Interventions for families affected by HIV

Area of Science:

• Public Health
• Implementation Science
• Family Health

Background:

• Family-based interventions show efficacy in human immunodeficiency virus (HIV) detection, prevention, and care but lack broad diffusion.
• Understanding intervention adaptation and translation is crucial for disseminating evidence-based interventions (EBIs).
• This review examines EBIs for families affected by HIV (FAH) adapted across five randomized controlled trials in the US, Thailand, and South Africa over 15 years.

Purpose of the Study:

• To review family-based interventions for families affected by HIV (FAH).
• To analyze commonalities and variations in risk environments and intervention features across diverse global settings.
• To identify key adaptation and translation processes that support the diffusion of EBIs for FAH.

Main Methods:

• Narrative review of EBIs for FAH from five randomized controlled trials.
• Utilized frameworks for intervention functions, principles, practice elements, and delivery processes.
• Examined adaptations in response to varying risk environments (healthcare, housing, food, financial security) and common challenges (health, mental health, transmission, relationships).

Main Results:

• Despite varied risk environments, EBIs for FAH effectively addressed common health, mental health, transmission, and relationship challenges.
• Interventions were adapted across contexts with fidelity to robust principles, processes, and practices.
• Key adaptation decisions included mainstreaming HIV services, selecting optimal delivery sites, and translating protocols to local contexts.

Conclusions:

• Replication with fidelity requires standardizing functions, principles, processes, and practices, not just manualized protocols.
• A continuous quality improvement paradigm can enhance the rapid and global diffusion of EBIs for FAH.
• Successful adaptation and translation are essential for scaling up effective family-based HIV interventions worldwide.