PROJECT SUMMARY/ ABSTRACT Epilepsy is responsible for about 1% of the global burden of disease, with the highest disease-related burden found in sub-Saharan Africa. The majority of people with epilepsy (>80%) live in low-resource settings, as is found in Kenya, where most have limited access to care. Delay in antiseizure medication (ASM) initiation and ASM non-adherence increase the disease-related burden in terms of low quality of life, high healthcare costs, and risk for seizure-related injuries and premature death. Our prior study at a tertiary public hospital in western Kenya showed that only 28% of newly diagnosed people with epilepsy (PWE) returned for follow-up, indicating a large treatment gap. Cost-effective, context-specific, and culturally appropriate interventions are critical to addressing access to care and improving epilepsy care retention and ASM adherence in PWE. The long-term goal of our research program is to address access to care and improve epilepsy treatment outcomes across the lifespan in western Kenya. We hypothesize that an evidence-based, task-sharing intervention supported by patient tracking data using an Epilepsy Medical Record System (EMRS) will provide a scalable and cost-effective approach to improving care retention, ASM adherence, and epilepsy care outcomes in western Kenya. Aim 1 is to build clinical and research capacity through the development of EMRS, the clinical training of less specialized staff to implement task-sharing intervention and the mentorship of a Kenyan investigator. Aim 2 is to evaluate the effectiveness, identify the mechanisms, and explore the sustainability of the task-sharing intervention supported by EMRS in improving epilepsy care outcomes. We will conduct a cluster-randomized trial comparing usual care and intervention groups to quantify the intervention's effectiveness in improving epilepsy care outcomes. Aim 3 is to conduct incremental cost-effectiveness and budget impact analysis of the intervention relative to usual care. In a long-standing partnership with the Government of Kenya, the Academic Model Providing Access to Healthcare Partnership (AMPATH) has expanded its clinical scope of work in rural western Kenya to address issues with chronic disease management. The proposed research will be conducted in collaboration with AMPATH. The study is innovative in that it will be the first intervention designed to improve access to care and epilepsy care outcomes in western Kenya. In addition, the clinical and research capacity-building effort will strengthen the health system capacity for epilepsy care and future independent research. The proposed research is significant because it is expected to improve the lives of people living with epilepsy, ensure capacity building, and provide evidence-based and sustainable strategies to inform clinical practice changes and policy development to improve epilepsy care outcomes and reduce the treatment gap in resource-limited settings.