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The ADAPT-ITT model: a novel method of adapting evidence-based HIV interventions
Global Health Sciences Literature Digest
Published October 5, 2009
Journal Article

Wingood G, DiClemente R. The ADAPT-ITT model: a novel method of adapting evidence-based HIV interventions. JAIDS 2008 March 1;47(Suppl 1):S40-S46.

In Context

There is increasing pressure for HIV prevention programs to implement evidence-based interventions (EBIs).(1) The Centers for Disease Control and Prevention (CDC) has developed a list of EBIs and methods to assist in disseminating and adapting them for additional risk populations.(2,3,4,5,6) The CDC model for adapting EBIs, called MAP, has three steps, each with its own set of detailed requirements. The result is that the model that may be limited in its utility because of its complexity. Another model, ADAPT-ITT, has been developed that may be more pragmatic than MAP.

Objective

To describe the ADAPT-ITT model and present case studies of its application

Study Design

Description of a new model for adapting EBIs to additional target populations

Model Description

ADAPT-ITT has eight steps, each corresponding to a letter in the acronym:

  1. Assessment is done to understand the risk in the target population and assess the capacity of agencies to adapt and implement the EBIs. It uses focus groups with the target population and interviews and focus groups with key stakeholders.
  2. Decision making is done regarding the selection of the EBIs. Reviews are done to identify the EBIs that seem most appropriate and to determine if they need adaptation.
  3. Adaptation involves pre-testing the EBI by presenting it to members of the target population and asking them to respond. Participants provide feedback following the demonstration through written surveys that are then discussed in the group.
  4. Production involves producing a first draft of the EBI, maintaining fidelity to the core elements, behavioral theory, and internal logic of the original EBI.
  5. Topical Experts are identified who have expertise in the content of the EBI; they review the first draft of the adapted version.
  6. Integration of the feedback from the topical experts is integrated into the first draft. The second draft may include additional validated, reliable, and culturally relevant measures identified by the topical experts.
  7. Training facilitators, recruiters and retention staff, interviewers, and data management staff is done to ensure proper conduct of the intervention.
  8. Testing the EBI is done in two steps. The first is pilot testing the intervention in a group of 20 participants who are representative of the target population. Feedback from the participants is obtained through exit interviews. Stakeholders and agency staff also observe the pilot testing and provide feedback from their perspectives as well. Based upon the pilot testing, the third draft of the EBI is developed. A second pilot test is done in which participants from the target population are randomized into the intervention or control condition. Baseline surveys, process measures, and at least a 3-month post-intervention assessment are done. This assessment should measure desired outcomes, such as changes in knowledge, attitudes, beliefs, or behaviors. Analysis of the data from the second pilot test is then used to determine if the EBI likely will be effective in the target population.

Table: Case Study: Applying the ADAPT-ITT Model to Adapt the SiHLE5 Intervention to Zulu-Speaking Adolescents
PhaseMethodology
AssessmentConducted focus groups with young adult Zulu-speaking women

Conducted focus groups with key stakeholders in a rural primary care clinic in KwaZulu-Natal

Conducted elicitation interviews with key stakeholders who were HIV/AIDS prevention scientists

Analyzed results of formative evaluations
DecisionDecided to adapt the SiHLE HIV intervention defined as an EBI by the CDC5
Administration

Administered theater test with Zulu adolescents

Analyzed results of the theater test
ProductionProduced draft 1 of the adapted EBI and developed process measures
Topical ExpertsIdentified three topical experts knowledgeable about HIV prevention and the population of Zulu-speaking adolescents living in KwaZulu-Natal, the target audience for intervention
Integration

Integrated content from topical experts and created draft 2 of the adapted EBI

Integrated scales that measure new intervention content in the study survey

Integrated readability testing into draft 2 of the EBI to create draft 3
TrainingTrained recruiters, facilitators, assessors, and data management staff to implement draft 3 of the adapted EBI
TestingPilot study is being planned
CDC = US Centers for Disease Control and Prevention, EBI = evidence-based intervention.

Conclusions

Although several rigorous studies have provided evidence for effective prevention interventions, these studies have generally demonstrated efficacy only in selected risk populations. Given the diversity of populations affected by HIV and the costs and time constraints of conducting randomized clinical trials, developing methods to adapt EBIs to additional risk populations is necessary.

Quality rating

This paper describes a process and as such cannot be objectively rated.

Programmatic Implications

The process described in this paper is likely to be useful to people responsible for developing and implementing prevention programs. Although the CDC has presented a model for this process as well, not every model will be feasible in all settings. Thus, having a detailed description of an alternative approach is likely to be contributory, although it would be best if an adapted EBI could be tested rigorously for efficacy.

References

  1. Institute of Medicine. Report brief. No time to lose: getting the most from HIV prevention. Washington, DC: National Academies Press; 2001. Accessed May 10, 2007.
  2. Centers for Disease Control and Prevention. 2003-2008. HIV prevention community planning guide. Accessed May 15, 2007.
  3. HIV/AID Prevention Research Synthesis Project. Compendium of HIV prevention interventions with evidence of effectiveness. Revised ed. Atlanta, GA: Centers for Disease Control and Prevention; 1999. Abstract unavailable.
  4. Kay L, Crepaz N, Lyles C, et al. Update of the compendium of HIV prevention interventions with evidence of effectiveness. Presented at: National HIV Prevention Conference; 2003; Atlanta. Abstract unavailable.
  5. Lyles CM, Kay LS, Crepaz N, et al. Best-evidence interventions: findings from a systematic review of HIV behavioral interventions for US populations at high risk, 2000-2004. Am J Pub Health 2007;9:133-43.
  6. McKleroy VS, Galbraith JS, Cummings B, et al. Adapting evidence-based behavioral interventions for new settings and target populations. AIDS Educ Prev 2006;18:59-74.