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