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Principal Investigator: Narayana Manjunatha
Organization: HARVARD MEDICAL SCHOOL
Fiscal Year: 2024
Award: $817,815
Funding agency: National Institute of Mental Health
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.
Terms: <21+ years old><Acceleration><Access to Care><Address><Adoption><Adult><Adult Human><Attention><Behavior><COVID crisis><COVID epidemic><COVID pandemic><COVID-19 crisis><COVID-19 epidemic><COVID-19 era><COVID-19 global health crisis><COVID-19 global pandemic><COVID-19 health crisis><COVID-19 pandemic><COVID-19 period><COVID-19 public health crisis><COVID-19 years><Caring><Chronic><Clinical><Clinical effectiveness><Collaborations><Communities><Community Health><Community Health Care><Community Healthcare><Complex><Cost Analyses><Cost Analysis><Data><Devices><Disease><Disorder><General Population><General Public><Government><Health><Health Services Accessibility><Health system><Hybrids><India><Individual><Infrastructure><Intervention><Intervention Strategies><LMIC><Life Expectancy><Life Style><Lifestyle><Link><Low-resource area><Low-resource community><Low-resource environment><Low-resource region><Low-resource setting><Measures><Mediator><Medical><Medical Rehabilitation><Mental Health><Mental Hygiene><Monitor><NIMH><National Institute of Mental Health><Outcome><Patient Participation><Patient outcome><Patient-Centered Outcomes><Patient-Focused Outcomes><Patients><Persons><Primary Care><Psychological Health><Randomized><Randomized, Controlled Trials><Recovery><Rehabilitation><Rehabilitation therapy><Research Infrastructure><Resource-constrained area><Resource-constrained community><Resource-constrained environment><Resource-constrained region><Resource-constrained setting><Resource-limited area><Resource-limited community><Resource-limited environment><Resource-limited region><Resource-limited setting><Resource-poor area><Resource-poor community><Resource-poor environment><Resource-poor region><Resource-poor setting><SARS-CoV-2 epidemic><SARS-CoV-2 global health crisis><SARS-CoV-2 global pandemic><SARS-CoV-2 pandemic><SARS-coronavirus-2 epidemic><SARS-coronavirus-2 pandemic><Schizophrenia><Schizophrenic Disorders><Services><Severe Acute Respiratory Syndrome CoV 2 epidemic><Severe Acute Respiratory Syndrome CoV 2 pandemic><Severe acute respiratory syndrome coronavirus 2 epidemic><Severe acute respiratory syndrome coronavirus 2 pandemic><Specialty><Supervision><Symptoms><Testing><Time><Training><access gaps><access to health services><access to services><access to treatment><accessibility to health services><adulthood><arm><assess cost><availability of services><burden of disease><burden of illness><care access><care coordination><care delivery><care services><care systems><community care><community setting><community-based health><coordinating care><coronavirus disease 2019 crisis><coronavirus disease 2019 epidemic><coronavirus disease 2019 global health crisis><coronavirus disease 2019 global pandemic><coronavirus disease 2019 health crisis><coronavirus disease 2019 pandemic><coronavirus disease 2019 public health crisis><coronavirus disease crisis><coronavirus disease epidemic><coronavirus disease pandemic><coronavirus disease-19 global pandemic><coronavirus disease-19 pandemic><cost><cost assessment><cost evaluation><dementia praecox><digital><digital data><digital intervention><digital phenotyping><digital platform><digital technology><disability><disease burden><effective intervention><effectiveness and implementation trial><effectiveness/implementation hybrid trial><effectiveness/implementation trial><evaluate cost><evidence base><examine cost><functional outcomes><gaps in access><health service access><health services availability><implementation outcomes><interventional strategy><low and middle-income countries><medical specialties><mortality><new approaches><novel><novel approaches><novel strategies><novel strategy><participant engagement><patient engagement><patient oriented outcomes><patient population><physical conditioning><physical health><primary care setting><programs><psychosocial><psychosocial rehabilitation><randomisation><randomization><randomized control trial><randomly assigned><rehab therapy><rehabilitative><rehabilitative therapy><rural locality><rural place><rural setting><scale up><schizophrenic><secondary outcome><service availability><severe acute respiratory syndrome coronavirus 2 global health crisis><severe acute respiratory syndrome coronavirus 2 global pandemic><treatment access><trial enrollment><uptake><urban environment><urban setting>