{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,12]],"date-time":"2026-10-12T16:21:44Z","timestamp":1791822104528,"version":"4.3.4"},"reference-count":42,"publisher":"Wiley","issue":"S5","license":[{"start":{"date-parts":[[2026,10,8]],"date-time":"2026-10-08T00:00:00Z","timestamp":1791417600000},"content-version":"vor","delay-in-days":7,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T00:00:00Z","timestamp":1790812800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/100000061","name":"Fogarty International Center","doi-asserted-by":"publisher","award":["D43 TW010060"],"award-info":[{"award-number":["D43 TW010060"]}],"id":[{"id":"10.13039\/100000061","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["MH124526"],"award-info":[{"award-number":["MH124526"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J Int AIDS Soc."],"published-print":{"date-parts":[[2026,10]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>HIV index case testing is an evidence\u2010based practice in which health care workers (HCWs) counsel people living with HIV (index clients) to offer HIV testing services to their sexual partners and biological children (contacts). For index case testing to be effective, it is important that index\u2010 and contact\u2010client counselling protocols are implemented as intended (fidelity). We evaluated whether a digital training implementation strategy improved HCWs\u2019 fidelity to these counselling protocols.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      We conducted a cluster\u2010randomized controlled trial at health facilities (clusters) in Southeastern Malawi. Primary study follow\u2010up was from October 2022 to September 2023. Thirty\u2010three clusters were randomized 1:2 to the Enhanced (\n                      <jats:italic>n<\/jats:italic>\n                      = 11) and Standard (\n                      <jats:italic>n<\/jats:italic>\n                      = 22) arms. HCWs in both arms received brief centralized in\u2010person training on processes and protocols for index case testing. HCWs in the Enhanced arm also received decentralized tablet\u2010guided digital training through 20 synchronous and asynchronous sessions. In all 33 clusters, a selection of index and contact client encounters were audio\u2010recorded in the year after the digital training. We applied a 15\u2010item fidelity checklist to assess counselling quality and adherence to index case testing protocols. Audio recordings were coded independently by two assessors blinded to the study arm. Fidelity scores ranged from 0% to 100%; higher scores indicate better protocol compliance. To compare fidelity scores between the Enhanced and Standard arms, we estimated a mean difference and 95% confidence interval (CI), using generalized estimating equations to account for clustered data.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      We audio\u2010recorded 341 index client\u2010HCW and 194 contact client\u2010HCW encounters. The mean fidelity score for index client\u2010HCW encounters was 66.3% (CI: 62.8%\u221269.7%) in the Enhanced arm and 45.7% (CI: 42.7%\u221248.6%) in the Standard arm (Mean Difference 20.6%; CI: 16.1%, 25.2%,\n                      <jats:italic>p<\/jats:italic>\n                      &lt;0.001). The mean fidelity score for contact client\u2010HCW encounters was 69.0% (CI: 63.8%\u221274.1%) in the Enhanced arm and 57.4% (CI: 55.5%\u221259.3%) in the Standard arm (Mean Difference 11.5%; CI: 6.1%, 17.1%,\n                      <jats:italic>p<\/jats:italic>\n                      &lt;0.001).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The digital training substantially improved HCW fidelity to index and contact client protocols. A decentralized digital training can be used to improve HCW counselling behaviour. Future research should explore the methods of assessing fidelity in trials of complex digital training interventions in other settings.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/jia2.70185","type":"journal-article","created":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T06:45:27Z","timestamp":1791528327000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Assessing Fidelity to HIV Index Case Testing Protocols in Malawian Clinical Settings: Results From a Cluster Randomized Controlled Trial"],"prefix":"10.1002","volume":"29","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5649-0817","authenticated-orcid":false,"given":"Tapiwa A.","family":"Tembo","sequence":"first","affiliation":[{"name":"Baylor College of Medicine Children's Foundation  Lilongwe Malawi"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nora E.","family":"Rosenberg","sequence":"additional","affiliation":[{"name":"Gillings School of Global Public Health University of North Carolina at Chapel Hill  Chapel Hill North Carolina USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katie R.","family":"Mollan","sequence":"additional","affiliation":[{"name":"Gillings School of Global Public Health University of North Carolina at Chapel Hill  Chapel Hill North Carolina USA"},{"name":"School of Medicine University of North Carolina at Chapel Hill  Chapel Hill North Carolina USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mike J.","family":"Chitani","sequence":"additional","affiliation":[{"name":"Baylor College of Medicine Children's Foundation  Lilongwe Malawi"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mtisunge","family":"Mphande","sequence":"additional","affiliation":[{"name":"Baylor College of Medicine Children's Foundation  Lilongwe Malawi"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jiayu","family":"Wang","sequence":"additional","affiliation":[{"name":"Gillings School of Global Public Health University of North Carolina at Chapel Hill  Chapel Hill North Carolina USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Victor","family":"Mwapasa","sequence":"additional","affiliation":[{"name":"Kamuzu University of Health Sciences  Blantyre Malawi"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katherine","family":"Simon","sequence":"additional","affiliation":[{"name":"Baylor College of Medicine Children's Foundation  Lilongwe Malawi"},{"name":"Department of Pediatrics Baylor College of Medicine  Houston Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Saeed","family":"Ahmed","sequence":"additional","affiliation":[{"name":"Baylor College of Medicine Children's Foundation  Lilongwe Malawi"},{"name":"Department of Pediatrics Baylor College of Medicine  Houston Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria H.","family":"Kim","sequence":"additional","affiliation":[{"name":"Baylor College of Medicine Children's Foundation  Lilongwe Malawi"},{"name":"Department of Pediatrics Baylor College of Medicine  Houston Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Linda\u2010Gail","family":"Bekker","sequence":"additional","affiliation":[{"name":"The Desmond Tutu HIV Centre Institute of Infectious Disease and Molecular Medicine Faculty of Health Sciences University of Cape Town  Cape Town South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,10,8]]},"reference":[{"key":"e_1_2_11_2_1","unstructured":"UNAIDS 2025 Global AIDS Update AIDS Crisis and the Power to Transform (UNAIDS 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