Acceptability and feasibility of the Ushirikiano treatment model for Kenyan adolescents: a pilot randomized controlled trial.

INTRODUCTION

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. Adolescents aged 12-18 years with DSM-5 TR depression, anxiety, and/or somatic symptom disorder (N = 32) were randomized to the Ushirikiano 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 COM-B framework informed the assessment of behavior change.

RESULTS

All adolescents in the intervention arm were retained compared with 69% in eTAU. Intervention fidelity ranged from moderate to high and showed improvement with supervision. Participants found the intervention acceptable, relevant, and supportive, and reported applying IPT-G-A skills to handle interpersonal and school-related stressors. Community health promoters reported increased confidence with blended training and ongoing supervision. Preliminary outcomes trends suggested potential reductions in depressive symptoms and modest functional improvement in the Ushirikiano arm, with most participants achieving symptomatic remission at the month 2 follow-up. As a pilot study, these findings provide preliminary evidence of potential benefit and support further evaluation of the intervention in a fully powered trial.

CONCLUSION

The Ushirikiano treatment model appears acceptable and feasible for addressing adolescent depression in Kenyan primary care. While preliminary findings suggest the potential for improvements in depressive symptoms and functioning, the study was not designed to establish effectiveness and did not assess for anxiety and somatic symptom disorder. These findings support further evaluation in fully powered trials to determine clinical effectiveness for CMDs, cost-effectiveness, and optimal implementation strategies.

CLINICAL TRIAL REGISTRATION: https://pactr.samrc.ac.za/TrialDisplay.aspx?TrialID=33227, Pan African Clinical Trial Registry, PACTR202503728947243.