Intervention:
The To respect cultural norms that discourage open discussion of sexuality between youth and adults or males and females, groups are homogenous for gender and age group (adult or youth). The age grouping for youth (13–19) was suggested by community members in formative evaluation for this study. This reflects community perspectives about what age group were likely to share common concerns related to HIV prevention and could discuss these issues comfortably in a single-gender group. Groups of 13–19-year-olds generated good discussion in the efficacy study. Because talking about sexuality with youth is a sensitive topic in Malawi, the peer group facilitators obtained experience and confidence facilitating adult groups before beginning In this implementation study, the role of the health workers was modified from the efficacy study. The local health system supported the project by providing health workers who served as volunteer trainers of the community peer group facilitators and provided ongoing support to the project. Before community implementation began, the research team trained healthcare workers who were then able to provide locally available assistance in training new community peer group facilitators. Their training was identical to the training for new community peer group facilitators. Healthcare workers also gained additional experience prior to training peer group leaders because they led the sessions for a pilot of the revised adult manual in a different community. In the first community, the initial training of the peer group leaders was done collaboratively by the research team and the trained health care workers. Later the research team decreased their involvement, and the training of new peer group leaders was conducted by the healthcare workers and experienced community peer group facilitators. By the end of the project several experienced community facilitators became trainers themselves, so that the communities could sustain the project independently.In this community implementation research, the 3-Step Community Implementation model was used by community volunteers to guide implementation procedures. Each community began implementation in the assigned order and followed the same steps. The Coordinating Committee was appointed by community leaders before implementation began.During the Prepare step (2–4 months), community volunteers were trained and made an implementation plan. First, the Coordinating Committee members were oriented to the 3-Step Implementation Model and the Peer group facilitator training included 16 facilitators in each community to allow for attrition and end up with at least 12 trained facilitators in each community. We planned that each pair of co-facilitators would conduct 2 adult and 2 youth groups, and each group would include 12 community members. This would achieve the sample size needed according to our power calculations. However, in each community all 16 trained facilitators successfully completed training and wanted to offer the program, so we increased the number of peer groups in each community from 12 to 16. This gave us an opportunity to ask the additional 48 youth group members to participate in both During the Rollout step (3–4 months) in each community, the planned initial set of Mzake peer groups for adults and youth were conducted. The Coordinating Committee worked with the newly trained facilitators to establish places and times for the group session meetings and informed the previously enrolled After a community completed the Rollout step, that community began the Sustain step which lasted through the end of the grant funding. Committee members and facilitators continued to offer 