title: Translating primary into 'positive' prevention for adolescents in Eastern Africa.
abstract: 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; HIV-disclosure; safer sex), pilot-testing the adapted programme and conducting a process evaluation of its first implementation. Areas added onto the original intervention's logic framework, based on social cognitive theory, the theories of reasoned action and planned behaviour were information and skills building on sexual relationships and protection behaviour, prevention of vertical HIV transmission, 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 aged 13-17 years. The systematic approach adopted facilitated the development of a contextualized and developmentally appropriate (i.e. age-specific) intervention for adolescents living with HIV.
authors.affiliation: Department of Public Health, Institute of Tropical Medicine (ITM), Nationalestraat 155, Antwerp B-2000, Belgium ITM HIV/AIDS Center, Nationalestraat 155, Antwerp B-2000, Belgium cnoestlinger@itg.be.
authors.forename: Christiana
authors.initials: C
authors.lastname: Nöstlinger
authors.affiliation: Department of Public Health, Institute of Tropical Medicine (ITM), Nationalestraat 155, Antwerp B-2000, Belgium ITM HIV/AIDS Center, Nationalestraat 155, Antwerp B-2000, Belgium.
authors.forename: Loos
authors.initials: L
authors.lastname: Jasna
authors.affiliation: Baylor College of Medicine Children's Foundation, Kampala, Uganda Department of Pediatrics, Makerere University College of Health Sciences, Kampala, Uganda.
authors.forename: Bakeera-Kitaka
authors.initials: BK
authors.lastname: Sabrina
authors.affiliation: Kenya Medical Research Institute, Kisumu, Kenya.
authors.forename: Christopher
authors.initials: C
authors.lastname: Obong'o
authors.affiliation: Department of Pediatrics, Makerere University College of Health Sciences, Kampala, Uganda.
authors.forename: Wobudeya
authors.initials: W
authors.lastname: Eric
authors.affiliation: Department of Public Health, Institute of Tropical Medicine (ITM), Nationalestraat 155, Antwerp B-2000, Belgium ITM HIV/AIDS Center, Nationalestraat 155, Antwerp B-2000, Belgium.
authors.forename: Anne
authors.initials: A
authors.lastname: Buvé
mesh_terms: D000293:Adolescent; D000295:Adolescent Medicine / Q000379:methods; D000351:Africa, Eastern; D005260:Female; D015658:HIV Infections / Q000517:prevention & control / Q000523:psychology / Q000628:therapy*; D006801:Humans; D008297:Male; D011322:Primary Prevention / Q000379:methods* / Q000458:organization & administration; D016730:Program Development; D015397:Program Evaluation
keywords: HIV/AIDS; adolescent; intervention; sexual behaviour