{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,27]],"date-time":"2026-08-27T22:23:27Z","timestamp":1787869407859,"version":"build-2784847793"},"reference-count":48,"publisher":"JMIR Publications Inc.","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JMIR Med Educ"],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Index case testing (ICT) is an effective strategy for HIV case finding, but implementation in low- and middle-income countries (LMICs) is often limited by cost and logistical challenges. Traditional ICT training\u2014centralized and in-person\u2014is costly, disrupts service delivery, and varies in quality.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>This study evaluates the cost-effectiveness of a blended learning (BL) implementation package designed to build health care worker capacity for ICT, combining tablet-guided teaching and practice sessions, phone-based feedback, and tablet-guided continuous quality improvement, compared with standard of care (SOC) training.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>The Package of Resources for Assisted Contact Tracing: Implementation, Costs, and Effectiveness (PRACTICE) cluster-randomized controlled trial included 33 clusters in southern Malawi from May 2022 to September 2023, randomized 2:1 to SOC (n=22) or SOC + BL implementation package (n=11). Our cost-effectiveness analysis, from the health system perspective, used microcosting, time-and-motion assessments, and observed trial outcomes. The decision tree model estimated total program costs, contact testing outcomes, and incremental cost-effectiveness ratios (ICERs) per contact tested and per person diagnosed with HIV across 1 year of implementation. Sensitivity analyses assessed parameter uncertainty, and a scenario analysis modeled a nationwide scale-up under a decentralized, Ministry of Health\u2013led approach.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Our model simulated 100,000 index clients eligible for contact elicitation over 1 year across 2 districts (50,000 per arm). The BL implementation package arm yielded 891 additional contacts tested and 54 more HIV diagnoses. The ICERs were US $125 per contact tested and US $2045 per person diagnosed with HIV; excluding training development costs reduced these to US $69 and US $1136, respectively. Nationwide scale-up under a Ministry of Health\u2013led model further reduced ICERs to US $43 per contact tested and US $698 per person diagnosed with HIV. Probabilistic sensitivity analyses showed the BL implementation package was cost-effective in most simulations.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The BL implementation package improved ICT delivery and HIV case finding. Scenario analyses suggested that a decentralized, government-led scale-up could substantially reduce costs and may represent an efficient case-finding strategy, particularly in Malawi\u2019s mature epidemic. BL implementation packages provide a scalable, system-integrated, cost-effective approach that could strengthen health care worker capacity across other service delivery areas in low-resource settings.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>International Registered Report Identifier (IRRID)<\/jats:title>\n                    <jats:p>RR2-10.1136\/bmjopen-2023-077706<\/jats:p>\n                  <\/jats:sec>","DOI":"10.2196\/95450","type":"journal-article","created":{"date-parts":[[2026,8,27]],"date-time":"2026-08-27T21:45:09Z","timestamp":1787867109000},"page":"e95450","source":"Crossref","is-referenced-by-count":0,"title":["Cost-Effectiveness of a Blended Learning Training Approach for Health Care Workers Conducting HIV Index Case Testing in Malawi: Secondary Economic Analysis of a Cluster-Randomized Controlled 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