Meet the Teams

Written by: Patricia M. Nabifo, Ochen Eric, Kintu Timothy Mwanje, Raymond Bernard Kihumuro | Team Tugambe 

Tugambe is a word in Luganda that means “talk to us.” The phrase captures a reality we kept missing in HIV clinics. Imagine this: a teenage girl sits across from a healthcare provider who is rushing to keep up with a long queue of patients. Her viral load is reviewed and her medication is dispensed, but no one asks how she feels. Antiretroviral therapy keeps her body healthy, yet the health of her mind often remains unseen.

Here’s something most people don’t know: Up to one in three young people living with HIV in sub-Saharan Africa experience depression. As young adults with a medical background in HIV care, our team recognizes that depression is a significant concern. Because depression is quiet, it is easy to miss. Crowded waiting rooms, ten-minute consultations, and overwhelmed providers create a system where mental health gets pushed aside. We had to do something.

The turning point came when we were accepted into the INSPIRE Designathon. Suddenly, there was space to think differently. We asked the simple questions: What if mental health screening did not have to compete with busy clinics and limited time? What if young people could engage on their own terms, privately and without pressure? 

These questions led us to Interactive Voice Response (IVR). IVR is not glamorous. It does not require smartphones or internet access. It is the same technology behind appointment reminders and automated phone menus. We believed its simplicity is its strength. A young person can call from any phone, listen to prompts in their own language, and respond using their keypad. No forms. No waiting rooms. No eyes watching.

Still, we did not know whether this approach would feel acceptable, which language would feel safe, or whether an automated system could be trusted with something as personal as emotional wellbeing. So instead of quickly building, we chose to slow down. We focused on formative work. The goal became listening before designing and learning before scaling.

As the idea took shape, we told our story; this time in a competitive pitching space. We shared not only the idea, but also the uncertainty behind it. We spoke honestly about our concern for young people living with HIV and our belief that IVR could help surface depression earlier. Emerging among the winners mattered. It gave us confidence and direction. It also helped us see this work beyond a single pilot. Our vision now stretches over the next several years, with the goal of making depression management a routine and integrated part of HIV care.

Progress, however, has not been straightforward. Like much research in Africa, one of the biggest challenges has been navigating ethics and regulatory approvals. As early career researchers, we have learned how slow, political, and demanding these processes can be. Inefficiencies within regulatory systems can delay promising work and strain limited resources. Learning how to maneuver these structures without losing momentum has required patience and resilience.

Beyond approvals, this journey has taught us how to pitch ideas clearly, how to develop community engagement plans that go beyond checklists, and how to listen during monthly engagements rather than defend assumptions. We have built new relationships, expanded our networks, and learned to recognize opportunity when it appears. So far, the work has been less about technology and more about people, trust, and learning to sit with uncertainty.

We now look ahead to securing institutional ethics approval and national regulatory clearance so the research can begin. That step matters, but it is not the point of this work. The point is whether young people living with HIV finally have a safe way to say how they are really doing.

This journey has taught us one clear lesson. Mental health in HIV care will not improve by adding more tasks to already overstretched clinics. It will improve when systems are designed to listen. If Tugambe succeeds in doing just that, in creating space for young people to speak without fear, interruption, or judgment, then it will have done something far more important than deploying a tool. It will have broken the silence.

Written by: Nomujuni Natukwatsa, Florence Mwangwa, and Collins Ampaire | Team Gamba Link, Uganda

In many rural communities across Uganda, young people rarely walk into hospitals to ask about sexual health products. Instead, they rely on community drug shops and trusted community care providers as their first point of contact for sexual health needs which may include HIV prevention services. Yet these accessible and trusted spaces are often excluded from formal HIV prevention strategies. 

