Evidence map›Paper›PMID 40854809›Full record

Trial reportBMJ global health2025

Factors associated with fluoxetine adherence among outpatients with common mental disorders in Western Kenya.

Rachel L Burger, Susan M Meffert, Linnet Ongeri, Josline Wangia, Raphael Wambura, Phanice Ajore, Grace Rota, Ammon Otieno, Raymond R Obura, Peter Muchembre and 7 more

Registry-linked trialAbstract readRandomized Controlled Trial
In one paragraph

Trial report in BMJ global health, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT03466346 (A Sequential, Multiple Assignment Randomized Trial), which is not on this map. Not yet cited in PubMed.

0numbers the graph read from it
0cells of the map it votes in
0citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT03466346 nacompletednot on this map

A Sequential, Multiple Assignment Randomized Trial (SMART) for Non-specialist Treatment of Common Mental Disorders in Kenya: Leveraging the Depression And Primary-care Partnership for Effectiveness-implementation Research (DAPPER) Project

TypeinterventionalSponsorUniversity of California, San FranciscoRan2020 to 2024Enrolled2,162ConditionsDepression, Unipolar, Posttraumatic Stress Disorder, TraumaArmsFluoxetine, Interpersonal Psychotherapy
3 · Its place in the literature

Who cites it

0 citing papers in PubMed.

No citing paper in PubMed yet.

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

17 authors.

Rachel L BurgerDepartment of Psychiatry and Behavioral Sciences, University of California, San Francisco, California, USA rachel.burger@ucsf.edu.ORCID 0000-0001-9373-2910
Susan M MeffertDepartment of Psychiatry and Behavioral Sciences, University of California, San Francisco, California, USA.ORCID 0000-0002-5882-7102
Linnet OngeriKenya Medical Research Institute, Nairobi, Kenya.
Josline WangiaUniversity of Nairobi, Nairobi, Kenya.
Raphael WamburaKisumu County Ministry of Health, Kisumu, Kenya.
Phanice AjoreKisumu County Ministry of Health, Kisumu, Kenya.
Grace RotaUniversity of Nairobi, Nairobi, Kenya.
Ammon OtienoUniversity of Nairobi, Nairobi, Kenya.
Raymond R OburaUniversity of Nairobi, Nairobi, Kenya.
Peter MuchembreUniversity of Nairobi, Nairobi, Kenya.
David BukusiUniversity of Nairobi, Nairobi, Kenya.
Anne MbwayoUniversity of Nairobi, Nairobi, Kenya.
Thomas C NeylanDepartment of Psychiatry and Behavioral Sciences, University of California, San Francisco, California, USA.
Dickens AkenaMakerere University, Kampala, Uganda.
Chengshi JinEpidemiology and Biostatistics, University of California, San Francisco, California, USA.
Charles McCullochEpidemiology and Biostatistics, University of California, San Francisco, California, USA.
Muthoni A MathaiUniversity of Nairobi, Nairobi, Kenya.

Funding

The SMART-DAPPER study: Implementation research on Tele-mental health care in the COVID19 eraR01MH113722 · NIMH · UNIVERSITY OF CALIFORNIA, SAN FRANCISCO · PI MEFFERT, SUSAN M. · 2019 to 2023
$3.6M
Depression And Primary-care Partnership for Effectiveness-implementation Research (DAPPER)R01MH115512 · NIMH · UNIVERSITY OF NAIROBI · PI MATHAI, MUTHONI MUTHONI, MEFFERT, SUSAN M. · 2018 to 2022
$3.1M
NIMH NIH HHS R01 MH113722NIMH NIH HHS R01 MH115512
6 · The paper itself

Abstract

objectiveNon-adherence to antidepressants has been linked to increased symptom severity, relapse and hospitalisation from common mental disorders. However, there is limited knowledge of factors associated with antidepressant adherence in low-income and middle-income countries, especially in public sector, primary care settings.

methodsWe quantified fluoxetine adherence using the medication possession ratio. A limitation of this measure is that it does not always reflect the ingestion of medication. We constructed a generalised estimating equations linear regression with robust SEs, clustered by the participant, to identify independent predictors of fluoxetine adherence.

resultsParticipants randomised to fluoxetine were dispensed an average of 126 daily doses, or 70% of the 180 possible doses. Adherence was higher in the first half of the treatment period at 86.3%, 95% CI (83.5% to 89.2%) compared with 46.5% in the second half (44.3% to 48.8%) (p<0.001). Participants who opted for community-delivered fluoxetine demonstrated adherence at 79.7% (77.0% to 82.4%) compared with 58.6% (55.7% to 61.5%) of those who only picked up medication at the facility (p<0.001). Use of mHealth for at least one but less than half of the visits had the highest level of adherence at 84.6% (82.4% to 86.9%) compared with 49.6% (46.1% to 53.0%) among those who did not use mHealth and 67.2% (62.5% to 72.0%) for those who used mHealth at least half their visits (p<0.001).

conclusionsAdherence to fluoxetine was high relative to existing selective serotonin reuptake inhibitors adherence data, the majority of which is from high-income countries. Adherence was higher during the first half of treatment. People who were older, living with HIV and opted to use community delivery of medication and/or mHealth had higher adherence. TRIAL REGISTRATION NUMBER: NCT03466346.

Indexed as

Antidepressive Agents, Second-GenerationFluoxetineMedication AdherenceMental DisordersOutpatientsAdolescentAdultFemaleHumansKenyaMaleMiddle AgedYoung AdultAntidepressive Agents, Second-GenerationFluoxetineGlobal HealthKenyaMental Health & PsychiatryPublic Health

Identifiers

PMID40854809
PMCPMC12382546

What OpenQuestion holds

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Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.