Utilizing the ADAPT-ITT framework to tailor stigma-reduction intervention for pregnant and postpartum women living with HIV: an adaptation process

Abstract Background HIV-related stigma remains a significant barrier to healthcare utilization for pregnant and postpartum women living with HIV (WLWH), yet most stigma-reduction interventions are designed for general adult populations and do not address maternal-specific stressors. Project ACCEPT has demonstrated effectiveness in stigma reduction globally, but its Post-Test Support Services (PTSS) module has not been tailored for perinatal populations. Methods This manuscript reports the qualitative intervention adaptation phase of the We Are Together (WAT) Study, a larger mixed-methods pilot study, focusing on the systematic adaptation of PTSS’s stigma reduction component conducted across four health facilities in Ghana. Longitudinal in-depth interviews were conducted with 35 WLWH across the perinatal period, as well as interviews with 20 healthcare providers. Data were analyzed using rapid qualitative and thematic approaches. A Community Advisory Board contributed to data interpretation and participated in a prioritization exercise. The adaptation followed iterative ADAPT-ITT phases, including assessment, drafting, expert review, and theater testing, to ensure cultural relevance, feasibility, and acceptability. Results Findings highlighted a “double burden” of HIV-related and maternal stigma shaping women’s experiences. Stakeholder engagement informed key adaptations of PTSS, including integration of maternal health content, culturally grounded peer-support strategies, and context-specific examples. Key adaptations included shifting the intervention’s individualistic coping framework to a collectivist orientation grounded in the ‘What Matters Most’ framework. This was reflected in communal language (e.g., ‘we/us’ instead of ‘I/me’), and the introduction of ‘Mentor Mothers,’ trained peer interventionists with lived experience of HIV and pregnancy, to strengthen trust and relatability during sessions. The resulting WAT intervention retained the six-session structure of PTSS, while modifying content and delivery to align with the needs of perinatal WLWH. Conclusions This study systematically applied the ADAPT-ITT framework to adapt a stigma-reduction intervention for a maternal population. The resulting intervention offers a culturally grounded model that may inform adaptation of evidence-based interventions for WLWH in similar settings.