Table 4.

Themes for training and QA reveal fit issues: high- and low-fidelity agencies

Theme	High-fidelity agencies	Low-fidelity agencies
Time	. . . if I sit in on a session and use direct observation, which is a QA component . . . An example could be, when we first started, the staff were very focused on time and having to get everything in within that specific time period. Now, we don’t like [to] cut corners. We don’t cut things short based on time. Some people just talk and you can’t just hold them to that, ‘18 to 20 min’ type of thing . . . [Agency B, SUP]	We adjust our time in terms of what’s working, what’s not working with the program, and . . . we change it [the protocol], you know, based upon things that we learn from the clients, based upon things we learn from the staff that. . . implementing interventions. [Agency D, ED/SUP]
Client load	. . . well going through . . . supervisory trainings, we’ve learned the things that we needed and the different QA things that we needed to do now that we have more clients. [Agency B, SUP]
Early assessments of capacity and pilot runs	We tried it out [pilot runs] with the first group of staff that were trained before anybody else was . . . [Agency C, ED]	. . . we didn’t have a lot of prep time and we weren’t familiar with [RESPECT]. . . [Agency F, ED]
Lack of adaptations to address mismatch between training and delivery	I had to hire a 40-hr staff person who would be the day to day staff Prevention Specialist for the RESPECT program. I also had to appoint the current supervisor of the counseling program. I had to increase her hours to provide the supervision for the program, and also identified a third staff person who would be trained in the absence of the primary staff. [Agency B, ED]	The person implementing RESPECT has just begun doing testing as a part of RESPECT. That’s brand new. Prior to that, none of our staff had done any HIV testing but we contract agencies to provide testing . . . [counselor name] just got trained in rapid testing maybe a month ago . . . [Agency E, ED/SUP]
		. . . I think for me it was like a leap—a big leap when—when I started actually providing the Rapid test and looking at one session . . . I think that was the most difficult thing to conceptualize . . . because I don’t remember in the training from [the external site] where they talked about [one session]—the training was for two sessions . . . so this whole thing about—doing the rapid testing—the one session was kind of just kind of remarkably surprising to me. I mean, you know, it—it’s WORKING but it’s, ‘Hum, how well?’ [Agency E, CN]
		I think it was that transition to be—being trained in two sessions. Now it’s, you know, being utilized in one session for rapid testing. [Agency E, CN1]