ABSTRACT:
Background. Implementation fidelity compliance to high-quality HIV counselling is essential for achieving optimal prevention, early diagnosis and improved patient outcome. However limited evidence exists on counsellor’s adherence to key counselling components within public sector facilities in South Africa. This study assessed implementation fidelity to the key components of the high-quality HIV and factors associated with fidelity compliance in public sector facilities in North-West province. Methodology. A cross-sectional study analytical study was conducted across public health facilities in three sub-districts (Bojanala, Ngaka Modiri Moleme and Kenneth Kaunda). Data was collected using a validated, modified self-administered questionnaire incorporating Likert Scale items. Descriptive and inferential analyses were performed to assess levels of implementation fidelity and associated factors Results. The study response rate was 97% with more females than males. Of the 65 participants, overall implementation fidelity was 16.9%. Female counsellors spent significantly more hours counselling compared to other genders. The participants with more than three years of experience conducted more counselling sessions than those with less experience. The expected number of clients varied across facilities, with 67% of clients receiving HIV counselling service. Conclusion. The study findings indicate that female counsellors demonstrated higher compliance with key component of high-quality counselling compared to males and other gender. Counsellors working eight hours per day, particularly females, were more likely to meet counselling targets. A significant association was observed between counsellors with three or more years of experience and their ability to manage workload and adhere to high quality counselling standards. The study highlights the need for policy adjustments with ta stronger focus on capacity building through ongoing training and awareness programmes to enhance implementation fidelity.