Application of ADAPT-ITT: adapting an evidence-based HIV/STI mother-daughter prevention intervention for Black male caregivers and girls – BMC Public Health

Phase 1: Assessment

Who is the new target population, and why are they at risk of HIV/STIs?

In Phase 1, we examined previous research and theory to identify the unique mechanisms linked to HIV/STI-risk behavior for Black girls [33, 54, 73, 74]. Preliminary qualitative data indicated Black girls as the target population, sociocultural conditions that place them at disproportionate risk of HIV/STIs, and the need for multilevel interventions to address their risk profiles [16, 20, 50].

• Black girls identified as the target population
• Sociocultural conditions place them at disproportionate risk of HIV/STIs
• Need for multilevel interventions to address their risk profiles

Phase 2: Decision

What EBI will be selected, and will it be adapted or adopted?

HIV/STI prevention EBIs for Black girls and women exist, but the effects are short-lived, and ongoing health disparities for Black girls require innovative approaches to strengthen the long-term effects. Well-known EBIs focus on modifying individual-level risky sexual behaviors and counseling women about safer sex behavior. The positive impacts of these programs may be strengthened for Black girls by tailoring the program for families to address interpersonal and structural drivers and including more information for girls to better understand how knowledge, attitudes, messages, and values about sexuality impact adolescence.

• Sisters Informing Sisters about Topics on AIDS (SISTA)
• Sisters Informing Healing Living and Empowering (SIHLE)
• Women Involved in Life Learning from Other Women (WiLLOW)

One family-based program, Informed, Motivated, Aware, and Responsible about AIDS (IMARA), encompasses both factors. IMARA is an evidence-based psychosocial HIV/STI prevention program designed for Black mothers and daughters to address individual, social, and structural drivers of HIV/STI risk. IMARA leverages the mother-daughter dyad as a structural factor for girls to encourage behavior change and empowers parents as role models. The IMARA curriculum consists of multiple scripted modules where mother-daughter dyads engage in activities to teach girls how to improve communication styles, engage in safe sex practices, protect themselves against domestic violence situations, and strengthen familial relationships.

• IMARA is an evidence-based psychosocial HIV/STI prevention program
• Designed for Black mothers and daughters
• Leverages the mother-daughter dyad as a structural factor
• Empowers parents as role models

Phase 3: Administration

What is in the original EBI that needs to be adapted, and how should it be adapted?

In the Administration phase, we conducted interviews with Black male caregivers to assess how they conceptualize protecting Black girls. We also convened a community advisory board (CAB) consisting of Black girls and male and female caregivers to provide feedback on how to create a culturally relevant family intervention. Thematic analysis was used to analyze the interview and focus group data, and themes emerged that guided the adaptation of the curriculum.

• Lack of knowledge about female adolescent development
• Structural factors impeding Black men from protecting Black girls
• Toxic masculinity and lack of positive Black male role models
• Body positivity
• Challenges of Black male caregiver-girl communication about SRH

Phase 4: Production

How are adaptions of the EBI produced, drafted, and documented?

Feedback from interviews and focus groups with Black male caregivers and the community advisory board informed the initial draft of the new program, IMARA for Black Male Caregivers and Girls Empowerment (IMAGE). Core components of the original IMARA intervention were preserved, but new content was added to address the specific needs and experiences of Black male caregivers and girls. The adapted curriculum was finalized after feedback from content experts and integration of their input.

Phase 5 & 6: Topic experts and integration

Who can help adapt the EBI, and what additional content should be included?

Content experts were consulted to assist in curriculum development in areas where the adaptation team lacked expertise. They provided feedback on the adapted curriculum and suggested additional activities to support Black male mental health and address toxic masculinity and stereotyping. Their input guided the improvement of the curriculum.

Phase 7: Training

Who needs to be trained?

Facilitators who deliver the intervention for dyads were trained to ensure competency and fidelity to the intervention. Training sessions included reviewing modules and practicing delivery of the intervention. Facilitators were trained to create a safe space, challenge participants’ perspectives, and address gender and sexuality in an inclusive manner.

Phase 8: Testing

Was the adaptation feasible and acceptable to the target population?

The adapted curriculum, IMAGE, was theater-tested with Black male caregivers and girls. Participants rated each module highly, indicating acceptability. Feedback from participants and observers was used to further refine the curriculum. The theater test demonstrated that the

SDGs, Targets, and Indicators

SDGs, Targets, and Indicators Identified in the Article:

1. SDG 3: Good Health and Well-being
• Target 3.3: By 2030, end the epidemics of AIDS, tuberculosis, malaria and neglected tropical diseases and combat hepatitis, water-borne diseases and other communicable diseases.
• Indicator 3.3.2: Tuberculosis incidence per 100,000 population.
• Indicator 3.3.4: Malaria incidence per 1,000 population at risk.
• Indicator 3.3.5: Number of people requiring interventions against neglected tropical diseases.
2. SDG 5: Gender Equality
• Target 5.6: Ensure universal access to sexual and reproductive health and reproductive rights as agreed in accordance with the Programme of Action of the International Conference on Population and Development and the Beijing Platform for Action and the outcome documents of their review conferences.
• Indicator 5.6.1: Proportion of women aged 15-49 years who make their own informed decisions regarding sexual relations, contraceptive use and reproductive health care.
3. SDG 10: Reduced Inequalities
• Target 10.2: By 2030, empower and promote the social, economic and political inclusion of all, irrespective of age, sex, disability, race, ethnicity, origin, religion or economic or other status.
• Indicator 10.2.1: Proportion of people living below 50 percent of median income, by age, sex and persons with disabilities.

Explanation:

1. SDG 3: Good Health and Well-being is addressed in the article as it discusses the risk of HIV/STIs among Black girls and the need for interventions to address their risk profiles.

2. Target 3.3: By 2030, end the epidemics of AIDS, tuberculosis, malaria and neglected tropical diseases and combat hepatitis, water-borne diseases and other communicable diseases can be identified based on the article’s content. The article mentions the risk of HIV/STIs among Black girls, which falls under the category of communicable diseases.

3. Indicators mentioned or implied in the article that can be used to measure progress towards the identified targets include:

– Indicator 3.3.2: Tuberculosis incidence per 100,000 population.

– Indicator 3.3.4: Malaria incidence per 1,000 population at risk.

– Indicator 3.3.5: Number of people requiring interventions against neglected tropical diseases.

– Indicator 5.6.1: Proportion of women aged 15-49 years who make their own informed decisions regarding sexual relations, contraceptive use, and reproductive health care.

– Indicator 10.2.1: Proportion of people living below 50 percent of median income, by age, sex, and persons with disabilities.

Table: SDGs, Targets, and Indicators

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Source: bmcpublichealth.biomedcentral.com

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