Translating primary into ‘positive’ prevention for adolescents in Eastern Africa
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There is an urgent need to develop positive prevention interventions for adolescents living with HIV in high endemic regions. Adapting existing evidence-based interventions for resource-constrained settings is effective when the intervention’s theoretical core elements are preserved while achieving cultural relevance. We describe the process of adapting a primary prevention to a secondary/positive prevention programme for adolescents living with HIV in Kenya and Uganda. The systematic adaptation was guided by the Centers for Diseases Control’s map for the adaptation process, describing an iterative process. The procedure included: assessing the target positive prevention group’s needs (safer sex; fertility-related issues), identifying the potential interventions through a literature review, conducting qualitative adaptation research to identify areas for adaptation by ensuring cultural relevance (revising the intervention logic by adding topics such as adherence; HIV-related stigma; HIVdisclosure; safer sex), pilot-testing the adapted programme and conducting a process evaluation of its ﬁrst implementation.Areasaddedonto theoriginal intervention’slogicframework,basedonsocialcognitivetheory,thetheoriesofreasonedactionandplannedbehaviourwereinformationandskillsbuilding onsexualrelationshipsandprotectionbehaviour,preventionofverticalHIVtransmission,contraception, HIV-disclosure, HIV-related stigma, HIV-treatment and adherence. The process evaluation using mixed methods showed that we delivered a feasible and acceptable intervention for HIV-positive adolescents aged13–17years. The systematic approach adopted facilitated the development ofacontextualized and developmentally appropriate (i.e. age-speciﬁc) intervention for adolescents living with HIV.