Abstract
<sec> <title>UNSTRUCTURED</title> <p>Introduction: Limited access to high-quality care for rural populations contributes to significant rural-urban health disparities and slows progress towards achieving universal health coverage worldwide. Using a cluster-randomized controlled trial, this project evaluates an integrated community health outreach model provided by government healthcare workers in hard-to-reach communities in Uganda. The primary aim of the trial is to evaluate the impact and implementation of this program on health care utilization and women’s contraceptive use. Methods and Analysis: Sixty-four health facilities in six rural districts will be randomized into two arms: 1) a treatment group (T), in which health facility staff conduct bimonthly integrated outreach visits to two remote villages within their catchment area; 2) a control group (C) in which health facilities operate under the status quo. Twenty households from each of the two outreach villages and key personnel from all 64 health facilities will be invited to participate in a baseline survey and a follow-up survey after 12 months of intervention implementation. In addition, surveys will be conducted with 20 households living close to each study health facility at baseline and at the 12-month follow-up period to measure the indirect effects of the intervention on service delivery. The primary outcomes of healthcare utilization and contraceptive use will be analyzed using intent-to-treat analysis. Ethics and dissemination: This study was approved by Mildmay Uganda Research Ethics Committee (MUREC Protocol No. MUREC-2024-520), Innovations for Poverty Action IRB (IPA IRB Protocol No. 17247), and Uganda National Council for Science and Technology (UNCST) (UNCST Registration No. SS3630ES). Findings will be disseminated via peer-reviewed publications, and national and international conference presentations. Trial registration: Trial is registered at the AEA Social Science Registry (AEARCTR-0015003) on January 27, 2025; revised again on June 12, 2026, to reflect the revised study design, and on Pan African Clinical Trials Registry (PACTR202607625603156).</p> </sec>