Pilot-Testing a Blended Learning Package for Health Care Workers to Improve Index Testing Services in Southern Malawi: An Implementation Science Study.
Pilot-Testing a Blended Learning Package for Health Care Workers to Improve Index Testing Services in Southern Malawi: An Implementation Science Study.
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DOI：
10.1097/qai.0000000000002796
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发表时间：
2021-12-15
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影响因子：
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通讯作者：
Rosenberg NE
中科院分区：
文献类型：
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作者：
Tembo TA;Simon KR;Kim MH;Chikoti C;Huffstetler HE;Ahmed S;Mang'anda C;Chu SQ;Manyeki R;Kavuta E;Majoni R;Phiri D;Kalanga A;Rosenberg NE
艾滋病病毒（HIV）指标检测是一种干预措施，即支持HIV阳性的“指标病例”（被诊断为HIV感染者）有效地召集其“接触者”（性伴侣和子女），它能有效识别出需要治疗的HIV感染者以及需要预防的未感染HIV者。然而，在撒哈拉以南非洲的医疗环境中，指标检测的实施情况并不理想。本研究的目的是开发并试点测试一个混合式学习能力建设方案，以改善马拉维的指标检测实施情况。
2019年，一个结合了数字化和面对面培训模式的混合式学习方案在马拉维穆兰杰的6家医疗机构进行了实地测试，采用了实施和效果结果的前 - 后II型混合设计。通过在培训前后观察医护人员（HCW）与患者的接触情况来评估他们对干预措施的依从性。通过比较培训前两个月和培训后四个月的指标检测项目指标来检验初步效果。指标包括每个机构每月筛查的指标病例平均数、召集的接触者数量以及接受HIV检测的接触者数量。
在30分的量表上，医护人员对指标检测方案的依从性从方案实施前的6.0分提高到实施后的25.5分（p = 0.002）。指标检测效果指标也有所提高：筛查的指标病例（实施前 = 63，实施后 = 101，p < 0.001）；召集的接触者（实施前 = 75，实施后 = 131，p < 0.001）；接受HIV检测的接触者（实施前 = 27，实施后 = 41，p = 0.014）。
混合式学习方案提高了对指标检测方案的依从性和初步效果。该方案有可能加强HIV指标检测方法的实施，这是终结艾滋病流行的必要步骤。
HIV index testing, an intervention in which HIV-positive “indexes” (persons diagnosed with HIV) are supported to recruit their “contacts” (sexual partners and children) efficiently identifies HIV-infected persons in need of treatment and HIV-uninfected persons in need of prevention. However, index testing implementation in sub-Saharan African healthcare settings has been suboptimal. The objective of this study was to develop and pilot test a blended learning capacity-building package to improve index testing implementation in Malawi. In 2019, a blended learning package combining digital and face-to-face training modalities was field tested at six health facilities in Mulanje, Malawi using a pre-/post- type II hybrid design with implementation and effectiveness outcomes. Health care worker (HCW) fidelity to the intervention was assessed via observed encounters before and after the training. Preliminary effectiveness was examined by comparing index testing program indicators in the two months before and four months after the training. Indicators included the mean number of indexes screened, contacts elicited, and contacts who received HIV testing per facility per month. On a 30-point scale, HCW fidelity to index testing protocols improved from 6.0 pre- to 25.5 post-package implementation (p=0.002). Index testing effectiveness indicators also increased: indexes screened (pre=63, post=101, p<0.001); contacts elicited (pre=75, post=131, p<0.001); and contacts who received HIV testing (pre=27, post=41, p=0.014). The blended learning package improved fidelity to index testing protocols and preliminary effectiveness outcomes. This package has the potential to enhance implementation of HIV index testing approaches, a necessary step for ending the HIV epidemic.