The state of the art of adaptation strategies for HIV-related interventions

This review synthesizes literature since January 2024 on the adaptation of HIV interventions and implementation strategies. Both the enormous, but currently unfilled potential of new treatment and prevention technologies, as well as the pressing need to meet global HIV epidemic control targets amid recent HIV funding cuts, necessitate adaptation to improve intervention and implementation effectiveness, scalability, and responsiveness in diverse populations and contexts.

Recent literature demonstrates the application of multistep frameworks guiding adaptation and improved documentation using tools such as FRAME, and rigorous study designs that inherently support and evaluate adaptation such as MOST and SMART. Adaptation targets include enhanced cultural relevance and implementer perspectives, while amplifying community voices and leveraging technology. More rigorous evaluation of adaptation processes and outcomes is still needed.

The findings highlight the importance of adaptation in improving scalability, equity, and impact in HIV implementation. Improved transparency in adaptation documentation and etiologies can improve adaptation efficiency, mechanistic understanding, and transferability. Novel study designs support adaptation with rigorous evaluation. Prioritizing structured, participatory adaptation processes can improve equity and health impact, especially for marginalized populations.