Abstract
Background
In low-income countries, only about a third of Human Immunodeficiency Virus/Acquired Immune Deficiency Syndrome (HIV/AIDS) patients eligible for anti-retroviral treatment currently receive it. Providing decentralized treatment close to where patients live is crucial to a faster scale up, however, a key obstacle is limited health system capacity due to a shortage of trained health-care workers and challenges of integrating HIV/AIDS care with other primary care services (e.g. tuberculosis, malaria, respiratory conditions). This study will test an adapted primary care health care worker training and guideline intervention, Practical Approach to Lung Health and HIV/AIDS Malawi (PALM PLUS), on staff retention and satisfaction, and quality of patient care.
Methods/Design
A cluster-randomized trial design is being used to compare usual care with a standardized clinical guideline and training intervention, PALM PLUS. The intervention targets middle-cadre health care workers (nurses, clinical officers, medical assistants) in 30 rural primary care health centres in a single district in Malawi. PALM PLUS is an integrated, symptom-based and user-friendly guideline consistent with Malawian national treatment protocols. Training is standardized and based on an educational outreach approach. Trainers will be front-line peer healthcare workers trained to provide outreach training and support to their fellow front-line healthcare workers during focused (1-2 hours), intermittent, interactive sessions on-site in health centers. Primary outcomes are health care worker retention and satisfaction. Secondary outcomes are clinical outcomes measured at the health centre level for HIV/AIDS, tuberculosis, prevention-of-mother-to-child-transmission of HIV and other primary care conditions. Effect sizes and 95% confidence intervals for outcomes will be presented. Assessment of outcomes will occur at 1 year post- implementation.
Discussion
The PALM PLUS trial aims to address a key problem: strengthening middle-cadre health care workers to support the broader scale up of HIV/AIDS services and their integration into primary care. The trial will test whether the PALM PLUS intervention improves staff satisfaction and retention, as well as the quality of patient care, when compared to usual practice.
Trial Registration
Current controlled Trials: ISRCTN47805230
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Details
1 Dignitas International, Toronto, Canada (GRID:grid.498756.1); University of Toronto, Department of Medicine, Toronto, Canada (GRID:grid.17063.33) (ISNI:0000 0001 2157 2938); Management and Evaluation, Department of Health Policy, Toronto, Canada (GRID:grid.17063.33); Sunnybrook Health Sciences Center, Toronto, Canada (GRID:grid.413104.3) (ISNI:0000000097431587)
2 Research for Equity and Community Health (REACH) Trust, Lilongwe, Malawi (GRID:grid.463633.7)
3 Ministry of Health Malawi, Lilongwe, Malawi (GRID:grid.415722.7)
4 University of Cape Town Lung Institute, University of Cape Town, Knowledge Translation Unit, Groote Schuur, South Africa (GRID:grid.7836.a) (ISNI:0000000419371151)
5 Management and Evaluation, Department of Health Policy, Toronto, Canada (GRID:grid.7836.a); University of Sydney, George Institute for Global Health, Sydney, Australia (GRID:grid.1013.3) (ISNI:000000041936834X)
6 Dignitas International, Toronto, Canada (GRID:grid.498756.1)
7 Dignitas International, Toronto, Canada (GRID:grid.498756.1); Management and Evaluation, Department of Health Policy, Toronto, Canada (GRID:grid.498756.1); University of Cape Town Lung Institute, University of Cape Town, Knowledge Translation Unit, Groote Schuur, South Africa (GRID:grid.7836.a) (ISNI:0000000419371151)
8 Ministry of Health Malawi, Lilongwe, Malawi (GRID:grid.415722.7); Kamuzu Highway, Zomba Central Hospital, Zomba, Malawi (GRID:grid.415722.7)
9 Nurses and Midwives Council of Malawi, Lilongwe, Malawi (GRID:grid.415722.7)