Depression is common among adolescents and young people living with HIV (AYPLHIV) in sub-Saharan Africa and is associated with poorer antiretroviral therapy adherence, reduced retention in care and worse health outcomes. In Uganda, routine depression screening using brief instruments such as the Patient Health Questionnaire-2 is recommended but is unevenly implemented. Implementation gaps are attributed to overburdened healthcare workers and limited mental health workforce capacity, creating a need for scalable approaches to improve early identification of depression among AYPLHIV.
The authors propose assessing an interactive voice response (IVR)–based depression-screening intervention as a potential scalable solution. IVR may permit remote, automated screening that aligns with existing mobile access patterns among youth and could reduce additional demands on clinic staff if integrated effectively with referral pathways.
The formative study aims to generate the contextual, user-level and health-system evidence needed to inform the design, feasibility and acceptability of an IVR-based depression-screening intervention for AYPLHIV in Uganda. Specific objectives are to characterize mobile phone access, digital habits and IVR preferences among AYPLHIV; to identify barriers and facilitators to routine depression screening and referral within HIV clinics from the perspective of healthcare workers; and to triangulate quantitative and qualitative findings to guide IVR design and implementation.
This is a convergent parallel mixed-methods formative study conducted at Makerere University Walter Reed Program (MUWRP) HIV clinics in Central Uganda. The study combines a quantitative cross-sectional survey of AYPLHIV with qualitative focus group discussions (FGDs) involving healthcare workers. Both strands will be conducted concurrently and the results triangulated to inform IVR system development and integration with clinic workflows.
The quantitative arm will survey 133 AYPLHIV aged 18–24 years. The survey is designed to capture data on mobile phone access, digital habits and preferences relevant to IVR delivery. Information collected will inform technical and user-interface choices (for example, language, call timing, call duration and message format) and help estimate the pool of users reachable by a phone-based screening intervention.
Specific measures reported in the protocol include demographic age range (18–24 years), and survey domains covering access to mobile phones, patterns of digital use and stated preferences for interacting with IVR systems. The sample size (133 participants) was selected for the quantitative strand; additional detail on sampling procedures or power calculations was not reported in the abstract.
The qualitative arm will convene focus group discussions with healthcare workers at the MUWRP clinics. FGDs will explore current barriers to routine depression screening, clinic capacity to manage and refer additional cases identified through screening, and views on how an IVR system could be integrated into existing HIV care pathways.
Healthcare worker input will probe health-system readiness, constraints in workforce and referral pathways, and practical considerations about absorption of new cases identified by systematic screening. The protocol indicates that findings from FGDs will be used to assess whether the health system can absorb the case-finding that an IVR system might yield and to identify necessary referral and linkage mechanisms.
This convergent parallel mixed-methods design entails collecting quantitative and qualitative data in parallel, analyzing each strand separately, and then triangulating results. Triangulation is intended to identify concordant and discordant findings about user access and preferences, workflow implications and system readiness. Outputs from integration will directly guide IVR design choices and implementation planning, including alignment with national HIV and mental health guidelines.
The protocol describes using triangulated evidence to tailor a youth-centered IVR intervention and to map referral pathways and health-system inputs needed to support scaling.
The study will generate context-specific evidence on three domains: user-level mobile access and IVR preferences among AYPLHIV; health-system readiness and capacity to manage additional case-finding from systematic screening; and referral pathway capacity for depression care within the HIV clinic environment. These findings are intended to inform the design of a youth-centered IVR depression-screening intervention that is aligned with national HIV and mental health guidance and feasible within the MUWRP clinic context.
By producing formative evidence, the study aims to bridge implementation gaps in routine depression screening for AYPLHIV in Uganda and to support future testing and scaling of an IVR-based screening approach as part of digital health strategies for mental health in HIV care.
The abstract indicates the study is a protocol for a formative mixed-methods investigation; it does not provide detailed information about ethical approvals, consent procedures or dissemination plans in the abstract text. The full protocol and manuscript are published in Sex Health (2026) and list institutional affiliations with Makerere University Walter Reed Program, Mbarara University of Science and Technology, the Harvard T.H. Chan School of Public Health, the Infectious Disease Institute and the African Center of Excellence in Bioinformatics and Data Intensive Sciences. Further details on ethics approval and dissemination would be expected in the full text but were not reported in the abstract.