Local collaborators conducted formative interviews and focus group discussions with community members.

Key informants in the community reviewed and contextualized the findings.

Local stakeholders, content experts, and potential implementers in community formed a steering committee.

Formative qualitative research revealed that HIV-related stigma in the local context is heavily gendered.

Identify and respond to power structures within research team and between research team and research participants (e.g., cultural, linguistic, and socioeconomic differences).

Identify and respond to power structures relevant to the intervention and work planned (e.g., gender), which may also influence the identification, recruitment, and engagement of local collaborators.

Actively involve local collaborators in formative cultural adaptation work.

Be equipped with adequate financial and infrastructural resources for recruitment, training, and payment of local collaborators.

Steering committee (including local clinical experts, psychology graduate students, and peer coleaders) met to develop and adapt manual.

Binational training between local collaborators and U.S.-based clinicians.

Women register late for antenatal care, so intervention recruitment strategies were changed accordingly to meet women when they typically visit clinics.

“Being free” was identified as a local idiom reflecting liberation and empowerment, so the cognitive behavioral therapy module was renamed “The Road to Self-Acceptance and Freedom.”

Feedback from local collaborators led to the development of a graduation ceremony component involving the bestowing of ceremonial shawls.

Actively seek out discussions of potential barriers and facilitators of intervention with local collaborators and other local key informants, even if they are not “researchers” in the formal sense.

Consider, identify, and respond to power imbalances at play during binational training.

Readily incorporate local views, concepts, and idioms into curriculum.

Note these contributions for evaluation in follow-up to monitor resonance with participants.

Local collaborators engaged in their own fidelity checks (in addition to formalized fidelity checks outlined in the study protocol with a clinical psychologist) and made real-time changes to curriculum (e.g., took notes of what worked best and what needed modification after each session, including terms and language use) based on participants’ feedback.

Local collaborators took the time to listen to participants and relay experiences to the research team.

Local collaborators changed timing of intervention based on clinic and participant availability and schedule.

Local collaborators were able to engage participants by flexibly switching between languages during the intervention.

Give local collaborators resources and support to listen to participant feedback and make the changes (e.g., in format, content) they see fit.

Engage and retain local collaborators who are bilingual when possible or appropriate.

Include language and other cultural considerations in agendas of fidelity checks, training sessions, or other meetings with local collaborators.

Consider and identify measures, outcomes, and data reporting methods that resonate with local collaborators and communities.

Local collaborators shared challenges faced during implementation.

A lack of translation of the MME manual into Setswana may hinder implementation in settings outside of Gaborone.

The obligation to work extra hours to host evening sessions may disincentivize implementation at other clinics.

Clinic staff were involved in antenatal care phase for participants but would not be involved in women’s experiences postpartum, which impacts sustainment of the MME intervention and continuity of nonstigmatizing care.

Prioritize listening to concerns and feedback from local collaborators and participants to inform sustainment.

Start seeking and noting feedback from local collaborators and participants relevant to sustainment as far back as the exploration stage.

Consider, budget for, and provide adequate financial and infrastructural resources for retention of local collaborators as well as recruitment and training of additional local collaborators.

Support local collaborators in pursuing self-identified professional goals as research projects expand.