E=mc 2 : Education (E), Medication (m), and Conditional Cash (c 2 ) to Improve Uptake of Antiseizure Medications in a Low-Resource Population: Protocol for Randomized Trial.

OBJECTIVE: Most people with epilepsy (PWE) could live seizure free if treated with one or more antiseizure medications (ASMs). The World Health Organization (WHO) estimates that 75% of PWE in low-resource settings lack adequate antiseizure treatment. Limited education surrounding epilepsy and the out-of-pocket costs of ASMs in particular pose barriers to managing epilepsy in resource-poor, low-income settings. The aim of this study is to implement and test a novel strategy to improve outcomes across the epilepsy care cascade marked by (1) retention in epilepsy care; (2) adherence to ASMs; and (3) seizure reduction, with the measured goal of seizure freedom.

METHODS: A randomized, double-blinded clinical trial will be performed, centered at the Ignace Deen Hospital in Conakry, Republic of Guinea, in Western Sub-Saharan Africa. Two hundred people with clinically diagnosed epilepsy, ages 18 years and above, will receive education on epilepsy and then be randomized to: (i) free ASMs versus (ii) conditional cash, conditioned upon return to epilepsy clinic. Participants will be followed for 360 days with study visits every 90 days following enrollment.

SIGNIFICANCE: We design a randomized trial for PWE in Guinea, a low-resource setting with a high proportion of untreated PWE and a nearly completely privatized healthcare system. The trial includes a conditional cash transfer intervention, which has yet to be tested as a targeted means to improve outcomes for people with a chronic neurological disorder. The trial aims to provide an evidence base for the treatment of epilepsy in such settings.