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.
