Assessing the feasibility of interactive voice response-based depression screening for adolescents and young people...

Depression is common among adolescents and young people living with HIV (AYPLHIV) in sub-Saharan Africa, and is associated with poor antiretroviral therapy adherence, reduced retention in care and poorer health outcomes. In Uganda, routine depression screening using brief tools, such as the Patient Health Questionnaire-2, is recommended, but inconsistently implemented due to overburdened healthcare workers and limited mental health workforce capacity. Scalable approaches to improve early identification of depression among AYPLHIV are needed to bridge this implementation gap. We describe a protocol for a formative mixed-methods study designed to generate the contextual, user-level and health-system evidence needed to inform the design, feasibility and acceptability of an interactive voice response (IVR)-based depression-screening intervention for AYPLHIV in Uganda.

We will conduct a convergent parallel mixed-methods study at Makerere University Walter Reed Program (MUWRP) HIV clinics in Central Uganda. The quantitative arm will survey 133 AYPLHIV aged 18-24 years on mobile phone access, digital habits and IVR preferences; the qualitative arm will run focus group discussions with healthcare workers to probe barriers to depression screening, whether the system can absorb the extra cases screening would find and how IVR could fit existing HIV care. The two strands will be triangulated to guide IVR design and implementation.

The study will generate context-specific evidence on user-level access and preferences, health-system readiness, and referral pathway capacity to support a future IVR-based depression-screening intervention for AYPLHIV. These findings inform tailoring of a youth-centered IVR intervention aligned with national HIV and mental health guidelines.