PROJECT SUMMARY Chronic psychotic disorders (CPDs) such as schizophrenia occur world-wide and cause significant burden, reduced quality of life, functional impairment and premature mortality due to suicide and other causes. Stigma and persistent disability, which usually begin early in life, profoundly and negatively impact people with CPD as well as their families and communities. Lower and middle income countries (LMICs) experience disproportionate burden due to poor adherence with evidence-based medication treatments, pervasive stigma, and lack of workforce capacity to adequately assess and treat CPD. Written in response to PAR-14-331 “Global Brain and Nervous System Disorders Across the Lifespan,” the proposed project will develop a person-centered CPD care approach that will be practical and effective in Tanzania, generalizable to other countries in Sub-Saharan Africa, and develop research capacity for future efforts in CPD burden reduction. The proposed study includes investigators from Muhimbili University of Health and Allied Sciences and Muhimbili National Hospital in Dar es Salaam, Tanzania, and from Case Western Reserve University (CWRU), Ohio, USA, and builds upon a successful behavioral + medication approach for high-risk individuals with CPD developed at CWRU. This proposed 3-phase/3-aim project will: 1) Conduct a mixed-methods (quantitative + qualitative) needs assessment regarding barriers and facilitators to CPD care in Tanzania; 2) Refine a brief, customized adherence enhancement (CAE) approach to improve antipsychotic medication adherence and mental health outcomes in Tanzanians with CPD, and 3.) Lay groundwork that establishes a clinical trials infrastructure, adequately trained staff, and data tools/procedures preparatory to implementation of a CPD adherence enhancement trial. In Phase 1/Aim 1, the mixed-methods analysis will involve 100 individuals with CPD to better understand antipsychotic adherence, adherence barriers and adherence attitudes. Phase 1 methods will include evaluation of adherence barriers and reasons for non-adherence, as well as stakeholder input regarding preferred approaches to deliver adherence promotion interventions. In Phase 2/Aim 2, a successful CPD adherence enhancement approach will be adapted for the Tanzanian setting, based upon findings from Phase 1. In Phase 3/Aim 3 appropriate outcome measures will be selected, staff will be trained in study and measure implementation, and the intervention will be finalized for delivery by healthcare workers. Finally, in a training/proof-of-concept exercise, the healthcare workers will implement adapted Customized Adherence Enhancement (CAE) in a high-risk sample of Tanzanians with CPD

PROJECT NARRATIVE While chronic psychotic disorders (CPDs) cause significant burden world-wide, lower and middle income countries (LMICs) experience disproportionate burden. The proposed project will adapt a successful behavioral treatment + medication approach that maximizes adherence and is intended for broad scale-up in Sub-Saharan Africa. Collaboration between Tanzanian and U.S. members of the study team will build capacity and set the stage for a future randomized controlled trial that has substantial potential for positive public health impact should preliminary work prove promising.