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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\u2013focused 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\u2013caregiver 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.<\/jats:p>","DOI":"10.1007\/s10461-026-05033-5","type":"journal-article","created":{"date-parts":[[2026,1,27]],"date-time":"2026-01-27T13:28:08Z","timestamp":1769520488000},"page":"2082-2090","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["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"],"prefix":"10.1007","volume":"30","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9506-8715","authenticated-orcid":false,"given":"Gina Diagou","family":"Sissoko","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tukiya","family":"Kanguya","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mwamba","family":"Mwenge","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anjali","family":"Sharma","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nok","family":"Chhun","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephanie H.","family":"Yu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Erin","family":"Emerson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sybil","family":"Hosek","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carolyn","family":"Bolton-Moore","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Geri R.","family":"Donenberg","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,1,27]]},"reference":[{"key":"5033_CR1","unstructured":"Joint United Nations Programme on HIV\/AIDS (UNAIDS). The path that ends AIDS [Internet]. Geneva: UNAIDS; 2023 [cited 2025 Mar 19]. Available from: https:\/\/thepath.unaids.org\/"},{"key":"5033_CR2","unstructured":"ZAMPHIA. Zambia Population-based HIV Impact Assessment (ZAMPHIA) 2016: Final Report [Internet]. Lusaka, Zambia: Ministry of Health Zambia; ICAP at Columbia University; US Centers for Disease Control and Prevention; 2019 [cited 2025 May 1]. Available from: https:\/\/phia.icap.columbia.edu\/wp-content\/uploads\/2019\/02\/ZAMPHIA-Final-Report__2.22.19.pdf"},{"key":"5033_CR3","doi-asserted-by":"publisher","DOI":"10.1186\/s12889-021-10472-x","author":"AB Heri","year":"2021","unstructured":"Heri AB, Cavallaro FL, Ahmed N, Musheke MM, Matsui M. Changes over time in HIV testing and counselling uptake and associated factors among youth in Zambia: a cross-sectional analysis of demographic and health surveys from 2007 to 2018. BMC Public Health. 2021. https:\/\/doi.org\/10.1186\/s12889-021-10472-x.","journal-title":"BMC Public Health"},{"key":"5033_CR4","unstructured":"Ministry of Health. National Health Strategic Plan for Zambia 2022\u20132026 (Revised February 2023) [Internet]. Lusaka: Government of the Republic of Zambia; 2023. Available from: https:\/\/www.moh.gov.zm\/wp-content\/uploads\/2023\/02\/National-Health-Stratergic-Plan-for-Zambia-2022-to-2026-revised-February-2023-lower-resolution.pdf"},{"key":"5033_CR5","unstructured":"Joint United Nations Programme on HIV\/AIDS (UNAIDS). UNAIDS strategy 2016\u20132021: On the fast-track to end AIDS [Internet]. Geneva: UNAIDS; 2015 [cited 2025 May 1]. Available from: http:\/\/www.unaids.org\/en\/resources\/documents\/2015\/UNAIDS_PCB37_15-18"},{"key":"5033_CR6","unstructured":"Centers for Disease Control and Prevention (CDC). Compendium of evidence-based interventions and best practices for HIV prevention: Risk reduction chapter \u2013 IMARA (Informed, motivated, aware, and responsible about AIDS) [Internet]. Atlanta, GA: CDC; 2022 Aug. Available from: https:\/\/stacks.cdc.gov\/view\/cdc\/149522"},{"issue":"8","key":"5033_CR7","doi-asserted-by":"publisher","first-page":"728","DOI":"10.1097\/01.chi.0000166381.68392.02","volume":"44","author":"GR Donenberg","year":"2005","unstructured":"Donenberg GR, Pao M. Youths and HIV\/AIDS: psychiatry\u2019s role in a changing epidemic. J Am Acad Child Adolesc Psychiatry. 2005;44(8):728\u201347.","journal-title":"J Am Acad Child Adolesc Psychiatry"},{"issue":"11","key":"5033_CR8","doi-asserted-by":"publisher","first-page":"e0239650","DOI":"10.1371\/journal.pone.0239650","volume":"15","author":"GR Donenberg","year":"2020","unstructured":"Donenberg GR, Kendall AD, Emerson E, Fletcher FE, Bray BC, McCabe K. 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Consent was obtained from individuals involved in stakeholder engagement activities\u2014including community advisory boards, focus groups, and theater testing sessions.","order":2,"name":"Ethics","label":"Ethical Approval and Consent to Participate","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Not applicable. The manuscript does not include identifiable personal data.","order":3,"name":"Ethics","label":"Consent for Publication","group":{"name":"EthicsHeading","label":"Declarations"}}]}}