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UK - Department for Business, Energy and Industrial Strategy

Supervised Treatment in Out-Patients for Schizophrenia (STOPS+)

Disclaimer: The data for this page has been produced from IATI data published by UK - Department for Business, Energy and Industrial Strategy. Please contact them (Show Email Address) if you have any questions about their data.

Project Data Last Updated: 10/11/2021

IATI Identifier: GB-GOV-13-FUND--GCRF-MR_S00243X_1


Schizophrenia is a severe long-term mental health condition. It causes a range of different psychological symptoms including hallucinations (hearing or seeing things that don't exist), delusions (unusual beliefs not based on reality), muddled thoughts based on hallucinations or delusions and changes in behaviour. Schizophrenia is a common cause of long-term disability in the 15-49-year-old group and whilst effective treatments are available, in developing countries around two thirds of patients receive no treatment. This lack of treatment, commonly known as the 'treatment gap' arises due to factors including poor treatment adherence, a lack of primary care involvement and poor access treatments. We have previously reported a new approach (Supervised Treatment in Out-Patients for Schizophrenia (STOPS)) that resulted in improved treatment adherence and functioning in a resource poor setting in Khyber Pakhtunkhwa (KP), Pakistan. In this study we trained and supported relatives and family members to monitor medication taking, building on the success of a similar approach used for patients with tuberculosis. We now aim to implement and evaluate a 'scaled-up' version of STOPS (STOPS+) which is based on the World Health Organisation mental health guidelines and maintain treatment adherence with the help of family members and text message reminders. We will work with primary care physicians and multipurpose primary are technicians to task shift care, under the supervision of mental health experts. The study has 3 phases: PHASE 1: PRE-IMPLEMENTATION PHASE involving community engagement, modification of STOP to STOPS+ (involving patient, healthcare and wider community partners) and the identification of potential study participants. PHASE 2: IMPLEMENTATION OF STOPS+ IN PRIMARY CARE SETTINGS USING A CLUSTER TRIAL DESIGN to determine the clinical and cost-effectiveness. 24 primary care centres in district Peshawar, KP will be randomised to deliver either STOPS+ or Enhanced Treatment As Usual (ETAU). We will recruit 526 patients (263 in each arm) suffering from Schizophrenia or schizoaffective disorder based on the International Classification of Diseases (ICD)-10 criteria. The outcomes of interest will include Global Assessment of Functioning and adherence to treatment regimen. PHASE 3: EVALUATION OF THE IMPLEMENTATION IN REAL WORLD SETTING will be measured using the standardised World Health Organization's Assessment Instrument for Mental Health Systems (WHO-AIMS), economic evaluation, secondary data from the trial and utilisation of primary health care, and in depth interview study involving all participants. If successful this trial will improve schizophrenia care, improving lives for patients and their families. This work will provide important information for policy makers and set the foundations for reducing disability and improving long term patient outcomes.


AIMS AND OBJECTIVES: We aim to assess the effectiveness and cost effectiveness, and implementation of STOPS+ versus Enhanced Treatment As Usual (ETAU) in improving the treatment adherence and access to the treatment in the community. PRIMARY OBJECTIVE The primary objective of the study is to evaluate the effectiveness and implementation of STOP+ in a primary health care setting in a resource poor setting in Pakistan. SECONDARY OBJECTIVES - To investigate the process and implementation outcomes for STOP+ in the community by estimating the cost effectiveness, assessing the impact of STOPS+ implementation in the whole health system and acceptability of STOPS+ for all stakeholders - To evaluate the effectiveness of STOPS+ compared to Enhanced Treatment As Usual (ETAU) in reducing the treatment gap by increasing medication adherence, improving the access to medication and mental health treatment in primary care. - To assess the effectiveness of STOPS+ in reducing family burden, stigma in the community, and improving physical health in people with schizophrenia. - To investigate the acceptability of STOPS+ for service users and health care providers, and assess the effects of the implementation of STOPS+ on the wider health system.

Status - Post-completion More information about project status
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A comparison across six financial years of forecast spend and the total amount of money spent on the project to date.

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