Technology‑Assisted Problem Management Plus to Improve Perinatal Mental Health in Rural Uganda

Perinatal depression is a major public health problem globally, yet it remains critically under-detected in Uganda, where prevalence estimates range from 5% to 35.8%. Limited mental healthcare service access due to barriers such as stigma and mental health workforce shortages disproportionately affects rural populations, who have the lowest treatment coverage for mental disorders. Community Health Workers (CHWs) represent a promising and unique opportunity for lay workers to bridge this treatment gap, given their community embeddedness and trust. However, CHWs face substantial challenges in delivering both routine health promotion activities and evidence-based psychological interventions, such as the World Health Organization's Problem Management Plus (PM+). This suggests higher cognitive load and workload burden on non-specialist providers, which affects intervention fidelity, CHW well-being, and the scalability of task-shifted mental health care in low-resource settings. This project will develop and evaluate a Technology‑Assisted Problem Management Plus Uganda (TA‑PM+ UG), a culturally adapted, CHW‑delivered digital mental health intervention to improve detection and treatment of perinatal depression in rural households. Building on evidence from Pakistan demonstrating feasibility and effectiveness of that TA‑PM+  to reduce cognitive load and standardizes delivery through avatar‑based videos and algorithm‑guided workflows that is integrated with a Clinical Decision Support Tool (CDST) with digital PHQ‑2/PHQ‑9 screening, automated triage, and real‑time remote physician consultation. Using the ADAPT‑ITT framework, we will iteratively co‑design and optimize the TA‑PM+ UG App with CHWs, pregnant women, and health system stakeholders to ensure cultural, linguistic, and contextual relevance. This collaborative international research project seeking NIH funding (PA-26-002) includes: (1) domestic technical development of the CDST and digital screening algorithms; (2) international adaptation and usability testing through iterative PDSA cycles; (3) community‑level prevalence assessment, pilot and cluster randomized trial to evaluate feasibility, fidelity, and preliminary effectiveness; and (4) implementation evaluation using RE‑AIM/PRISM. The project will generate scalable evidence on CHW‑delivered digital psychotherapy and strengthen Uganda’s capacity for community‑based maternal mental healthcare. By shifting evidence‑based psychological treatment from facilities to households, TA‑PM+ UG aims to reduce the perinatal mental health treatment gap and improve maternal wellbeing in resource‑limited settings.