Adapting the HealthMpowerment (HMP) mobile application for youth living with or at risk of HIV in Africa using the ADAPT-ITT model

BACKGROUND: Adaptation plays a critical role in implementation science (IS) by optimizing the fit of evidence-based interventions (EBIs) to local contexts and populations. Adaptation is especially relevant in digital health, where technologies, user preferences, and needs evolve rapidly. Yet, methodological approaches to guide and document adaptation processes are seldom included. Grounded in an IS framework, we describe a multi-phase process and results for the adaptation of a digital health intervention (DHI) for HIV prevention and treatment for sexual and gender minority (SGM) youth in Malawi, Kenya, Nigeria, and Zambia. METHODS: Guided by the Assessment, Decision, Administration, Production, Topical Experts, Integration, Training, and Testing (ADAPT-ITT) model, we adapted the EBI HealthMpowerment (HMP) DHI for SGM youth. We conducted eight focus group discussions with SGM youth (N = 80) living with or at risk for HIV and four with other key experts (N = 29) to inform app adaptations. Rapid qualitative analyses were conducted, and the findings were summarized using the Mobile App Rating Scale. Subsequently, we conducted beta testing with 40 SGM youth to assess the app's usability with the validated System Usability Scale. The data were collected from June 2024 to April 2025. RESULTS: Most HMP adaptations were within two domains of the Mobile App Rating Scale: Engagement and Information Quality. Engagement adaptations focused on increasing support and reducing provider response times through the app, along with added gamification. Information Quality adaptations focused on expanding resources (e.g., mental health, economic strengthening) and ensuring that healthcare referrals made via the app were to SGM-competent providers. Functionality enhancements included adding content in local languages and integrating WhatsApp. Data safety was prioritized and addressed by creating an emergency lockout code. For Subjective Quality, participants perceived the app favorably for its support for medication adherence. Results from the beta testing indicated a score of 70.0, indicating above-average usability. Modifications were made to the ADAPT-ITT model to embed consultations with key experts throughout the different phases. CONCLUSIONS: The HMP app was collaboratively and iteratively adapted with SGM youth and key partners. This methodological approach enhances HMP's functionality, quality, and safety, increasing the likelihood of success in future trials and scale-up. TRIAL REGISTRATION: NCT06350682. Registered on February 20, 2024. https://reporter.nih.gov/project-details/11373152.