Digital Implementation Support to Achieve Uptake and Integration of Task-Shared Care for Schizophrenia in Primary Care in India

Project Summary Abstract Schizophrenia is a significant contributor to the global burden of disease. In India, this burden is further exacerbated because individuals living with schizophrenia have limited access to effective psychosocial interventions aimed at promoting recovery, rehabilitation, and community tenure, while there is inadequate

attention to managing co-occurring chronic medical conditions that result in significantly reduced life expectancy among this patient group compared to the general population. There now exists strong evidence demonstrating that community programs delivered in primary care and leveraging psychosocial interventions

combined with linkage to specialty psychiatric services are effective for supporting treatment and recovery of schizophrenia in low-resource settings. Therefore, there is an urgent need to integrate these effective programs into existing non-communicable disease care services delivered in primary care settings towards

scaling up community care for schizophrenia. With the accelerated adoption of digital technologies in the health system in India, driven by the COVID-19 pandemic, there are new opportunities to leverage these digital devices to coordinate care delivery for complex conditions such as schizophrenia. We propose to capitalize on

this newly established digital infrastructure to support the integration of task-shared care for schizophrenia and allow monitoring of mental health, physical health, and functional outcomes over time. Specifically, we propose to train and supervise frontline health workers tasked primarily with addressing chronic health conditions in

community settings in the delivery of an evidence-based psychosocial rehabilitation program for schizophrenia called the Community Care for People with Schizophrenia in India (COPSI). We will leverage our existing collaboration and robust research infrastructure in both rural and urban settings in Madhya Pradesh and

Karnataka, India to conduct a hybrid type 1 effectiveness-implementation trial to evaluate whether use of a digital platform offers added clinical benefit and can support integration of this task shared care for schizophrenia into routine primary care settings. We will conduct an individual randomized controlled trial

enrolling 240 adults with schizophrenia to evaluate whether use of the mindLAMP digital platform can enhance the clinical effectiveness of the COPSI program in reducing disability for individuals living with schizophrenia. We will also measure a range of secondary outcomes for physical health and lifestyle behaviors linked to early

mortality, and mental health. We will also determine whether the addition of mindLAMP to the delivery of the COPSI program has an impact on implementation metrics when compared to delivery of COPSI alone. Our study directly supports NIMH RFA-MH-22-130 by seeking to evaluate whether a novel digital platform can

support the clinical effectiveness and integration of a proven psychosocial rehabilitation intervention for schizophrenia into the ongoing national roll out of comprehensive NCD services in primary care in India.