Table 3.

Primary themes arising, staff, facilitators, clinic leaders, patients, providers

Theme	Patient Intervention	Provider Intervention
Feasibility
1. Recruiting	Recruiters reduced patient burden by coordinating their study appointments with physician visits; there were no differences between sites in recruitment. Utilizing several strategies to recruit, staff recruited from support groups by physician referrals; patients in the public setting were difficult to telephone.	Providers were recruited by clinic leaders prior to the onset of interventions; the majority of providers agreed to participate. Most agreed to participate.
2. Attendance	Non-attendance was an ongoing challenge, despite reminder phone calls and confirmations. Private setting, some patients were challenged by work and travel time, facilitators in both settings were flexible with meeting times. Both settings had drop out (~40%) before the sessions began. Encouraged discussion about commitment to care and attendance at the time of enrollment & in first session.	No issues
3. Session Length & Frequency	Facilitators felt sessions could not be reduced in length should be increased by 2 sessions, meeting weekly was a good fit. Clinic leaders felt that four sessions was too many, recommended once a month for 3 months, extra sessions offered to those who miss a session. Clinic leaders advised to condense sessions, offer a menu of sessions to attend. Patients wanted sessions to continue, once a month, suggested providers and family members attend.	Providers felt that the length of the training was appropriate, and suggested additional training twice a year, as a refresher. The majority agreed they would attend further trainings, and that the role playing of patient interactions was helpful.
Acceptability
1. Information	Patients shared their new information from their intervention materials on HIV and the body with friends and peers, and reported to the group facilitators information was new and helpful.	Providers commented that the intervention training and techniques were a good fit for their practices, especially with challenging patients.
2. Group support	In both settings, facilitators commented that patients used the groups as an opportunity to share information, ask questions, and seek support. Patients commented that they ‘felt good about hearing others’ stories,’ that they had felt isolated with HIV. The group had helped them gain confidence and trust in others, and to develop healthier lifestyles.	Providers also recognized the value of the group training strategy, commenting on the value of discussing patients. Most wanted to continue to collectively review the elements of the technique, viewing the training as an investment in themselves and their patients. Some suggested regular meetings to share experiences, every 6 months for 3 hours.
3. Communic- ation	Facilitators shared at intervention onset, patients from both sites voiced anxiety about communicating with their physicians; patients sometimes experienced providers as ‘freezers’ (cold), scolding, pressed for time, and to be using complicated language. Patients were uncomfortable with asking questions when they had doubts or confusion, and felt their physicians were not listening to them. However, both sites asserted that the group intervention encouraged patients to ask questions and ‘wake up,’ and to develop the idea of an alliance with their physician.	Providers stated communication strategies were challenging, but helpful; some did not implement all of the methods in each consultation. Some struggled to synthesize what the patient was telling them, and realized the need to more carefully track what they were being told to summarize the consultation. Most felt the strategies improved communication with patients and enhanced adherence. Several asserted learning to summarize and to stay silent was especially useful.