Digital Training for Lay Health Care Workers’ Knowledge and Skills in HIV Index Case Testing: Cluster Randomized Trial
Year: 2026
Type: article
Study designs: Randomized Controlled Trial, Clinical Trial
Abstract: Background: Task shifting in low-resource settings requires lay health care workers (HCWs) to provide a variety of health services, such as HIV index case testing, whereby sexual partners and family members of people living with HIV are offered HIV testing. For this, lay HCWs require adequate specialized training. Digital technologies hold promise for training lay HCWs in low-resource settings, but their impacts on improving knowledge, attitudes, and skills are not understood. Objective: This study evaluates the impact of digital training on lay HCWs' knowledge, attitudes, and skills to provide HIV index case testing. Methods: We recruited lay HCWs from 34 health facilities in Malawi. We conducted a 2-arm cluster randomized controlled trial from 2022 to 2023, evaluating the impact of a digital training approach. Health facilities (clusters) were randomized 1:2 to the enhanced or standard arms. Lay HCWs in both arms received the standard in-person index case testing training. In addition, lay HCWs in the enhanced arm received tablet-guided training. Knowledge acquisition was measured using multiple-choice questionnaires administered before and after training. Attitudinal gains were assessed through a questionnaire with Likert scale responses before and after training. Between-arm mean differences were evaluated using generalized estimating equations. Skills (fidelity to index and contact testing protocols) were measured using 15-item checklists. Fidelity scores were compared between the enhanced and standard arms by estimating mean differences and 95% CIs using generalized estimating equations. Results: We enrolled 306 lay HCWs, with 125 (40.8%) in the enhanced arm and 181 (59.2%) in the standard arm. In the enhanced arm, there was 100% completion of the digital portion, 98% (123/125) completion of the face-to-face tablet-guided portion, and 81% (101/125) to 93% (116/125) completion of quality improvement sessions. Knowledge improved by 4.4% (95% CI 0.7%-8.2%) more in the enhanced arm than in the standard arm (P=.02). Attitudes toward digital training improved by 4.5% (95% CI 0.3%-7.0%) more in the enhanced arm than in the standard arm (P=.03). Lay HCWs' fidelity to index client counseling protocols was 30.5 (95% CI 26.0%-35.0%; P<.001) percentage points higher in the enhanced arm than in the standard arm. Fidelity to contact client counseling protocols was 24.0 (95% CI 20.6%-27.3%; P<.001) percentage points higher in the enhanced arm than in the standard arm. Conclusions: Digital training improved lay HCWs' knowledge, attitudes, and skills surrounding index case testing counseling. These findings support digital training as a useful strategy for strengthening the capacity of lay HCWs in low-resource contexts.
Source: JMIR Medical Education
DOI: 10.2196/89942
Language: English
Subfield: Infectious Diseases
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $1,873
Funders: National Aeronautics and Space Administration, U.S. Department of Veterans Affairs, Pew Charitable Trusts, Simons Foundation, John Templeton Foundation, Welch Foundation, Cancer Prevention and Research Institute of Texas, Helen Hay Whitney Foundation, Thrasher Research Fund, University of Texas Southwestern Medical Center, Global Down Syndrome Foundation, Pennsylvania State University, Karlsruhe Institute of Technology, University of Manitoba, Ministère de l’Enseignement Supérieur et de la Recherche Scientifique, UK Research and Innovation, Trond Mohn stiftelse, Japanese Society of Hematology, Den A. P. Møllerske Støttefond, Indian Institute of Science Education and Research Thiruvananthapuram, Ontario HIV Treatment Network, National Institute for Health and Care Research, Royal Society, Rosetrees Trust, National Heart Foundation of Australia, Rebecca L. Cooper Medical Research Foundation, La Trobe University, National Research Foundation, Indian Council of Medical Research, Council of Scientific and Industrial Research, India, Deutsche Forschungsgemeinschaft, Agence Nationale de la Recherche, Institut National de la Santé et de la Recherche Médicale, Keio University, Schweizerischer Nationalfonds zur Förderung der Wissenschaftlichen Forschung, Københavns Universitet, University of Technology Sydney, Fundação de Amparo à Pesquisa do Estado de São Paulo, National Natural Science Foundation of China, ZonMw, AXA Research Fund, Chinese Academy of Sciences, King Saud University, Austrian Science Fund, Beijing Normal University, Assistance Publique - Hôpitaux de Paris, Alfred Wegener Institute Helmholtz Centre for Polar and Marine Research, Generalitat Valenciana, Korea Research Institute of Standards and Science, Korea Health Industry Development Institute, Korea Basic Science Institute, National Research Foundation of Korea, Gottfried Wilhelm Leibniz Universität Hannover, Max-Planck-Gesellschaft, Princess Nourah Bint Abdulrahman University, Türkiye Bilimsel ve Teknolojik Araştırma Kurumu, China Scholarship Council, Nagoya University, Zhejiang Chinese Medical University, Universitetet i Bergen, Norges Forskningsråd, Bộ Giáo dục và Ðào tạo, University of Johannesburg, Lung Foundation Australia, Umm Al-Qura University, Natural Science Foundation of Shandong Province, Université de Rouen, Al Jouf University, Sir Edward 'Weary' Dunlop Medical Research Foundation, University of Sri Jayewardenepura, National Institute of Polar Research, Foundation of Liaoning Province Education Administration, Netherlands Earth System Science Centre, Ministry of Science and ICT, South Korea, JKA Foundation, Helmholtz-Zentrum Dresden-Rossendorf, Agencia Nacional de Investigación y Desarrollo, Alliance de recherche numérique du Canada, National Institutes of Health, National Institute of Food and Agriculture, Goddard Space Flight Center, Johnson Space Center, Horizon 2020 Framework Programme, Robert H. Lurie Comprehensive Cancer Center, NASA Headquarters, Canadian Institutes of Health Research, Natural Sciences and Engineering Research Council of Canada, Medical Research Council, Engineering and Physical Sciences Research Council, Natural Environment Research Council, Science and Technology Facilities Council, Australian Research Council, National Health and Medical Research Council, Japan Society for the Promotion of Science, Science and Engineering Research Board, Japan Science and Technology Agency, Bundesamt für Umwelt, Natural Science Foundation of Anhui Province, Innovate UK, European Regional Development Fund, Earmarked Fund for China Agriculture Research System, National Key Research and Development Program of China, Fundamental Research Funds for the Central Universities, National Major Science and Technology Projects of China, NIHR Imperial Biomedical Research Centre, Inserm Transfert, Deanship of Scientific Research, University of Jordan, Deanship of Scientific Research, Princess Nourah Bint Abdulrahman University, National Heart, Lung, and Blood Institute, National Institute of Mental Health, National Institute of General Medical Sciences, National Institute of Allergy and Infectious Diseases, Fogarty International Center, Office of Polar Programs, Defense Sciences Office, DARPA, NOAA Research, Medical Science and Technology Project of Zhejiang Province, Air Force Office of Scientific Research, HORIZON EUROPE European Innovation Council, Natural Science Foundation of Zhejiang Province, Daicel, Graduate Studies, University of California, Davis, Bezos Family Foundation, Research Ireland
OpenAlex ID: W7162871045