Assessing stigma and perceptions of respectful care in Malawi’s index case testing program: Findings from a cluster randomized controlled trial
6 affiliations
- 1Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
- 2Baylor College of Medicine Children’s Foundation Malawi, Lilongwe, Malawi
- 3RTI International, Research Triangle Park, Durham, North Carolina, United States of America
- 4Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- 5Department of Pediatrics, Division of Global Health, Baylor College of Medicine, Houston, Texas, United States of America
- 6Center for AIDS Research, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
Abstract
Background: 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. Methods: 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. Results: We enrolled 305 HCWs, 341 index clients, and 194 contact clients. Overall stigma levels were low and respectful care ratings were high across arms. Mean HCW stigma scores were 0.8 (wave 1) and 0.7 (wave 2); adjusted mean differences between arms were −0.1 (p = 0.3) at wave 1 and 0.0 (p = 1.0) at wave 2. Index and contact client anticipated stigma means were both 0.1; adjusted mean differences between arms were 0.0 (p = 0.9) for index and 0.0 (p = 0.7) for contact clients. Respectful care means were 4.0 for index and 4.2 for contact clients; adjusted mean differences between arms were 0.0 (p = 0.9) for index and −0.1 (p = 0.3) for contact clients. Conclusions: The enhanced training package did not improve HCW or client stigma-related outcomes. Further research is needed to reduce HCW and client stigma and improve respectful care.
Related
- Machined versus cast abutments for dental implants: a 1-year within-patient multicentre randomized controlled trial assessing marginal seal capacity and outcomes
- Lactoferrin supplementation enhances natural killer cell activity in adults: findings from a 12-week randomized, double-blind, placebo-controlled trial
- Empowering adults to manage their hearing loss: assessing the benefits of user-controlled, smartphone-connected hearing aids.
- INSPECT-SR tool for assessing trustworthiness of randomised controlled trials
- Reframing Expectations about aging - Physical Activity and Inclusive Reappraisal (RE-PAIR): Protocol of a randomized intervention promoting positive self-perceptions of aging and physical activity in older couples
BibTeX
@article{jeanbaptiste2026assessing,
title = {{Assessing stigma and perceptions of respectful care in Malawi’s index case testing program: Findings from a cluster randomized controlled trial}},
author = {Milenka Jean-Baptiste and H. Luz McNaughton Reyes and Tapiwa A. Tembo and Laura Nyblade and Vivian F. Go and Abigail M. Hatcher and Mike J. Chitani and Angella Mkandawire and Caroline Kumbuyo and Ireen Chirombo and Jiayu Wang and Maria H. Kim and Katie R. Mollan and Katherine R. Simon and Nora E. Rosenberg},
journal = {PLOS One},
year = {2026},
month = oct,
doi = {10.1371/journal.pone.0345705},
url = {https://doi.org/10.1371/journal.pone.0345705},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Assessing stigma and perceptions of respectful care in Malawi’s index case testing program: Findings from a cluster randomized controlled trial
AU - Milenka Jean-Baptiste
AU - H. Luz McNaughton Reyes
AU - Tapiwa A. Tembo
AU - Laura Nyblade
AU - Vivian F. Go
AU - Abigail M. Hatcher
AU - Mike J. Chitani
AU - Angella Mkandawire
AU - Caroline Kumbuyo
AU - Ireen Chirombo
AU - Jiayu Wang
AU - Maria H. Kim
AU - Katie R. Mollan
AU - Katherine R. Simon
AU - Nora E. Rosenberg
PY - 2026
DA - 2026/10/27
JO - PLOS One
DO - 10.1371/journal.pone.0345705
UR - https://doi.org/10.1371/journal.pone.0345705
AB - Background: 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. Methods: 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. Results: We enrolled 305 HCWs, 341 index clients, and 194 contact clients. Overall stigma levels were low and respectful care ratings were high across arms. Mean HCW stigma scores were 0.8 (wave 1) and 0.7 (wave 2); adjusted mean differences between arms were −0.1 (p = 0.3) at wave 1 and 0.0 (p = 1.0) at wave 2. Index and contact client anticipated stigma means were both 0.1; adjusted mean differences between arms were 0.0 (p = 0.9) for index and 0.0 (p = 0.7) for contact clients. Respectful care means were 4.0 for index and 4.2 for contact clients; adjusted mean differences between arms were 0.0 (p = 0.9) for index and −0.1 (p = 0.3) for contact clients. Conclusions: The enhanced training package did not improve HCW or client stigma-related outcomes. Further research is needed to reduce HCW and client stigma and improve respectful care.
SN - 1932-6203
ER -