JMIR Publications

ABSTRACT

Despite progress towards the UNAIDS “95-95-95” targets (95% of HIV-positive persons tested, 95% of tested persons on treatment, and 95% of treated persons virally suppressed), a gap remains in achieving the first 95% target. Assisted contact tracing (ACT), in which health workers support HIV-positive indexes to recruit their contacts (sexual partners and children) for HIV testing, efficiently identify HIV-positive persons in need of treatment. ACT is recommended in the World Health Organization’s 2016 guidance, and although many countries, including Malawi, began implementing ACT, testing outcomes in routine settings have been worse than those in trial settings. To bridge the gap between research and practice and support scale-up in Malawi, a set of implementation strategies (“implementation package”) was developed using frameworks and theories. First, the Consolidated Framework for Implementation Research (CFIR) guided qualitative research to identify key barriers and facilitators to intervention delivery. Limited clinic coordination and health worker capacity to address the complexities of ACT were identified as key barriers; ongoing individual training and group problem-solving were identified as facilitators. Next, the theory of expertise, social cognitive theory and principles of continuous quality improvement informed the development of the implementation package to address these barriers and facilitators. Finally, human-centered design principles guided the translation of the implementation package from in-person to digital delivery. This trajectory highlights the key roles behavioral theories, implementation frameworks, and technology can play in bringing an evidence-based intervention, such as ACT, to scale in a low-income setting like Malawi.