Benedict Akimana

In Uganda and other low- and middle-income countries, access to healthcare is constrained by shortages of health workers, long travel distances, and inadequate infrastructure. Telemedicine offers a potential solution, but its effectiveness depends on how key stakeholders perceive, accept, and experience it. This study explored the acceptance and experiences of telemedicine by policymakers, healthcare providers, and service users in Kampala, Uganda. An exploratory qualitative study was conducted between November 2024 and February 2025 at four sites in Kampala: Rocket Health, Uganda Cancer Institute, Butabika National Referral Mental Hospital, and the Ministry of Health. Participants were purposively selected to ensure direct experience with telemedicine. Data was collected through 15 key informant interviews with policymakers and healthcare providers and three focus group discussions with service users (patients and caregivers) who had accessed telemedicine within the previous year. Interviews and discussions were conducted in English or Luganda, audio-recorded with consent, and transcribed verbatim. Data were analyzed thematically using Braun and Clarke’s six-phase approach, supported by NVivo 12 software. Three main themes emerged: perceived benefits, perceived challenges, and recommendations for improving telemedicine. Participants described telemedicine as convenient, reducing travel and contributing to cost and time savings. It also enhanced continuity of care, flexibility, privacy, and autonomy. These benefits were particularly evident among people with disabilities and digitally literate urban users. However, challenges included poor internet connectivity, limited infrastructure, low digital literacy, concerns about diagnostic accuracy without physical examination, and variable levels of trust, with some participants preferring in-person interaction. Telemedicine was perceived as acceptable and useful. However, its broader adoption is limited by structural, technical, and trust-related barriers. Addressing these challenges will require investment in infrastructure, strengthened digital literacy, provider training, increased public awareness, and a robust national telemedicine policy to support equitable and sustainable integration into healthcare delivery in Uganda.

Background:Depression is a critical public health issue among youth in Uganda, with limited access to mental health services. This pilot randomized controlled trial (RCT) evaluated the mechanisms and cost-effectiveness of mobile phone-based Tele-Support Psychotherapy (TSP) delivered by lay counselors for youth with depression in Kampala. Methods: We randomized 300 youth aged 15–30 with mild to moderate depression to TSP combined with Standard Mental Health Services (SMHS) or SMHS alone. Assessments at baseline, 6, and 12 months measured depression (Mini International Neuropsychiatric Interview), stigma, and income generation. Generalized structural equation modeling (GSEM) explored mediation pathways, and a provider-perspective cost-effectiveness analysis calculated the incremental cost-effectiveness ratio (ICER) using disability-adjusted life years (DALYs). Results: TSP significantly reduced depression through stigma reduction and increased income generation (total effect β = -3.736, p<0.001, 95% CI [-4.273, -3.198]). The ICER was US$2,293 per DALY averted, cost-effective compared to Uganda’s GDP per capita (US$1,002). Conclusions: TSP is an effective and cost-effective intervention for youth depression in low-resource settings, with potential for integration into national mental health strategies. Trial Registration: PACTR202201684613316.

Introduction: Children and adolescents living with HIV(CALWH) face significant mental health challenges, such as depression and anxiety, which negatively impact their HIV treatment outcomes. This study investigated the prevalence and factors associated with emotional problems among children and adolescents with unsuppressed viral loads in Northern Uganda. Methods: In 2021, 121 dyads of caregivers and CALWH (10 to 18 years) with unsuppressed viral loads were recruited from five community-based HIV clinics in Kitgum district. They were assessed for emotional problems using the Revised Child Anxiety and Depression Scale (RCADS-25), the Patterson Suicide Risk Assessment Tool and the Clinician-administered Post-traumatic Stress Disorder Scale for Children and Adolescents (CAPS-CA). Bivariate and multivariate analysis of the data was carried out using STATA version 18. Results: Emotional problems were observed in 61.97% of participants. Among these, depression was present in 45.45% of individuals, and all participants diagnosed with depression also exhibited significant comorbid anxiety symptoms. Notably, 16.52% of participants experienced anxiety without comorbid depression. Factors independently associated with emotional problems included food insecurity (p = 0.003; OR = 0.03), post-traumatic stress disorder (PTSD) (p < 0.0001; OR = 1.33), and high transportation costs to health facilities (p = 0.0069; OR = 1.00). However, no significant association was observed between emotional problems and gender (p = 0.94; χ² = 0.009). Conclusion : These results emphasize the importance of addressing underlying socio-economic and psychological factors to improve emotional well-being. Targeted interventions focused on reducing barriers to resources and providing mental health support are essential for fostering equitable mental health outcomes.

