An application of the ADAPT-ITT model to an evidence-based behavioral HIV prevention intervention for men who have sex with men in Ghana

Abstract

Despite constituting only about 1% of Ghana’s population, men who have sex with men (MSM) carry a disproportionate burden of HIV infections, constituting 18% of the population of people living with HIV in the country. Scholars have associated the disproportionate infection rates of HIV among MSM with existing structural factors (such as criminalization and stigma against MSM), and individual-level factors (such as sex without a condom, and transactional sex). Nonetheless, limited scholars consider intervention as an approach to reducing HIV and STI risk among MSM in the country. As such, in collaboration with community partners, we engaged MSM through the use of the ADAPT-ITT model to adapt the Many Men Many Voices (3MV) to address the needs of MSM. We addressed HIV/STD risk factors and ways to reduce HIV/STD infections. In this paper, we describe the use of the ADAPT-ITT model in the adoption and adaptation of the 3MV with MSM in Ghana. Whereas the 3MV was a good fit for our target population, we made modifications to fit the Ghanaian cultural setting by examining HIV and STD risk in the context of bisexuality, emphasizing on secrecy in location choice, and incorporating historical colonial setting in contextualizing sexuality and stigma in the Ghanaian sociocultural context. Our implementation process shows the efficacy of collaboration with community partners to implement culturally relevant interventions in HIV and STD prevention efforts in highly stigmatized environments.

HIV Education, Empathy, and Empowerment (HIVE3): A Peer Support Intervention for Reducing Intersectional Stigma as a Barrier to HIV Testing among Men Who Have Sex with Men in Ghana

“…This paper describes an adapted HIVE 3 , a peer-to-peer support platform that facilitates increased communication between MSM in Ghana on sexual health needs. Like previous interventions, we used the ADAPT-ITT model to adapt the original HIVE 3 into its current form to address the support needs of a general MSM population, instead of MSM living with HIV as initially implemented [ 9 , 25 , 26 , 27 ]. Whereas we maintained the focus of the peer support model that informed the development of the intervention, we made modifications to include current health concerns, such as intersectional stigma and identity among MSM in Ghana.…”

“…Various scholars have used it to adapt HIV interventions. However, some have also applied the framework in implementing other forms of interventions, such as substance use [ 9 , 25 , 26 , 27 ].…”

“…These steps described reflect the guidelines provided by the ADAPT-ITT framework to guide intervention adaptation. We explain the detailed steps in our previous article [ 9 ]. The model consists of eight components that drive the adoption or adaptation of evidence-based interventions to fit the cultural context of the population of interest [ 9 , 24 –27].…”

“…We explain the detailed steps in our previous article [ 9 ]. The model consists of eight components that drive the adoption or adaptation of evidence-based interventions to fit the cultural context of the population of interest [ 9 , 24 –27]. The steps include: (1) Assessment —establishing the need of intervention; (2) Decision —deciding on the intervention to be adapted; (3 ) Adaptation —theatre testing with the target population, and identifying changes to be implemented; (4) Production —producing draft manual contents; (5) Topical Experts —soliciting expert review of contents, and recommendations for improvement; (6) Integration —analyzing and incorporating feedback; (7) Training —building capacity of intervention implementation team; (8) Testing— pilot testing of the adapted intervention [ 9 , 24 –27].…”

“…MSM in Ghana remain disproportionately affected by the HIV epidemic, with an estimated prevalence of 18% compared to 2% for the general population [ 6 , 7 , 8 ]. Factors contributing to the increased risk of HIV transmission among MSM in Ghana include low rates of HIV testing, and stigma associated with HIV testing, insufficient knowledge of HIV pre-exposure prophylaxis (PrEP), and inconsistent condom use [ 2 , 9 , 10 , 11 , 12 ]. Additionally, MSM living with HIV in Ghana experience various barriers to receiving quality healthcare services, such as experiences of stigma, unaffordability of healthcare services, long wait times at medical facilities, and poor patient–provider relationships [ 9 , 10 , 11 , 12 ].…”