An interventional pilot of customized adherence enhancement combined with long-acting injectable antipsychotic medication (CAE-L) for poorly adherent patients with chronic psychotic disorder in Tanzania

Jessie Mbwambo,Sylvia Kaaya,Christopher J Burant,Carol E Blixen,Catherine Magwiza,Isaac Lema,Martha Sajatovic,Kim Madundo,Godwin Njiro,Jennifer B Levin,Kristin A Cassidy

doi:10.1186/s12888-022-03695-8

Abstract

BackgroundChronic psychotic disorders (CPD) impose a particularly significant burden in resource-limited settings. Combining long-acting antipsychotic medication (LAI) with a customized adherence enhancement intervention (CAE-L) has potential to advance care.MethodsNineteen adults ≥ age 18 with CPD who self-reported missing ≥20% of antipsychotic medication within the last month were stabilized on oral haloperidol prior to transitioning to monthly haloperidol decanote for 25 weeks. Outcome evaluations were conducted at baseline and Week 25. Primary outcomes were oral medication adherence assessed via the Tablet Routines Questionnaire (TRQ) and LAI injection frequency. Secondary outcomes included CPD symptoms measured by the Brief Psychiatric Rating Scale and Clinical Global Impressions, functioning evaluated using the Social and Occupational Functioning Scale, and medication attitudes assessed with the Drug Attitudes Inventory.ResultsMean sample age was 38.79 (SD = 9.31) with 18 individuals completing the study. There was one serious adverse event, a relapse into substance use, not deemed study-related. Mean endpoint LAI dosage was 65.79 mg (SD = 22.38). TRQ mean scores were 21.84 (SD =13.83) and 12.94 (SD = 11.93) at screen and baseline respectively. For only two individuals who were on concomitant oral medication at 25 weeks, TRQ change was not calculated. LAI injection frequency was 100%. Medication attitudes scores significantly improved from 7.89 (SD = 2.72) to 9.83 (SD = 0.52) (p = .001.) Changes in CPD symptoms and functioning were non-significant.ConclusionsCAE-L appears to be preliminarily feasible and acceptable in Tanzanians with CPD.Trial registrationThe study was registered on ClinicalTrials.gov (NCT04327843) on March 31, 2020.

Highlights

Chronic psychotic disorders (CPDs) occur world-wide but impose a significant burden in resourcelimited settings where the professional workforce is spread thin and access to both medication and behavioral treatments may be limited [1]
Mbwambo et al BMC Psychiatry (2022) 22:62 (SSA), as is the case for people with CPD in other parts of the world, poor medication adherence is seen in approximately half of individuals with CPD and is a major driver of relapse [2,3,4,5,6]
Screening evaluations began on Oct 28, 2019 and the first participant was enrolled on Nov 5, 2019

Summary

Introduction

Chronic psychotic disorders (CPDs) occur world-wide but impose a significant burden in resourcelimited settings where the professional workforce is spread thin and access to both medication and behavioral treatments may be limited [1]. Because a major impediment to adherence in CPD is difficulty with consistent medication routines, long-acting injectable antipsychotic medication (LAI) can be a potentially efficient and effective treatment option [8, 9]. Medication alone is unlikely to modify long-term attitudes and behaviors, and LAI is not a stand-alone care approach for CPD given the long-term and individual care needs of people with CPD [11, 12]. Chronic psychotic disorders (CPD) impose a significant burden in resource-limited settings. Combining long-acting antipsychotic medication (LAI) with a customized adherence enhancement intervention (CAE-L) has potential to advance care

Methods

Results

Conclusion