Using the Framework for Reporting Adaptation and Modifications-Expanded (FRAME) to Adapt an Evidence-Based HIV-Prevention Intervention for Zambian Adolescent Girls and Young Women

Despite substantial global efforts, adolescent girls and young women (AGYW) in Southern Africa remain disproportionately affected by HIV. In Zambia, the HIV prevalence among AGYW is nearly three times that of their male peers. The Informed Motivated Aware and Responsible Adolescents and Adults (IMARA) program, an evidence-based HIV/STI prevention intervention initially developed in the United States and later adapted in South Africa, demonstrated promising reduction in HIV risk through culturally tailored, mother-daughter-focused strategies. This paper outlines the process of adapting IMARA for Zambian AGYW by utilizing the Framework for Reporting Adaptations and Modifications-Expanded (FRAME). The adaptation process consisted of four phases: (1) Assessment through stakeholder meetings and focus groups involving adolescents and caregivers; (2) Intervention Delivery Decisions guided by community feedback; (3) Curriculum Adaptation through iterative revisions and collaborative input from Zambian and U.S.-based researchers; and (4) Theater Testing with adolescent-caregiver dyads to refine the content. All modifications were documented using FRAME. Eight key modifications, covering content, context, and training, were implemented to create ZAIMARA (Zambian Informed Motivated Aware and Responsible Adolescents and Adults). These changes were proactively planned, occurred pre-implementation, and were deemed fidelity-consistent. Examples include translating materials into a local language and changing intervention terms and scenarios to reflect cultural norms. Applying FRAME to adapt IMARA in Zambia provided a transparent, systematic method to maintain cultural relevance with fidelity to an evidence-based intervention. Our study demonstrates the utilization of the FRAME for future adaptations of HIV prevention programs in diverse global contexts.