Design of a cluster randomized trial assessing integrated infectious diseases training and on-site support for midlevel practitioners in Uganda

Abstract

SummaryTraining mid-level practitioners (MLP), usually nurses or clinical officers, to perform tasks conventionally assigned todoctors increases access to care and addresses health worker shortages in resource-constrained countries. In the face ofthe shortcomings of traditional training approaches, identification of effective training methods that create and maintainhighly competent MLP is a priority. A cluster randomized trial with pre–post components was conducted between Marchand December 2010 at 36 subdistrict health centres in Uganda. Eighteen out of the 36 health centres were randomized tothe intervention (Arm A) to receive sequenced integrated infectious diseases training for two MLPs followed by integratedinfectious diseases on-site support for the health worker teams once a month for nine months and 18 were randomized toreceive only sequenced training for two MLPs but no on-site support (Arm B). Outcomes measured included individualMLP knowledge and competence scores from written and observed clinical assessments; health facility performanceagainst indicators of care for malaria, tuberculosis and HIV as determined from patient care records; and mortalityamong children under five years during the project period measured using survey methods. Trial Registration: ClinicalTrials-NIH NCT01190540.