Enhancing HIV assisted contact tracing in Malawi through blended learning: an implementation science study

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Summary Abstract Background: Assisted Contact Tracing (ACT) is a voluntary process in which the contacts of persons living with HIV, also called index cases, are identified and contacted for HIV testing. Multiple studies have shown ACT’s efficacy in identifying new HIV cases across sub-Saharan Africa. Despite its proven efficacy, limited research has been done showing how stigma may specifically impact ACT uptake. This is critical as stigma, a phenomenon defined as an individual or group of individuals being perceived as having a discrediting, undesirable, or negative attribute that ‘others’ them in their own eyes or the eyes of others, has repeatedly been shown to negatively impact HIV outcomes and the quality of life for people living with HIV (PLWH). Aims & Methods: Under the parent cluster randomized controlled PRACTICE study (R01MH124526) a blended learning implementation package is being assessed for its ability to improve ACT outcomes, health care worker fidelity to ACT counseling, and cost-effectiveness. Blended learning involves training health workers using both electronic and in-person modalities. The proposed mixed methods supplement aims to assess the impact that stigma has on ACT and the role that the blended learning training can have on stigma reduction. This will be accomplished through three aims. Aim 1 examines whether the blended learning package reduces stigmatizing attitudes towards PLWH held by health workers. This aim will use both quantitative and qualitative data collection. Through quantitative analysis we will characterize and compare health worker stigma scores across study arms over time through the administration of two adapted stigma scales. Qualitatively, we will explore health worker perceptions of PLWH, and their attitudes and beliefs about working with index clients and their contacts over time through in-depth interviews with health workers. Aim 2 compares enhanced and standard arms for anticipated stigma among index clients. Index clients will participate in exit interviews that include the 9-item Weiser stigma scale to compare anticipated stigma between study arms. Team: Offering mentorship in HIV stigma, implementation science, and quantitative and qualitative research methodologies, the mentored trainee is well positioned to address these aims. Further, the team’s years of combined experience mentoring and guiding students offers a wealth of support to the student carrying out the proposed study aims. Significance: This research makes a significant contribution by examining stigma as a factor that may negatively impact ACT uptake in real world settings and ultimately how to address it. Conduct of the research will also lead to successful completion of doctoral training for this promising trainee.