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Beyond Efficacy: The Access, Delivery Systems, Acceptability, Persistence, and Transition Management "ADAPT"
Eric Nzirakaindi Ikoona1, Lucy Namulemo2, Ronald Kaluya3
1Department of Evaluation and Research, National Public Health Agency, Freetown, Sierra Leone.
HIV/AIDS (Auckland, N.Z.)
|July 28, 2026
Summary
Long-acting injectable pre-exposure prophylaxis (LA-PrEP) offers improved HIV prevention but requires careful implementation. The ADAPT framework guides planning for equitable LA-PrEP rollout in sub-Saharan Africa.
Area of Science:
- HIV Prevention Research
- Implementation Science
- Public Health Policy
Background:
- Long-acting injectable pre-exposure prophylaxis (LA-PrEP) represents a significant advancement in HIV prevention, yet its successful implementation hinges on more than just efficacy.
- Challenges in oral PrEP uptake and adherence, particularly among young women in South Africa, highlight the need for innovative delivery strategies.
- LA-PrEP, while reducing daily pill burden, introduces new implementation demands such as appointment-based adherence and specialized delivery systems.
Purpose of the Study:
- To introduce the Access, Delivery Systems, Acceptability, Persistence and Transition Management (ADAPT) framework.
- To provide a conceptual, practice-oriented model for the implementation of LA-PrEP in sub-Saharan Africa.
Main Methods:
- Structured narrative synthesis of peer-reviewed and grey literature on oral PrEP scale-up and LA-PrEP (cabotegravir and lenacapavir) efficacy.
- Incorporation of insights from HIV service delivery, task shifting, and implementation frameworks.
- Integration of practical experience from implementation support programs in Uganda and Sierra Leone.
Main Results:
- The ADAPT framework addresses key implementation domains: regulatory access, product-specific delivery, acceptability, appointment persistence, and transition management.
- It complements existing implementation science frameworks like CFIR and RE-AIM by offering product awareness and planner orientation.
- The framework emphasizes the critical role of Transition Management as a safety domain for LA-PrEP.
Conclusions:
- Equitable and effective LA-PrEP rollout in sub-Saharan Africa necessitates deliberate planning across financing, service delivery, community engagement, adherence support, and discontinuation protocols.
- The ADAPT framework offers a structured and testable model to guide this planning process.
- Further validation through Delphi consensus, stakeholder consultation, and implementation studies is recommended.
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