Background: Most people with schizophrenia in low- and middle-income (LAMI) countries receive minimal formal care, and there are high rates of non-adherence to medication.

Aims: To evaluate the effectiveness of an intervention that involves a family member in supervising medication administration - supervised treatment in out-patients for schizophrenia (STOPS) - in improving treatment adherence and clinical outcomes.

Methods: Individuals in Pakistan (n = 110) with schizophrenia or schizoaffective disorders were allocated to STOPS or to treatment as usual (TAU) and followed up for 1 year.  The primary outcome was adherence to the treatment regimen.  Positive and Negative Syndrome Scale for Schizophrenia and Global Assessment of Functioning scores were also assessed.

Results: Participants in the STOPS group had better adherence (complete adherence: 37 (67.3%) in STOPS vs 25 (45.5%) in TAU; P less than 0.02) and significant improvement in symptoms and functioning.

Conclusions: STOPS may be useful in enhancing adherence to treatment for schizophrenia in LAMI countries.