Assessing stigma and perceptions of respectful care in Malawi's index case testing program: Findings from a cluster randomized controlled trial

Healthcare worker (HCW) HIV-related stigma can reduce participation in HIV prevention services in Malawi, including HIV index testing. However, evidence on interventions to reduce HCW stigma and improve client experiences of care in index testing settings remains limited. We evaluated HCW stigmatizing attitudes and also assessed anticipated stigma and perceptions of respectful care among both people living with HIV (index clients) and their sexual partners (contact clients) in index testing settings.

We conducted a cluster randomized controlled trial across 33 clusters providing index case testing in southeastern Malawi. All HCWs received standard, in-person training. Enhanced cluster HCWs additionally received the blended learning training package consisting of tablet-based modules and in-person sessions incorporating stigma-reduction content. HCW stigmatizing attitudes were evaluated one-month (wave 1) and one-year post-training (wave 2). A subset of index and contact clients completed anticipated stigma and respectful care scales at exit interviews. Scales ranged from 0-3 (HCW stigma), 0-1 (anticipated stigma), and 1-5 (respectful care), with higher scores reflecting more stigma or respectful care. Generalized estimating equations with an identity link and gamma distribution estimated adjusted mean differences between arms.