Training Lay Healthcare Workers to Optimize TB Care and Improve Outcomes in Malawi

Dignitas International

Status: Completed

Conditions: Tuberculosis

Treatments: Other: KT intervention

Study type: Interventional

Funder types: Other

Identifiers

NCT02533089

TB KT intervention

Details and patient eligibility

About

Task shifting of less complex healthcare tasks to lay health workers (LHWs) is increasingly employed strategy to address the global shortage of skilled health workers. Despite availability of effective treatment, tuberculosis (TB) remains an important cause of mortality with 1.3 million lives lost globally to TB in 2012. The greatest proportion of new TB cases occurs in Africa and over 95% of TB deaths occur in low income countries (LICs). In response to the combined high TB burden and severe healthcare worker shortages in these settings, outpatient TB care is among the tasks commonly shifted to LHWs.

LHWs are community members who have received some training but are not healthcare professionals. Randomised trials show LHWs improve access to basic health services and TB treatment outcomes, however, insufficient training and supervision are recognized barriers to their effectiveness.

The investigators' goal is to improve TB care provided by LHWs in Malawi by implementing and evaluating a knowledge translation (KT) strategy designed to facilitate incorporation of evidence into LHW practice. The investigators will employ a mixed methods design including a pragmatic cluster randomized controlled trial to evaluate effectiveness of the strategy and qualitative methods to understand barriers and facilitators to scalability and sustainability of the program.

Enrollment: 1,153 patients

Sex: All

Volunteers: No Healthy Volunteers

Inclusion criteria

• all health centers in participating districts that routinely provide TB care will be included.
• LHWs who have received the intervention and patients receiving care at participating health centers will be eligible to participate in interviews

Exclusion criteria

• health centers that do not routinely provide TB care
• LHWs unwilling or unable to give informed consent.
• TB patients less than 18 years of age unaccompanied by a parent or guardian, patients/guardians or LHWs unwilling or unable to give informed consent, patients presenting to a health center they are not routinely followed at.

Trial design

1,153 participants in 2 patient groups

KT intervention

Experimental group

Description:

Multifaceted KT strategy employing peer-trainer led educational outreach, a point of care reminder tool, and a peer mentoring network.

Treatment:

Other: KT intervention

Control

No Intervention group

Description:

Control sites will receive no intervention, with LHW training left to the discretion of the health centers TB focus LHW. Control sites will not have access to the point of care tool.