How to incorporate lived experience into evidence-based interventions: assessing fidelity for peer-delivered substance use interventions in local and global resource-limited settings

Interventions led by peer recovery specialists (PRSs) have rapidly expanded in response to a global shortage of access to substance use treatment. However, there is a lack of guidance on how to incorporate PRSs' lived experience into the delivery of evidence-based interventions (EBIs). Moreover, few resources exist to assess fidelity that integrate both content fidelity, peer competence, and incorporation of lived experience (i.e., PRS role fidelity). This study aimed to: (a) describe a novel PRS fidelity monitoring approach to assess both content and PRS role fidelity; (b) compare independent rater and PRS-self-reported content fidelity; (c) examine associations between content and PRS role fidelity; and (d) assess whether the PRS role fidelity was associated with substance use at posttreatment. This study was conducted across two PRS-led behavioral intervention trials conducted in global resource-limited settings: Baltimore City, U.S., and Khayelitsha. South Africa. A significant difference was found between PRS- and independent rater content fidelity in both interventions. with PRSs reporting significantly higher content fidelity in both sites. PRS role and content fidelity were not significantly correlated, suggesting greater adherence to the PRS role was not associated with lower adherence to structured EBI content. PRS role fidelity was not significantly associated with substance use at posttreatment. This study provides an important step toward understanding how to assess PRS role fidelity in the context of EBIs for underserved individuals with SUD while also incorporating PRS lived experience.