PATIENT PATHWAYS TO UGANDA'S FIRST SPECIALISED EARLY INTERVENTION IN PSYCHOSIS SERVICE AND RELATION TO THEIR CLINICAL...

Area of Science:

• Psychiatry
• Global Mental Health
• Public Health

Background:

• Early Intervention for Psychosis Services (EIPS) improve outcomes for first-episode psychosis (FEP).
• Limited data exists on FEP patient pathways, referral acceptance, and outcomes in low-resource settings.
• Uganda's first EIPS, STEP_MaKH, offers a unique research opportunity.

Purpose of the Study:

• Examine pathways to EIPS in Uganda.
• Identify factors influencing referral acceptance and completion.
• Assess the impact of initial treatment-seeking on long-term outcomes.

Main Methods:

• Multiple-method study including retrospective pathway assessment (WHO Encounter Form) and prospective follow-up.
• Modified Poisson regression for referral predictors.
• Kaplan-Meier and Cox models for time to remission and quality of life.

Main Results:

• Native/religious healers were the primary contact for 187 FEP patients; only 29.9% accepted referral.
• Referrals from Mulago Hospital were more likely to enroll; delays reduced enrollment likelihood.
• 60% achieved remission by Month 1; those initially seen by mental health workers remitted faster and had better quality of life outcomes.

Conclusions:

• FEP care pathways in Uganda are complex with significant attrition.
• Referral completion depends on referral site and care pathway delays.
• Specialized care leads to rapid improvement; early mental health worker contact is crucial for better outcomes.