Comparing centralized and decentralized delivery of the Shamiri intervention for adolescent depression and anxiety in Kenya: a randomized controlled trial

This was a three-arm randomized controlled trial comparing centralized versus decentralized implementation of the Shamiri intervention among Kenyan secondary school students. The study addresses a critical gap in implementation science by empirically comparing dissemination strategies for evidence-based youth mental health interventions in low-resource settings. Study Design: Three-arm parallel-group RCT conducted across seven public secondary schools in Machakos and Makueni counties, Kenya (February-August 2023). Participants were randomized to: (1) centralized Shamiri delivery by originating organization, (2) decentralized delivery by trained external partner (AFRIMEB), or (3) treatment-as-usual control. Primary Outcomes: Depression (PHQ-8) and anxiety (GAD-7) symptoms at endpoint and one-month follow-up. Secondary outcomes included psychological wellbeing (SWEMWS) and comprehensive implementation metrics (fidelity, acceptability, penetration, cost-effectiveness). Registration: Pan-African Clinical Trials Registry (PACTR202305589854478) Ethics Approval: Kenyatta University Ethics Review Committee (PKU/2627/E1752) Funding: Fond's d'Innovation pour le développement (FID), Grant CKE 1196