{
  "abstract": "Introduction Training health workers is a common implementation strategy to expand evidence-based interventions. Digital training is a promising way of reaching more health workers, minimising clinical interruptions and lowering costs, but clinical outcomes are rarely evaluated in low-income settings. Clinical outcomes were evaluated in Malawi’s HIV index case testing programme through the Package of Resources for Assisted Contact Tracing: Implementation, Costs, and Effectiveness study.Methods An unblinded cluster randomised controlled trial was conducted in 33 health facilities in two Malawian districts (2022–2023). Facilities were stratified by district and size and randomly assigned 2:1 to receive standard training or standard training plus a digital-based package. The package included asynchronous role-modelling, small-group practice, one-on-one feedback and tablet-guided quality improvement. Participants were lay health workers involved in index case testing. Index clients were people diagnosed with HIV. Contact clients were their partners, children and household members. Five coprimary outcomes, abstracted from programme registers over 1 year, were assessed at the cluster level: index client participation, contacts elicited, contacts tested, new HIV diagnoses and self-test kit provision. Impacts were estimated using negative binomial mixed-effects models (α=0.05).Results Clusters were randomly assigned to enhanced (n=11) or standard (n=22) arms and analysed in four 3-month increments (calendar-quarters) over a 1-year period. In each calendar quarter, clusters had a median of 281 potential index clients (IQR 220–427). Significant effects were observed for three primary outcomes: contact client elicitation (RR=1.37, 95% CI 1.10 to 1.71, p=0.006), contact client testing (RR=1.45, CI 1.10 to 1.92, p=0.01) and self-test kit provision (RR=2.29, 95% CI 1.19 to 4.40, p=0.01). Positive, but non-significant effects were observed for index client participation (RR=1.22, CI 0.93 to 1.60, p=0.1) and new HIV diagnoses (RR: 1.28, CI 0.94 to 1.76, p=0.1). No study-related adverse events occurred.Conclusions Enhanced digital training positively impacted meaningful clinical outcomes and could be replicated for expansion to other evidence-based interventions.Trial registration number NCT05343390.",
  "authors": [
    {
      "affiliations": [
        "Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA"
      ],
      "name": "Nora Rosenberg"
    },
    {
      "affiliations": [
        "Center for AIDS Research, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA",
        "School of Medicine, University of North Carolina at, Chapel Hill, North Carolina, USA"
      ],
      "name": "Katie Mollan"
    },
    {
      "affiliations": [
        "Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA"
      ],
      "name": "Jiayu Wang"
    },
    {
      "affiliations": [
        "Baylor College of Medicine Children’s Foundation Malawi, Lilongwe, Malawi"
      ],
      "name": "Tapiwa Tembo"
    },
    {
      "affiliations": [
        "Baylor College of Medicine Children’s Foundation Malawi, Lilongwe, Malawi"
      ],
      "name": "Mike Chitani"
    },
    {
      "affiliations": [
        "Baylor College of Medicine Children’s Foundation Malawi, Lilongwe, Malawi"
      ],
      "name": "Elizabeth Wetzel"
    },
    {
      "affiliations": [
        "School of Medicine, University of North Carolina at, Chapel Hill, North Carolina, USA"
      ],
      "name": "Sarah E Rutstein"
    },
    {
      "affiliations": [
        "School of Global and Public Health, Kamuzu University of Health Sciences, Blantyre, Malawi"
      ],
      "name": "Victor Mwapasa"
    },
    {
      "affiliations": [
        "Baylor College of Medicine Children’s Foundation Malawi, Lilongwe, Malawi"
      ],
      "name": "Duncan Phiri"
    },
    {
      "affiliations": [
        "Baylor College of Medicine Children’s Foundation Malawi, Lilongwe, Malawi"
      ],
      "name": "Angella Mkandawire"
    },
    {
      "affiliations": [
        "Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA",
        "Center for AIDS Research, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA"
      ],
      "name": "Vivian Go"
    },
    {
      "affiliations": [
        "Baylor College of Medicine Children’s Foundation Malawi, Lilongwe, Malawi",
        "Baylor College of Medicine Department of Pediatrics, Houston, Texas, USA"
      ],
      "name": "Maria Kim"
    },
    {
      "affiliations": [
        "Baylor College of Medicine Children’s Foundation Malawi, Lilongwe, Malawi",
        "Baylor College of Medicine Department of Pediatrics, Houston, Texas, USA"
      ],
      "name": "Saeed Ahmed"
    },
    {
      "affiliations": [
        "Baylor College of Medicine Children’s Foundation Malawi, Lilongwe, Malawi",
        "Baylor College of Medicine Department of Pediatrics, Houston, Texas, USA"
      ],
      "name": "Katherine R Simon"
    }
  ],
  "title": "Effect of a digital training package on clinical outcomes in Malawi’s index case testing programme: a cluster randomised controlled trial",
  "uid": "795241a3-cf37-5022-938c-7b7f91ce3eea"
}