The INSPIRE Designathon provided a platform for us to develop the Gamba Link project. Gamba means to speak, tell or address in Bantu languages in Uganda. Our project aims to onboard community medicine providers by introducing them to structured HIV prevention information in order to support them to speak to young people about accessing biomedical HIV prevention products. The Gamba Link project developed the PREP-Go toolkit, a tool box of familiar communication tools to support community medicine providers like drug shop attendants to initiate youth-friendly, non-judgmental conversations about using HIV prevention products and link adolescents and young adults (AYAs) to peer navigators for PrEP services at formal health facilities. 

Pre-exposure prophylaxis (PrEP) and post-exposure prophylaxis (PEP) are proven, effective HIV prevention tools. However, uptake among adolescents and young adults (15–24 years), particularly in rural areas, remains low. Young adolescents who are just beginning their sexual health journeys (15-20 years) are particularly vulnerable. Structural barriers such as low knowledge, fear of discussing sexual related matter with authority figures, stigma, limited youth-friendly services, and weak referral systems continue to stand in the way. 

Through community engagement and prior evidence, we learned an important insight — many rural youth do go and seek sexual health products from trusted community drug shops. These spaces are informal, familiar, and discreet. Despite this, drug shop attendants are rarely equipped with the confidence, language, or tools to discuss sensitive topics like HIV prevention. 

This gap presented both a challenge and an opportunity.

We designed PREP-Go, a structured communication toolkit that supports drug shop attendants to confidently and non-judgmentally initiate conversations about accessing HIV prevention with the help of age appropriate support through peer navigators, who provide PrEP in formal health services. 

Because community drug shops are not yet authorized to prescribe PrEP, we believe PREP-Go toolkit enables them to participate in HIV prevention actively by:

• Arousing curiosity about PrEP products 

• Sharing accurate, stigma-free PrEP information 

• Providing a clear referral pathway to supportive PrEP providers 

The toolkit includes a simple poster with visual information on who needs PrEP and how to access it, flash cards with PrEP choices, and a short, animated video to watch privately or share with acquaintances. All participating shops will have the name and phone contact of the nearest PrEP peer navigator. 

We engaged multiple stakeholders from the start: adolescents and young adults, drug shop attendants, and peer navigators. Their lived experiences helped shape every design decision. 

Drug shop attendants told us they often wanted to help young people but feared saying the wrong things which would scare away their customers. Youth shared that they valued confidentiality, discretion, and respectful communication more than medical expertise. Peer navigators emphasized the importance of building trust in the communities. These insights informed a key design principle: keep it simple, visual, supportive, and scalable.

The PREP-Go tool kit is being tested through a qualitative pilot study in four rural community pharmacies and drug shops in Lyantonde District of southwestern Uganda. The study uses a pre- and post-intervention design to assess feasibility, acceptability, fidelity, and sustainability. 

To understand how the toolkit works in practice, we are collecting data from: 

• Drug shop attendants who are using the toolkit 

• Peer navigators supporting referrals 

• Trained youth mystery clients observing real interactions

By combining focus group discussions, in-depth interviews, and mystery client visit reports, we aim to capture honest feedback on how youth experience PrEP conversations in these informal health settings. 

Young people in rural communities face a disproportionate risk of HIV due to social vulnerability, early sexual debut, limited access to services, and stigma. By bringing youth acceptable PrEP conversations closer to where youth already are, the PREP-Go toolkit helps normalize HIV prevention conversations even in commercial spaces and reduces missed opportunities for seeking these services. 

Equally important, the project builds youth leadership. Peer navigators and mystery clients gain skills in advocacy, communication, and community engagement — strengthening local capacity beyond the project lifespan. 

We envision a world where talking about HIV prevention is as normal, stigma-free, and accessible as buying pain relief medicine at a drug shop. 

Through the PREP-Go toolkit, we test if well-designed communication tools can unlock big changes in how communities approach HIV prevention. With continued collaboration, learning, and refinement, this model has the potential to transform rural HIV prevention across Uganda and similar settings. 

Innovation does not always require new buildings or complex technologies. Sometimes, it starts with the right tools sparking a conversation among willing people.