Enhancing HIV assisted contact tracing in Malawi through blended learning: An Implementation Science Study

项目总结/摘要 背景：自愿协助接触者追踪（ACT）是一种循证方法， 需要艾滋病毒治疗和预防的人。马拉维与撒哈拉以南非洲的许多国家一样， 通过了ACT政策，以支持其艾滋病毒检测、治疗和病毒抑制的“95-95-95”目标。然而，在这方面， 由于卫生工作者能力不足和临床协调不足，马拉维的青蒿素综合疗法实施情况一直不佳。 通过前期工作，我们的团队1）制定了一套实施策略（基于理论的健康 工人培训和持续质量改进过程），解决这些障碍; 2）包装这些 战略融入一个混合学习平台，结合数字和面对面的方式;和3）实地测试 马拉维的一揽子计划取得了可喜的初步成果。在这一建议中，一揽子计划将严格 在马拉维对执行情况、服务吸收情况和成本效益结果进行了评价。总体 假设是混合学习ACT包将是可行的，可接受的实施，建立健康 工作人员和设施的ACT能力，导致更多的接触者接受艾滋病毒检测，并在马拉维具有成本效益 上下文目的和方法：通过一项两组实用性随机分组实施试验， 拟议的研究将通过三个具体目标解决这些差距。马拉维两个地区的20个设施 将以1：1的比例随机分配，以接受混合学习实施包（增强版）和标准版 实施包（标准），并遵循了两年。在第一个目标中，共助社区的执行成果 将在增强型和标准型之间进行比较。卫生工作者对ACT程序的忠诚度（主要 结果）将通过音频记录的ACT遭遇进行评估。次要结局包括设施 通过强化执行战略，以及卫生工作者的可行性和可接受性。在 第二个目标是，将在加强组和标准组之间比较艾滋病毒服务的接受结果。的 ACT提供的指数数量、引出的接触数量、检测艾滋病毒的接触数量（主要） 结果），并将比较两组之间诊断为HIV阳性的接触者人数。在 第三个目标是审查成本和成本效益结果。主要结果是增量成本 每挽救的残疾调整生命年。这将在试验人群中估计并在全国范围内预测。 团队：该团队由一名具有ACT专业知识的新的早期主要研究者领导。这项工作是一个 学术机构和一个位于马拉维的大型PEPFAR执行伙伴之间的合作奋进 在马拉维卫生部的指导下。该小组在艾滋病毒实施、实施和管理方面 以科学、技术为基础的干预措施、定性和定量研究方法以及成本效益 分析.影响：该提案通过创新的研究问题解决了重大的知识差距 使用精心设计的研究计划。这些发现将为如何弥合 ACT研究与实践之间的差距，这是实现95-95-95目标的关键一步。

Project Summary/Abstract Background: Voluntary assisted contact tracing (ACT) is an evidence-based approach that efficiently identifies persons in need of HIV treatment and prevention. Malawi, like many countries in sub-Saharan Africa, has adopted ACT policies to support its “95-95-95” targets for HIV testing, treatment, and viral suppression. However, Malawi’s ACT implementation has been poor due to deficits in health worker capacity and clinical coordination. Through preliminary work, our team has 1) developed a set of implementation strategies (theory-based health worker training and continuous quality improvement processes) that address these barriers; 2) packaged these strategies into a blended learning platform that combines digital and face-to-face modalities; and 3) field-tested the package in Malawi with promising preliminary results. In this proposal, the package will be rigorously evaluated in Malawi for implementation, service uptake, and cost-effectiveness outcomes. The overarching hypothesis is that the blended learning ACT package will be feasible and acceptable to implement, build health worker and facility ACT capacity, lead to more contacts tested for HIV, and be cost-effective in the Malawian context. Aims and Methods: Through a two-arm pragmatic cluster randomized implementation trial, the proposed research will address these gaps through three specific aims. Twenty Malawian facilities in two districts will be randomized 1:1 to receive the blended learning implementation package (enhanced) versus standard implementation package (standard) and followed for two years. In the first aim, ACT implementation outcomes will be compared between the enhanced and standard arms. Health worker fidelity to ACT procedures (primary outcome) will be assessed through audio-recorded ACT encounters. Secondary outcomes include facility adoption of the enhanced implementation strategy, as well as health worker feasibility and acceptability. In the second aim, HIV service uptake outcomes will be compared between the enhanced and standard arms. The number of indexes offered ACT, number of contacts elicited, number of contacts tested for HIV (primary outcome), and number of contacts diagnosed as HIV-positive will be compared between the two arms. In the third aim, cost and cost-effectiveness outcomes will be examined. The primary outcome is the incremental cost per disability adjusted life year saved. This will be estimated in the trial population and projected nationally. Team: The team is led by a new and early stage Principal Investigator with ACT expertise. The work is a collaborative endeavor between academic institutions and a large Malawi-based PEPFAR implementing partner with guidance from the Malawi Ministry of Health. The team has expertise in HIV implementation, implementation science, technology-based interventions, qualitative and quantitative research methods, and cost-effectiveness analysis. Impact: This proposal addresses a significant knowledge gap via an innovative research question using a well-designed research plan. The findings will offer important insights and innovations into how to bridge the gap between ACT research and practice, a critical step towards achieving the 95-95-95 targets.