Evaluating the Impact of a Community Health Worker Program in Neno, Malawi

Summary

This protocol concerns the implementation and evaluation of an intervention designed to realign the existing cadre of Community Health Workers (CHW) in Neno District, Malawi to better support the care needs of the clients they serve. The proposed intervention is a 'Household Model' where CHWs will be assigned to households, rather than HIV or TB specific patients, and will be trained to provide support for a wider range of conditions including HIV, hypertension, diabetes, and pediatric malnutrition. The new model is designed to improve retention in care for clients with chronic, non-communicable diseases, along with increased uptake of women's health services and treatment for pediatric malnutrition, while sustaining the high retention rates for clients in the HIV program. Eleven sites (health centres and hospitals) were arranged into six clusters by estimated size of the catchment area populations, with a population range of 11,680 to 26,260 and an average population of 20,400. The order in which the intervention will be rolled out across the sites will be randomized so that the intervention can be evaluated in a stepped-wedge cluster randomized controlled trial. These clusters were grouped based mostly on geographic location but also on catchment area sizes, in order to maximize feasibility of training for the CHW team and not overload CHW training sessions with too many trainees.

Conditions

• HIV/AIDS
• Hypertension
• Asthma
• Diabetes
• Epilepsy
• Mental Health Disorder
• Malnutrition
• Tuberculosis
• Antenatal Care
• Family Planning

Interventions

BEHAVIORAL

Household model

The proposed intervention is a 'Household Model' where, instead of being assigned to HIV or TB patients, CHWs will rather be assigned to households and will be trained to provide support for a wider range of conditions including HIV, hypertension, diabetes and pediatric malnutrition. The new model is designed to improve retention in care for clients with chronic, non-communicable diseases, along with increased uptake of women's health services and treatment for pediatric malnutrition, while sustaining the high retention rates for clients in the HIV program.

Sponsors & Collaborators

• University of Warwick

  collaborator OTHER

• Partners in Health

  lead OTHER

Principal Investigators

• Luckson Dullie, MBBS, M Fam Med · Partners in Health

• Elizabeth Dunbar, MPH · Partners in Health

• Emily Wroe, MD, MPH · Partners in Health

• Richard Lilford, Dsc, PhD, FRCOG, FRCP, FFPH · University of Warwick

• Celia Taylor, BSocSc (Hons), PhD, QTS, FHEA · University of Warwick

• Samuel Watson, PhD, MPH · University of Warwick

Study Design

Allocation

RANDOMIZED

Purpose

HEALTH_SERVICES_RESEARCH

Masking

NONE

Model

SEQUENTIAL

Eligibility

Sex

ALL

Healthy Volunteers

Yes

Timeline & Regulatory

Start

2017-03-01

Primary Completion

2019-07-31

Completion

2019-07-31

Countries

• Malawi

Study Locations