of the world’s people with epilepsy (PWE) - those who are currently untreated, many of whom are undiagnosed. As many as 60%-95% of people with epilepsy in Africa are undiagnosed and/or untreated, and rates of undiagnosed and untreated epilepsy vary across every country in the world. The 2022 Intersectoral Global Action Plan on Epilepsy (IGAP) established goals by 2031 among the world’s people with epilepsy (PWE): (1) 90% will know their diagnosis, (2) 80% will have access to anti-seizure medications (ASMs), and (3) 70% will achieve seizure control. In LMICs where physician shortages, lack of neurodiagnostic services, high epilepsy prevalence and high treatment gaps co-exist, IGAP suggests that task-shifting epilepsy care to community health workers (CHWs) could reduce the number of untreated people with epilepsy. A recent 60-site non-inferiority cluster randomized clinical trial (RCT) (BRIDGE-1; R01 NS113171) has documented that epilepsy outcomes among those treated by epilepsy-trained CHWs were not inferior to epilepsy outcomes among those treated by physicians, and that malnutrition is a major contributor to mortality among children with epilepsy. Task-shifted malnutrition care to CHWs is also promising based upon a recently completed clinical trial. We have developed, validated and implemented community-based epilepsy screening, and implemented curricula for training community health workers (CHWs) in epilepsy and in malnutrition task-shifted care. In SHIFT we propose to integrate task-shifted epilepsy care and task-shifted malnutrition care in five communities with populations of over 100,000, each community with a different dominant local language. We will train local community health volunteers (CHVs) in screening for epilepsy and for malnutrition, implement door-to-door screening, and refer those who screen positive for epilepsy and/or malnutrition to epilepsy- and malnutrition-trained CHWs for diagnosis and treatment at community-based primary healthcare centers, under supervision by physicians. Previously untreated PWE, including children with epilepsy with and without malnutrition, will be followed for 24 months to determine outcomes including epilepsy- and malnutrition-associated mortality. The implementation of integrated task-shifted screening, diagnosis and care for epilepsy and for malnutrition will be studied using the RE-AIM framework, and the cost-effectiveness of integrating epilepsy and malnutrition task-shifted care will be determined. SHIFT outcomes will include an online task-shifted epilepsy and malnutrition toolkit that will include: (a) an integrated epilepsy and malnutrition task-shifted protocol; (b) an online flipped classroom epilepsy and malnutrition training program for CHWs; (c) REDCap-based health record systems for coordinating task-shifted care, combined with (d) statistical software to help health authorities determine local treatment needs and epilepsy prevalence needed to plan task-shifted care at the state and local levels.