Grant: Operating Grant: Knowledge to Action

<html> <body>The global shortage of skilled healthcare workers is estimated at 4.2 million, with1.5 million healthcare workers needed in Africa. Task shifting of less complex healthcare tasks to lay health workers (LHWs) is increasingly employed to address this shortage. 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. <br> <br> 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 by providing care and adherence support in the community. However, insufficient training and supervision are recognized barriers to their effectiveness.<br> <br> Our goal (as identified by the knowledge users) is to improve care provided by LHWs in Malawi by refining, implementing and evaluating a knowledge translation (KT) strategy designed to facilitate incorporation of evidence into LHW practice. <br> <br> <u>Specific objectives:</u> <br> 1. Improve TB outcomes by implementing and evaluating a KT strategy developed and tested by our group to address an identified gap in care provided by LHWs in Malawi. <br> <br> 2. Identify barriers and facilitators to scalability and sustainability of this KT strategy, and its potential to address other gaps in care provided by LHWs. <br> <br> <u>Methods</u> <br> Our project uses the Knowledge to Action Framework, which is based on a review of planned action theories. The project will employ a mixed methods design. We will conduct a pragmatic cluster (RCT) to evaluate effectiveness and understand how to scale up and sustain the strategy (objectives 1 &amp;2). As TB care is provided at health centers (HCs) on a rotating basis patients receive care from several LHWs over their course of treatment. Given this system of care, a cluster RCT (with allocation at the HC level) was chosen to prevent contamination. The RCT will be registered with ClinicalTrials.gov and reported using the CONSORT guidelines. Qualitative interviews and document analysis of training logs will be used to gain an understanding of barriers and facilitators to scalability and sustainability of the program (objectives 2).<br> <br> <u>Significance</u> <br> <br> Given the increasing role of LHW in LIC healthcare systems, approaches to addressing knowledge gaps among LHWs through adequate training and supervision are essential to improving health outcomes. This project has potential to generate principles that will inform other care provided by LHWs.<br> <br> The results will strengthen the health system in Malawi and other LICs by directly informing the efforts of knowledge users by:<br> 1. Addressing an identified knowledge gap among LHWs by developing a scalable, sustainable KT strategy to improve TB care and outcomes for the over 20000 new TB cases treated annually in Malawi. <br> 2. Directly informing the efforts of KU within TB care and through extension of the approach, to other areas of care provided by LHWs. <br> <br> </body> </html>