Speaker
Description
Abstract
Background: Adolescents in low and middle-income countries experience high rates of common mental disorders (CMDs) but have limited access to adolescent-friendly, evidence-based care. While Interpersonal Psychotherapy for Adolescents (IPT-A) is effective, brief group IPT-A delivered through task-shifted, stepped care has not been rigorously evaluated in Kenyan primary care.
Methods: We conducted a pilot randomized controlled trial to examine the acceptability, feasibility, and preliminary effectiveness of the Ushirikiano treatment model, a task-shifted, stepped care approach combining a brief (four-session) group IPT A (IPT G A) delivered by community health promoters, with fluoxetine for severe cases where indicated. Ethical approval was granted by the Kenyatta National Hospital/University of Nairobi Ethics & Research Committee (Approval no: P479/06/2024), National Commission for Science, Technology, and Innovation (License no: NACOSTI/P/24/41938), and the Nairobi City County Government (Ref: NCCG/HWN/REC/693).
Adolescents aged 12–18 years with DSM-5-TR major depressive disorder, anxiety disorder, and/or somatic symptom disorder (N=32) were randomized to the Ushirikiano treatment model or enhanced treatment as usual (eTAU). Quantitative and qualitative data were collected at baseline, post-treatment, and at follow-up at months 1 and 2. The capacity, opportunity, motivation to behavior (COM-B) framework informed the analysis of behavior change.
Results: All adolescents in the intervention arm were retained compared with 69% in eTAU at the termination phase of the intervention. Intervention fidelity was moderate to high and improved with supervision. Participants reported that the intervention was acceptable, relevant, and supportive, and that they applied IPT-G-A skills to interpersonal and school-related stressors. Preliminary outcomes suggested greater reductions in depressive symptoms and modest functional improvement in the Ushirikiano arm, with most participants achieving symptomatic remission at the month 2 follow-up. Community health promoters reported increased confidence with blended training and ongoing supervision.
Conclusions: The Ushirikiano treatment model appears acceptable and feasible for addressing adolescent CMDs in Kenyan primary care and shows promising early signals of effectiveness. These findings support further evaluation in fully powered trials to determine clinical effectiveness, cost-effectiveness, and optimal implementation strategies.