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.