IMPAACT 2016: Operationalizing HIV Intervention Adaptations to Inform the Science and Outcomes of Implementation

Area of Science:

• Implementation Science
• Global Health
• HIV/AIDS Research

Background:

• Uptake of evidence-based interventions for adolescents and young adults living with HIV (AYA-LWH) in sub-Saharan Africa (SSA) is hindered by cultural differences, necessitating local adaptations.
• Existing models for intervention tailoring are limited, yet operationalizing adaptation strategies is crucial for successful implementation outcomes like acceptability, appropriateness, feasibility, fidelity, and sustainability.

Purpose of the Study:

• To describe the operationalization of the ADAPT-ITT framework for tailoring a manualized trauma-informed cognitive behavioral therapy (TI-CBT) intervention for AYA-LWH in SSA.
• To develop and test well-defined processes and tools for intervention adaptation to ensure fidelity and optimize implementation outcomes in preparation for a randomized controlled trial (RCT).

Main Methods:

• Operationalized steps 3-7 of the ADAPT-ITT framework across eight sites in Botswana, Malawi, South Africa, and Zimbabwe.
• Developed standardized, step-by-step processes and tools for translation, adaptation, and community stakeholder feedback, ensuring consistent application and fidelity.
• Engaged community stakeholders, AYA-LWH, and caregivers through community engagements and focus groups to inform local adaptations.

Main Results:

• Successfully developed and operationalized adaptation materials and processes, including a translation review process that identified cultural nuances and differing interpretations.
• Utilized feedback and translation verification forms to meticulously manage adaptations, ensuring core concepts were maintained while allowing for local relevance.
• Facilitated robust collaborations among investigators, site personnel, and experts, involving approximately 10-15 personnel per site to effectively gather and integrate local feedback.

Conclusions:

• The study presents a novel, generalizable approach to intervention adaptation using well-defined processes based on the ADAPT-ITT framework.
• The operationalized processes enhance the science of implementation by providing specificity in adaptation steps, optimizing real-world impact.
• This approach empowers researchers and stakeholders to leverage existing infrastructure, culture, and resources for effective and sustainable intervention implementation.