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Acknowledgements: The authors gratefully acknowledge the contribution of all study participants. The support of MLW staff was key to the successful completion of this study, especially the CAPS Chikwawa field team led by Andrew Nuanje., We carried out a qualitative study to gain a deeper understanding of the social context of the Cooking and Pneumonia Study (CAPS) and implications for implementation of clean cooking and similar interventions. Such initiatives are recognised as complex, power-laden processes, which has consequences for outcomes and uptake. However, understanding of how precarious livelihoods and unequal power differentials impact on trials of technology is limited and potentially hampers the achievement of the SDGs including SDG 7, Affordable and Clean Energy. An in-depth exploration of experiences and perceptions of cooking and cookstove use within CAPS was completed using qualitative methods and the participatory methodology Photovoice. Ten CAPS participants from each of five villages participated in Photovoice activities and five village representatives were interviewed. Twelve fieldworkers participated in gender specific focus groups and four were interviewed. A thematic content approach was used for data analysis. The analysis showed that economic and power inequity underpinned the complex social relationships within CAPS impacting on trial participation, perceptions of the cookstoves, and on the potential of the intervention to affect health and other benefits. Power can be understood as relational and productive within the research environment. This is illustrated by an analysis of the role of fieldworkers and community representatives who needed to negotiate resistance to trial compliance decisions, including 'satanic' rumours about cookstoves and blood-taking. Transformative approaches that challenge existing power inequities are needed to maximise the success and beneficence of cookstove and other health promoting interventions, and achievement of the SDGs.

Background: Assisted index case testing, in which health care workers take an active role in referring at-risk contacts of people living with HIV for HIV testing services, has been widely recognized as an evidence-based intervention with high potential to increase PLHIV status awareness. Promising evidence for the approach has led to several attempts to scale assisted index case testing throughout eastern and southern Africa in recent years. However, despite effective implementation being at the heart of any assisted index case testing strategy, there is limited implementation science research from the perspective of the HCWs who are doing the "assisting". This study examines the feasibility of assisted index case testing from the perspective of health care workers implementing the approach in Malawi., Methods: In-depth interviews were conducted with 26 lay health care workers delivering assisted index case testing in Malawian health facilities. Interviews explored health care workers' experiences counselling index clients and tracing these clients' contacts, aiming to inform development of a blended learning implementation package. Transcripts were inductively analyzed using Dedoose coding software to identify and describe key factors influencing feasibility of assisted index case testing. Analysis included multiple rounds of coding and iteration with the data collection team., Results: Participants reported a variety of barriers to feasibility of assisted index case testing implementation, including privacy concerns, limited time for assisted index case testing amid high workloads, poor quality contact information, logistical obstacles to tracing, and challenges of discussing sexual behavior with clients. Participants also reported several health care worker characteristics that facilitate feasibility: robust understanding of assisted index case testing's rationale and knowledge of procedures, strong interpersonal skills, positive attitudes towards clients, and sense of purpose in their work., Conclusions: Findings demonstrate that maximizing assisted index case testing's potential to increase HIV status awareness requires adequately equipping health care workers with appropriate knowledge, skills, and support to address and overcome the many feasibility challenges that they face in implementation., Trial Registration Number: NCT05343390 Date of registration: April 25, 2022., Competing Interests: Declarations Competing interests The authors declare no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.