Background Community health worker (CHW) programmes are a valuable component of primary care in resource-poor settings. The evidence supporting their effectiveness generally shows improvements in disease-specific outcomes relative to the absence of a CHW programme. In this study, we evaluated expanding an existing HIV and tuberculosis (TB) disease-specific CHW programme into a polyvalent, household-based model that subsequently included non-communicable diseases (NCDs), malnutrition and TB screening, as well as family planning and antenatal care (ANC). Methods We conducted a stepped-wedge cluster randomised controlled trial in Neno District, Malawi. Six clusters of approximately 20 000 residents were formed from the catchment areas of 11 healthcare facilities. The intervention roll-out was staggered every 3 months over 18 months, with CHWs receiving a 5-day foundational training for their new tasks and assigned 20–40 households for monthly (or more frequent) visits. Findings The intervention resulted in a decrease of approximately 20% in the rate of patients defaulting from chronic NCD care each month (−0.8 percentage points (pp) (95% credible interval: −2.5 to 0.5)) while maintaining the already low default rates for HIV patients (0.0 pp, 95% CI: −0.6 to 0.5). First trimester ANC attendance increased by approximately 30% (6.5pp (−0.3, 15.8)) and paediatric malnutrition case finding declined by 10% (−0.6 per 1000 (95% CI −2.5 to 0.8)). There were no changes in TB programme outcomes, potentially due to data challenges. Interpretation CHW programmes can be successfully expanded to more comprehensively address health needs in a population, although programmes should be carefully tailored to CHW and health system capacity. Data are available on reasonable request. Data collected for this study will be made available to others as aggregate and de-identified data. The study protocol is published in a peer-reviewed journal, and supplemental materials include the CHW procedures and the data forms and data flow used in the project. Data and programmatic documents will both be shared via email request to the first author, and additional analysis proposals must be discussed and approved by the first and last authors to ensure dataset is well understood.

中文翻译：

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针对非传染性疾病、营养不良、结核病、艾滋病毒和孕​​产妇健康的家庭社区卫生工作者计划：马拉维内诺区的阶梯楔形集群随机对照试验

背景 社区卫生工作者 (CHW) 计划是资源贫乏地区初级保健的重要组成部分。支持其有效性的证据通常表明，与缺乏 CHW 计划相比，特定疾病的结果有所改善。在这项研究中，我们评估了将现有的 HIV 和结核病 (TB) 疾病特定 CHW 计划扩展为一个多价、以家庭为基础的模型，该模型随后包括非传染性疾病 (NCD)、营养不良和结核病筛查，以及计划生育和产前保健 (ANC)。方法 我们在马拉维的 Neno 区进行了阶梯楔形集群随机对照试验。由 11 个医疗机构的集水区组成了 6 个大约 20 000 名居民的集群。在 18 个月内每 3 个月交错实施干预措施，CHW 接受了为期 5 天的新任务基础培训，并分配了 20-40 个家庭每月（或更频繁）访问。结果 该干预措施使每月慢性 NCD 护理的违约率降低了约 20%（-0.8 个百分点 (pp)（95% 可信区间：-2.5 至 0.5）），同时保持已经很低的违约率HIV 患者（0.0 pp，95% CI：-0.6 至 0.5）。孕早期非国大就诊率增加了约 30%（6.5pp（-0.3，15.8）），儿科营养不良病例发现率下降了 10%（-0.6/1000（95% CI -2.5 至 0.8））。结核病规划结果没有变化，这可能是由于数据挑战。解释 CHW 计划可以成功扩展以更全面地解决人群的健康需求，尽管计划应根据 CHW 和卫生系统能力精心定制。可应合理要求提供数据。为这项研究收集的数据将作为汇总和去标识化数据提供给其他人。研究方案发表在同行评审期刊上，补充材料包括 CHW 程序以及项目中使用的数据表格和数据流。数据和程序化文档都将通过电子邮件请求共享给第一作者，并且必须由第一作者和最后作者讨论和批准额外的分析建议，以确保数据集被很好地理解。研究方案发表在同行评审期刊上，补充材料包括 CHW 程序以及项目中使用的数据表格和数据流。数据和程序化文档都将通过电子邮件请求共享给第一作者，并且必须由第一作者和最后作者讨论和批准额外的分析建议，以确保数据集被很好地理解。研究方案发表在同行评审期刊上，补充材料包括 CHW 程序以及项目中使用的数据表格和数据流。数据和程序化文档都将通过电子邮件请求共享给第一作者，并且必须由第一作者和最后作者讨论和批准额外的分析建议，以确保数据集被很好地理解。