{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,2]],"date-time":"2026-04-02T08:53:56Z","timestamp":1775120036472,"version":"3.50.1"},"reference-count":37,"publisher":"BMJ","issue":"8","license":[{"start":{"date-parts":[[2025,8,25]],"date-time":"2025-08-25T00:00:00Z","timestamp":1756080000000},"content-version":"unspecified","delay-in-days":24,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000025","name":"National Institute of Mental Health","doi-asserted-by":"publisher","award":["R01MH113722"],"award-info":[{"award-number":["R01MH113722"]}],"id":[{"id":"10.13039\/100000025","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000025","name":"National Institute of Mental Health","doi-asserted-by":"publisher","award":["R01MH115512"],"award-info":[{"award-number":["R01MH115512"]}],"id":[{"id":"10.13039\/100000025","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100022974","name":"Global Alliance for Chronic Diseases","doi-asserted-by":"publisher","award":["R01MH115512"],"award-info":[{"award-number":["R01MH115512"]}],"id":[{"id":"10.13039\/100022974","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Glob Health"],"accepted":{"date-parts":[[2025,6,28]]},"published-print":{"date-parts":[[2025,8]]},"abstract":"<jats:sec>\n                  <jats:title>Objective<\/jats:title>\n                  <jats:p>Non-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.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>We 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.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Participants 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%\u2009CI (83.5% to 89.2%) compared with 46.5% in the second half (44.3% to 48.8%) (p&lt;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&lt;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&lt;0.001).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>Adherence 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.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Trial registration number<\/jats:title>\n                  <jats:p>\n                     <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"clintrialgov\" xlink:href=\"NCT03466346\">NCT03466346<\/jats:ext-link>.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/bmjgh-2024-017929","type":"journal-article","created":{"date-parts":[[2025,8,26]],"date-time":"2025-08-26T02:05:14Z","timestamp":1756173914000},"page":"e017929","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":1,"title":["Factors associated with fluoxetine adherence among outpatients with common mental disorders in Western Kenya"],"prefix":"10.1136","volume":"10","clinical-trial-number":[{"clinical-trial-number":"nct03466346","registry":"10.18810\/clinical-trials-gov"}],"author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9373-2910","authenticated-orcid":false,"given":"Rachel L","family":"Burger","sequence":"first","affiliation":[{"name":"Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, California, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5882-7102","authenticated-orcid":false,"suffix":"meffert","given":"Susan M","family":"Meffert","sequence":"additional","affiliation":[{"name":"Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, California, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Linnet","family":"Ongeri","sequence":"additional","affiliation":[{"name":"Kenya Medical Research Institute, Nairobi, Kenya"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Josline","family":"Wangia","sequence":"additional","affiliation":[{"name":"University of Nairobi, Nairobi, Kenya"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Raphael","family":"Wambura","sequence":"additional","affiliation":[{"name":"Kisumu County Ministry of Health, Kisumu, Kenya"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Phanice","family":"Ajore","sequence":"additional","affiliation":[{"name":"Kisumu County Ministry of Health, Kisumu, Kenya"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Grace","family":"Rota","sequence":"additional","affiliation":[{"name":"University of Nairobi, Nairobi, Kenya"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ammon","family":"Otieno","sequence":"additional","affiliation":[{"name":"University of Nairobi, Nairobi, Kenya"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Raymond R","family":"Obura","sequence":"additional","affiliation":[{"name":"University of Nairobi, Nairobi, Kenya"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Peter","family":"Muchembre","sequence":"additional","affiliation":[{"name":"University of Nairobi, Nairobi, Kenya"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"David","family":"Bukusi","sequence":"additional","affiliation":[{"name":"University of Nairobi, Nairobi, Kenya"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Anne","family":"Mbwayo","sequence":"additional","affiliation":[{"name":"University of Nairobi, Nairobi, Kenya"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Thomas C","family":"Neylan","sequence":"additional","affiliation":[{"name":"Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, California, 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