Recipient organisationUniversity of ManchesterSource-published name: The University of Manchester
Funding£7.0M
PeriodSept 2022 — Aug 2027
In plain English
AI plain-English summary
In South Asia, children with autism and other developmental disabilities are being identified and treated for the first time through a care pathway delivered by non-specialist health workers. This matters because South Asia has the highest prevalence of neurodevelopmental disability of any region, and roughly 95% of children with autism live in low- and middle-income countries. Existing detection and intervention tools are scarce, and specialist clinicians are rare. The NAMASTE unit builds on a decade of collaboration that produced PASSPlus—the first non-specialist-delivered autism intervention shown to work in published trials—and the WHO’s group intervention for developmental disability. If successful, the project will show that a combined stepped pathway—detecting children and linking them to either group or individual therapy—can work across four very different health systems in South Asia. That would give governments a tested, cost-effective model for scaling up care, moving toward universal health coverage for developmental conditions. The unit will also create a regional training hub, building clinical and research capacity that outlasts the grant.
View original technical description
Research Question. Evaluation of the implementation and effectiveness of a detection and intervention care pathway for neurodevelopmental disability and autism spectrum disorder in four contrasting health systems in South Asia. Background. Neuro psychiatric disorder accounts for 15 to 30% of the disability adjusted life years lost during the first three decades of life and poses new challenges for health systems. South Asia has the highest prevalence of neurodevelopmental disability (NDD) of any nation and about 95% of autistic spectrum disorder (ASD) children live in low and middle income countries. Over a decade of collaboration, we have undertaken the first detection study for NDD and ASD in India, and have adapted for South Asia an effective UK ASD intervention. The resulting PASSPlus intervention, delivered by non-specialists, is the first of its kind with demonstrated effectiveness in published trials; supported by a digital training and supervision platform. In parallel, colleagues in the World Health Organisation have developed CST, a group intervention for child developmental disability. Aims and Objectives. Building on this previous work, NAMASTE will test the implementation and effectiveness of a combined stepped detection and intervention pathway; identifying children with NDD or ASD and linking them to CST and/or PASSPlus ASD intervention. We will test the the components of this pathway within four health systems that differ markedly in their implementation settings, along with building their clinical and research capacity and investigating cost-effectiveness aspects of delivery. Methods. Four workstreams: WS1 - tool and workforce development; WS2 - detection pathway implementation; WS3 - intervention implementation; WS4 - community inclusion and participation. Detection and intervention evaluation measures will be adapted and evidence-based. We will evaluate: i) the accceptability and effectiveness of digital training; ii) the feasibility and acceptability of detection and its validity against independent clinical assessment; iii) intervention effectiveness on family outcomes and child development, through a pre-post observational cohort design; iv) case studies and mixed methods evaluation of community and public engagement. A combined analysis will evaluate the whole detection intervention system by site as a measure of programme success and implementation learning. Timelines. Y1, establishment and start-up, community engagement, completion of WS1. Y2, detection pathway. Y3, intervention pathway. Y4, detection and intervention pathway completed. Y5, Analysis, write-up, dissemination and completion of postgraduate programmes. Dissemination and Impact. The evaluation of the digitally-supported detection and care pathway in NAMASTE will be the first of its kind in LAMIC, disseminated professionally and in the community. This GHRU will have built clinical and research capacity and have impact as a regional research and training hub in South Asia and potentially beyond; along a theory of change pathway towards universal health coverage for NDD and ASD in LAMIC.
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