Mix of digital and in-person training improves index testing in Malawi

30 September 2021

Trial offering health workers ‘blended’ training results in a two-fold increase in the number of people diagnosed with HIV

A nurse wearing a stethoscope looks into the camera

A trial in Malawi that provided health workers with a mix of digital and in-person training on assisted index testing has resulted in a two-fold increase in the number of people being diagnosed with HIV. 

Assisted index testing is when a person with HIV receives counselling and a choice of support to tell their sexual and injecting partners and their children they have HIV. Options include the person with HIV having a health worker present when they disclose their status, or having a healthcare worker tell their contacts they have been exposed to HIV without revealing the identity of the person with HIV (this person is known as the ‘index case’).

Many sub-Saharan African countries have an assisted index testing policy. But in reality, most healthcare facilities struggle to provide this service well. 

To improve this situation, in 2019 researchers provided a mix of digital and in-person index-testing training for 12 healthcare workers at six clinics in Mulanje, Malawi.

The training consisted of a PowerPoint presentation with a pre-recorded narration. It included role-play videos showing experienced counsellors in different index-testing scenarios. Throughout the course, participants received prompts to practice the skills they had learned in small, face-to-face groups and to have group discussions. They also received feedback on their practice sessions.

Researchers compared data from two months before the blended training, when only face-to-face training was available, and four months after the blended training had taken place.

The mean number of people with HIV who received index-testing counselling rose from 63 to 101 per facility per month.

The number of identified partners or children rose from 75 to 131 per facility per month.

The number of partners or children who took an HIV test rose from 27 to 41 per facility per month.  

These rises resulted in a 2.3 increase in the mean number of people diagnosed with HIV.

The proportion of people diagnosed with HIV who chose assisted index testing, rather than ‘passive referral’, rose from 88% to 95%. Passive referral is when someone with HIV is encouraged to tell their contacts they have HIV, but does not receive any direct support to do so.

Researchers also used a 30-point scale to assess how well the trained health workers provided index testing. Before the blended training, the median score was 6 out of 30. After the training, this rose to 25.5 out of 30.

The findings suggest that blended training could improve HIV index testing in Mulanje and in similar settings.

The trial happened before the COVID-19 pandemic began. But as COVID-19 has made it more difficult to provide in-person training courses, blended training that has a large digital element may offer an effective, inexpensive alternative. 

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Written by Hester Phillips