In response to the rise in mental health problems among youth during the COVID-19 pandemic, we conducted a qualitative study in March 2022, using a user-centered design approach guided by ecological theories, to adapt group support psychotherapy into tele-support psychotherapy (TSP) via mobile phones. The development of a call platform, informed by the unified theory of acceptance and use of technology, was integrated into the Medical Concierge Group’s (TMCG) telehealth services under Rocket Health Africa. This platform included a dedicated toll-free line for psychotherapy, connecting users with lay counselors. An open-label randomized controlled trial (PACTR202201684613316) was conducted to assess the feasibility, acceptability, and effectiveness of TSP in combination with standard mental health services (n = 154) compared with standard mental health services alone (n = 146) among youth with mild to moderate major depression in Kampala. Participants commonly equated mental health with mental illness and reported significant challenges, including financial stress, substance abuse, and family dysfunction. Although digital interventions were largely accepted, some participants preferred in-person services. The adapted TSP maintained gender sensitivity and used folk tales, stories, riddles, and creative visualizations to facilitate emotional expression, acquisition of coping strategies, and income-generating skills, addressing both emotional and socio-economic needs.

After successfully developing and evaluating group support psychotherapy (GSP) as a first-line treatment for mild-to-moderate depression in adults, we aimed to adapt and assess this approach for children and adolescents (CA) (ages 10–18) living with HIV. In June 2021, 30 young people and 30 caregivers participated in separate GSP sessions. Data on psychosocial issues and GSP effectiveness were collected through focus groups and interviews. Insights were guided by the ecological validity and culturally sensitive framework. An open-label randomized controlled trial in Kitgum, with 120 participants, registered with PACTR, number 202006601935462, compared GSP plus intensive adherence counseling (IAC) to IAC alone, assessing feasibility, acceptability, depression, anxiety, and HIV treatment outcomes. We found that CA with HIV struggled with self-esteem issues, suicidal thoughts, medication adherence, and food insecurity, alongside stigma, discrimination, and limited mental health programs. The adult GSP model was adapted for CA by creating gender- and age-specific groups, simplifying language, and incorporating play and expressive art activities. Caregivers were concurrently engaged with the adult GSP model. GSP participants showed a significantly greater reduction in depression symptoms compared to IAC participants.

Introduction: Addressing the intersection between mental health and HIV is critical for the wellbeing of persons living with HIV (PLWH). This systematic review synthesized the literature on mental health interventions for PLWH in low‐ and middle‐income countries (LMICs) to determine intervention components and explore their relationship with intervention effectiveness.Methods: We included only controlled clinical trials of interventions aiming to improve the mental health of PLWH. We conducted a search in the following databases: PubMed, CINAHL, PsycINFO and EMBASE for eligible studies describing the evaluation of interventions for mental health problems among PLWH in LMICs published through August 2020. Two reviewers independently screened references in two successive stages of title/abstract screening and then full‐text screening for references meeting title/abstract criteria.Results: We identified a total of 30 eligible articles representing 6477 PLWH who were assigned to either the intervention arm (n = 3182) or control arm (n = 3346). The mental health interventions evaluated were psychological (n = 17, 56.67%), pharmacological (n = 6, 20.00%), combined psychological and pharmacological (n = 1, 3.33%) and complementary/alternative treatments (n = 6, 20.00%). The mental health problems targeted were depression (n = 22, 73.33 %), multiple psychological symptoms (n = 1, 3.33%), alcohol and substance use problems (n = 4, 13.33%), post‐traumatic stress disorder (n = 1, 3.33%) and HIV‐related neuro‐cognitive impairment (n = 2, 6.67%). Studies of interventions with significant effects had significantly a higher number of active ingredients than those without significant effects [3.41 (2.24) vs. 1.84 (1.46) Mean (SD)] [Mean difference = −1.56, 95% CI = −3.03 to −0.09, p = 0.037].Conclusions: There continue to be advances in mental health interventions for PLWH with mental illness in LMICs. However, more research is needed to elucidate how intervention components lead to intervention effectiveness. We recommend scale up of culturally appropriate interventions that have been successfully evaluated in low‐ and middle‐income countries.

The prevalence and factors associated with major depressive disorder (MDD) among adults with cancer have been documented in the scientific literature. However, this data is limited among children and adolescents with cancer; especially in low resource settings such as Uganda. We assessed the prevalence and factors associated with MDD in children and adolescents attending the Uganda cancer institute out-patient clinic. This was a cross-sectional study in which three hundred and fifty-two children and adolescents with any cancer diagnosis were screened for depression using the Child Depression Inventory (CDI) and evaluated with the mini neuropsychiatric interview for children and adolescents (MINI-KID). Associated factors were assessed using a standardized questionnaire that assessed child and caregiver demographic and psychosocial characteristics. Multiple logistic regression models were used to assess factors independently associated with MDD. Of the 352 children and adolescents recruited in the study 134(38%) scored above a cut-off point of 13 on the CDI indicating significant depression symptoms. However, 91(26%) met criteria for MDD. The majority of those with MDD (n = 59 64.8%) had CDI scores of 13–19 indicating mild depression, 30(33%) had scores of 20–25 indicating moderate depression and 2(2.2%) had scores of 25 and above indicating severe depression. Protective factors against MDD were having a special person in the respondent’s life (p = 0.002) and using self-distraction as a coping method (p = < 0.001). Risk factors were being an adolescent(p = < 0.001). The prevalence of MDD is substantial in children and adolescents with cancer in Uganda. Given that the majority had a mild-moderate depression, there is an urgent need to integrate psychotherapy-the first-line treatment for depression into the routine care of children and adolescents with cancer.