For the health authority

Do people understand their results, and reach care in time?

What is actually happening as people try this demo, next to a clearly labelled synthetic month for the whole emirate after rollout that shows the view at its real scale, then the pilot that would test it first. No number shows a person.

The pilot

How the numbers above would be tested against usual care before anything is bought. Every input below is an assumption the pilot measures.

Design: Randomised, 1:1: usual care, or usual care plus Two Keys. Randomised by extended family, so related couples land in the same arm. Only couples with new results join (at all 22 centres), because older results have already been explained and families may already have talked.
Size: About 145 couples are newly found at increased chance in six months of recruitment. If three in four agree, about 110 join: 55 per arm, who between them count about 660 married relatives of reproductive age (a number each couple gives, never names). That detects a rise from 20% to 35% of relatives tested (80% power, 5% significance), assuming relatives in one family correlate at 0.25. If fewer agree, recruitment runs two months longer, as registered in advance.
Primary outcome: Relatives tested under their family’s study code within six months, as a share of the married relatives of reproductive age each couple counted at enrolment. In both arms the couple gets a family study code to pass on however they like; a relative who brings it to a screening centre and consents to the test is counted at the lab. No relative is named, listed or looked up in Malaffi or any other record. The Two Keys arm adds its explained, anonymous family notes. The pilot pays for a targeted test of the family’s known change in both arms, because married relatives are outside the premarital mandate.
Understanding: Target: 15 percentage points more people with good knowledge than in usual care, on an 8-item knowledge measure adapted from the Multidimensional Measure of Informed Choice and validated in Arabic and English before the pilot starts.
Timeline: Months 0–6: approvals (DoH sandbox, ethics, data protection impact assessment, UAE hosting, security audit, content sign-off by the operator’s counsellors). Months 6–12: recruitment. Months 12–18: follow-up and analysis. Months 18–30: matching across labs. From month 30: procurement and all centres.
Price: No licence fee during the pilot unless the operator signs a paid pilot (AED 150,000 for months 6–18). After procurement: AED 200,000 a year plus AED 30 per screened couple, licensed into the operator’s screening contract, with a quarter of the yearly fee at risk against uptime, notification time, the knowledge margin and the share of couples who tell a relative (asked at follow-up, since notes aren’t linked to couples).