Table 1.

Adherence Counseling Fidelity Monitoring Process for MTN-025 (The HOPE Study)

Design	Training	Monitoring	Receipt of intervention
Theoretical foundation Client-Centered Counseling Motivational Interviewing Manual development Overview of counseling goals Outline points of contact and timing of sessions Outline of session tasks Detailed description of approach Examples Tabletop flipchart reinforced manual and facilitated conversational interaction Flipchart translated into five languages	In-person trainings Joint training with all study counselors Three training sessions Initial introduction (June 2016; 6 hrs.) In-person training timed to initiation of enrollment (Sept 2016; 16 hrs.) Follow-up training focused on follow-up and product use end visits (Sept 2017, 16 hours) Additional training conducted for counselors with low fidelity ratings (March 2017; 16 hours) Content of trainings Review of client-centered concepts Review of manual Role-play Discussion Certification Audio-recorded mock sessions Three mock sessions had to meet fidelity criteria for approval to see study participants Feedback and coaching until three mock sessions met fidelity criteria	Fidelity monitoring procedures Rating forms Establish fidelity criteria for each session task and element of client-centeredness Establish passing scores: Session tasks: Scale of 1 (poor/ not done) to 5 (Excellent); Mean ≥ 4 to pass Client-centeredness: Scale of 1 to 5 for each component; Mean ≥ 4 to pass Standard form using tick boxes for key aspects of session tasks Interrater Reliability Guidelines for rating established Training in client-centered counseling and Options Counseling Monthly interrater reliability assessment Selection of Sessions All session recordings uploaded to secure server All sessions logged into a spreadsheet First 5 sessions rated; if all were Enrollment Visits, the first 3 Follow-Up visit sessions were also rated. Then 1 in 10 sessions randomly selected for rating. Feedback coaching sessions Informed by rating forms Discussion of cases Review of counseling skills Corrective feedback Additional group or individual coaching if needed	Attendance Receipt of adherence counseling session Duration of session Received key components of intervention Explanation of residual drug levels and increased protection from HIV Problem solving obstacles to adhering to ring use