Clinical trial recruitment is challenging, 1 particularly for socially disadvantaged patients. 2 The COVID-19 pandemic has amplified this challenge. In this research letter, we report on adaptations we made to participant recruitment processes for a clinical trial conducted across three geographic regions impacted by COVID-19 and their impact on recruitment. The trial, Implementation Research: Translating the ABCS into HIV Care (5U01HL142107-02), is a stepped wedge, cluster, randomized trial to test implementation strategies designed to promote uptake of evidencebased cardiovascular interventions for People Living with HIV. 3 Implementation strategies target patient, clinician and practice participants. The trial involves recruitment of 600, largely low-income and minority patients and 40-60 clinicians who care for these patients across nine separate practices, largely serving lowincome and minority patients from three geographic regions (NYC; Rochester, NY; and Dallas, TX). 4 Patients must have HIV, be 40-75 years, at ø5% 10year risk for atherosclerotic cardiovascular disease using the ASCVD Risk Estimator Plus, 4 be willing to participate, be proficient in English or Spanish, own a cell phone with texting capabilities and be approved by the consented clinician. Recruitment involves identification of potentially eligible participants using electronic health record data, 5 communication between the clinician and research assistant, referral by the clinician and communication between the prospective participant and the research assistant. Beginning 9-10 March 2020, all sites from Dallas, NYC and Rochester experienced a sudden, institutionally, COVID-19-mandated shutdown of in-person clinical and research activities. Hospitals and Federally Qualified Health Centers quickly transitioned all nonemergent/urgent patient visits to telehealth visits by video or phone, often from clinicians' homes. 6 These transformative changes required immediate adaptations for our research interventions, 7 for example, shifting