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We used participatory qualitative approaches and a process evaluation to assess intervention acceptability and feasibility. Co\u2010adapting involved a 3\u2010day workshop with 16 learners aged 15\u201319 (Grade 9\u201310), four discussions with school leadership and two focus group discussions (FGDs) with parents\/guardians, to understand the context and social validity of the programme. Intervention acceptability was assessed through five in\u2010depth interviews with teachers\/school leadership and three with peer leaders, two workshops with intervention and clinical delivery teams, two FGDs with community members and five with learners. Interactions were audio\u2010recorded, transcribed and analysed using thematic analysis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Schools were described as learning spaces providing opportunities for health promotion through health and well\u2010being lessons. Teachers and parents\/guardians noted a need for Safer Choices to provide SRH\/HIV services in schools, as most learners were already sexually active. Provision of mobile SRH\/HIV services in schools was perceived to be feasible if negotiated with the school and HIV\u2010status neutral services were provided to minimize stigma. Adaptations to Safer Choices were focused on optimizing intervention delivery or emphasizing social validity of the programme. During implementation of Safer Choices, myths and misconceptions around HIV and pregnancy were addressed. Challenges such as no electricity and large classes made it difficult to deliver Safer Choices. Peer navigators (lay youth\u2010workers) were engaged to help deliver the intervention.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>In a context of high sexual risk and vulnerability, it was feasible to co\u2010adapt and deliver the Safer Choices programme, which provided accurate and accessible SRH information and services to address adolescent SRH needs of learners in our rural schools. Adaptation challenges included balancing fidelity to intervention with both the \u201creal\u2010world\u201d context and the practicality of peer navigators supporting intervention delivery. These results suggest that optimizing the impact necessitates appropriately resourcing school\u2010based interventions to address the challenges of programming in rural settings.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/jia2.70192","type":"journal-article","created":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T06:30:42Z","timestamp":1791527442000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Adaptation and Evaluation of a Multi\u2010Component School\u2010Based Sexual Reproductive Health Intervention Safer Choices Programme in Rural KwaZulu\u2010Natal, South Africa \u2013 A Process Evaluation"],"prefix":"10.1002","volume":"29","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3125-978X","authenticated-orcid":false,"given":"Natsayi","family":"Chimbindi","sequence":"first","affiliation":[{"name":"Africa Health Research Institute  KwaZulu\u2010Natal South Africa"},{"name":"Institute of Global Health University College London  London UK"},{"name":"University of KwaZulu\u2010Natal  KwaZulu\u2010Natal South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1046-1479","authenticated-orcid":false,"given":"Ursula","family":"Ngema","sequence":"additional","affiliation":[{"name":"Africa Health Research Institute  KwaZulu\u2010Natal South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0583-5272","authenticated-orcid":false,"given":"Janet","family":"Seeley","sequence":"additional","affiliation":[{"name":"Africa Health Research Institute  KwaZulu\u2010Natal South Africa"},{"name":"University of KwaZulu\u2010Natal  KwaZulu\u2010Natal South Africa"},{"name":"London School of Hygiene and Tropical Medicine  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2812-5377","authenticated-orcid":false,"given":"Andrew","family":"Gibbs","sequence":"additional","affiliation":[{"name":"University of KwaZulu\u2010Natal  KwaZulu\u2010Natal South Africa"},{"name":"Gender and Health Research Unit South African Medical Research Council  Pretoria South Africa"},{"name":"University of Exeter  Exeter UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abigail","family":"Harrison","sequence":"additional","affiliation":[{"name":"Brown University  Providence Rhode Island USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7784-9000","authenticated-orcid":false,"given":"Alun","family":"Davies","sequence":"additional","affiliation":[{"name":"University of Oxford  Oxford UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5482-2419","authenticated-orcid":false,"given":"Stefan","family":"Baral","sequence":"additional","affiliation":[{"name":"Johns Hopkins School of Public Health  Baltimore Maryland USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7088-3118","authenticated-orcid":false,"given":"A. 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