This case study with one lay adherence counsellor
assessed the implementation of Options for Health, a
sexual risk-reduction intervention based on Motivational
Interviewing (MI), in an antiretroviral clinic in Cape Town,
South Africa. In most cases Options was not delivered with
fidelity and less than one-third of intended recipients
received it; the counsellor often forgot to do Options, was
unsure how to deal with particular cases and felt that there
was not always time to do Options. Options was not
implemented in a way that was consistent with MI. Revisions
to the implementation plan and training programme
are required.