Process evaluation of HIV prevention peer groups in Malawi: a look inside the black box

This paper reports the process evaluation of a peer group intervention for human immuno-deficiency virus (HIV) prevention which had positive outcomes for three target groups in Malawi: rural adults, adolescents and urban hospital workers. The six-session intervention was delivered to small groups of 10–12 partic-ipants by 85 trained volunteer peer leaders working in pairs. A descriptive, observational mixed methods design was used with a conve-nience sample of 294 intervention sessions. Using project records and a conceptually based observation guide, we examined five aspects of the implementation process. The context was favorable, but privacy to discuss sensitive issues was a concern for some groups. In study com-munities, program reach was 58 % of rural adults, 70 % of adolescents and nearly all hos-pital workers. Session records confirmed that all peer groups received the intended six ses-sions (dose delivered). The dose received was high, as evidenced by high participant engage-ment in peer group activities. Peer leaders were rated above the median for three indica-tors of peer group content and process fidelity: session management skills, interpersonal facil-itation skills and whether more like a peer group than classroom. Documenting that this HIV prevention peer group intervention was delivered as intended by trained peer volun-teers supports widespread dissemination of the intervention