Trial reportJMIR medical education2026
Cost-Effectiveness of a Blended Learning Training Approach for Health Care Workers Conducting HIV Index Case Testing in Malawi: Secondary Economic Analysis of a Cluster-Randomized Controlled Trial.
Trial report in JMIR medical education, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Authors and funding
14 authors.
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Abstract
backgroundIndex case testing (ICT) is an effective strategy for HIV case finding, but implementation in low- and middle-income countries (LMICs) is often limited by cost and logistical challenges. Traditional ICT training-centralized and in-person-is costly, disrupts service delivery, and varies in quality.
objectiveThis study evaluates the cost-effectiveness of a blended learning (BL) implementation package designed to build health care worker capacity for ICT, combining tablet-guided teaching and practice sessions, phone-based feedback, and tablet-guided continuous quality improvement, compared with standard of care (SOC) training.
methodsThe Package of Resources for Assisted Contact Tracing: Implementation, Costs, and Effectiveness (PRACTICE) cluster-randomized controlled trial included 33 clusters in southern Malawi from May 2022 to September 2023, randomized 2:1 to SOC (n=22) or SOC + BL implementation package (n=11). Our cost-effectiveness analysis, from the health system perspective, used microcosting, time-and-motion assessments, and observed trial outcomes. The decision tree model estimated total program costs, contact testing outcomes, and incremental cost-effectiveness ratios (ICERs) per contact tested and per person diagnosed with HIV across 1 year of implementation. Sensitivity analyses assessed parameter uncertainty, and a scenario analysis modeled a nationwide scale-up under a decentralized, Ministry of Health-led approach.
resultsOur model simulated 100,000 index clients eligible for contact elicitation over 1 year across 2 districts (50,000 per arm). The BL implementation package arm yielded 891 additional contacts tested and 54 more HIV diagnoses. The ICERs were US $125 per contact tested and US $2045 per person diagnosed with HIV; excluding training development costs reduced these to US $69 and US $1136, respectively. Nationwide scale-up under a Ministry of Health-led model further reduced ICERs to US $43 per contact tested and US $698 per person diagnosed with HIV. Probabilistic sensitivity analyses showed the BL implementation package was cost-effective in most simulations.
conclusionsThe BL implementation package improved ICT delivery and HIV case finding. Scenario analyses suggested that a decentralized, government-led scale-up could substantially reduce costs and may represent an efficient case-finding strategy, particularly in Malawi's mature epidemic. BL implementation packages provide a scalable, system-integrated, cost-effective approach that could strengthen health care worker capacity across other service delivery areas in low-resource settings. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR2-10.1136/bmjopen-2023-077706.
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