Digital Training for Lay Health Care Workers' Knowledge and Skills in HIV Index Case Testing: Cluster Randomized...

Area of Science:

• Global Health
• Digital Health Interventions
• HIV/AIDS Prevention

Background:

• Task shifting in low-resource settings relies on lay healthcare workers (HCWs) for essential services like HIV index case testing.
• Adequate, specialized training is crucial for lay HCWs to effectively provide these services.
• The impact of digital technologies on lay HCW training in low-resource contexts remains underexplored.

Purpose of the Study:

• To evaluate the effectiveness of digital training interventions for lay HCWs in Malawi.
• To assess the impact of digital training on lay HCWs' knowledge, attitudes, and skills related to HIV index case testing.

Main Methods:

• A cluster randomized controlled trial involving 306 lay HCWs across 34 health facilities in Malawi.
• Comparison of an enhanced arm (standard training + tablet-guided digital training) with a standard arm (in-person training only).
• Assessment of knowledge, attitudes, and skills (fidelity to protocols) using questionnaires and checklists before and after training.

Main Results:

• The enhanced digital training arm showed statistically significant improvements in knowledge (4.4% higher) and attitudes (4.5% higher) compared to the standard arm.
• Lay HCWs in the enhanced arm demonstrated substantially higher fidelity to both index client (30.5 pp higher) and contact client (24.0 pp higher) counseling protocols.
• High completion rates (81-100%) were observed for the digital training components in the enhanced arm.

Conclusions:

• Digital training is a viable and effective strategy for improving lay HCW performance in HIV index case testing.
• This approach holds significant promise for enhancing healthcare capacity and service delivery in resource-limited settings.
• Digital interventions can supplement traditional training methods to improve health outcomes.