{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,25]],"date-time":"2026-09-25T18:59:09Z","timestamp":1790362749950,"version":"4.1.0"},"reference-count":44,"publisher":"Public Library of Science (PLoS)","issue":"9","license":[{"start":{"date-parts":[[2026,9,25]],"date-time":"2026-09-25T00:00:00Z","timestamp":1790294400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100004417","name":"Global Fund to Fight AIDS, Tuberculosis and Malaria","doi-asserted-by":"publisher","award":["FA No.: 202100741"],"award-info":[{"award-number":["FA No.: 202100741"]}],"id":[{"id":"10.13039\/100004417","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosglobalpublichealth.org"],"crossmark-restriction":false},"short-container-title":["PLOS Glob Public Health"],"abstract":"<jats:p>In Kenya, the DREAMS Partnership (\u201cDetermined, Resilient, Empowered, AIDS-free, Mentored and Safe\u201d) aims to reduce new HIV cases among adolescent girls and young women (AGYW; aged 10\u201324) through a comprehensive programme of interventions. The impact of DREAMS varies across settings but reasons for this are not well understood. One potential reason is the differential implementation of DREAMS interventions due to on-the-ground adaptations made by implementers. We sought to understand if, how, and why DREAMS delivery was adapted in three Kenyan settings, so that complex interventions like DREAMS can be tailored to diverse contexts and challenges.We analysed 40 transcripts from individual and group discussions with DREAMS implementing teams. Data were collected between 2017\u20132019 in rural Gem and two Nairobi informal settlements. Using both FRAME and CFIR frameworks, we identified programming and contextual challenges that affected implementation, local adaptations made in response to these realities and challenges, and the goals and reasoning for adaptation. Reasons for adapting DREAMS were similar across settings yet the type of adaptation varied by context. Adaptations were made to: 1) improve programme attendance; 2) tailor content to better suit AGYW, encourage programme attendance and address community concerns; 3) support participants\u2019 wellbeing, amidst poverty, hunger and violence; and 4) cope with insufficient programming resources. Given their close contact with participants and families, DREAMS mentors often developed unique context-specific strategies to make interventions more appealing and accessible to participants of different ages and circumstances. Understanding shared reasons for adaptation across settings can help anticipate challenges before implementation, and inform the co-design of interventions with communities. As context-specific issues inevitably arise during implementation, mentors can be instrumental in adapting DREAMS, serving as a bridge between programme implementers and beneficiaries. Supporting mentors\u2019 ideas and ongoing commitment can ensure that those delivering programmes plan, learn, adapt and improve in partnership with communities.<\/jats:p>","DOI":"10.1371\/journal.pgph.0006701","type":"journal-article","created":{"date-parts":[[2026,9,25]],"date-time":"2026-09-25T18:00:26Z","timestamp":1790359226000},"page":"e0006701","update-policy":"https:\/\/doi.org\/10.1371\/journal.pgph.corrections_policy","source":"Crossref","is-referenced-by-count":0,"title":["How can complex interventions be adapted to context? A qualitative analysis of the implementation of DREAMS in three Kenyan settings"],"prefix":"10.1371","volume":"6","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3649-3049","authenticated-orcid":true,"given":"Anush\u00e9","family":"Hassan","sequence":"first","affiliation":[{"name":"LSHTM","place":["London, United Kingdom"],"department":["Faculty of Epidemiology and Population Health"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9608-5368","authenticated-orcid":true,"given":"Aliz\u00e9e","family":"McLorg","sequence":"additional","affiliation":[{"name":"LSHTM","place":["London, United Kingdom"],"department":["Faculty of Epidemiology and Population Health"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vivienne","family":"Kamire","sequence":"additional","affiliation":[{"name":"Kenya Medical Research Institute","place":["Kisumu, Kenya"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Venetia","family":"Baker","sequence":"additional","affiliation":[{"name":"LSHTM","place":["London, United Kingdom"],"department":["Faculty of Epidemiology and Population Health"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4843-5586","authenticated-orcid":true,"given":"Jane","family":"Osindo","sequence":"additional","affiliation":[{"name":"African Population and Health Research Centre","place":["Nairobi, Kenya"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9137-8014","authenticated-orcid":true,"given":"Elizabeth","family":"Kemigisha","sequence":"additional","affiliation":[{"name":"African Population and Health Research Centre","place":["Nairobi, Kenya"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3736-0603","authenticated-orcid":true,"given":"Jane","family":"Ferguson","sequence":"additional","affiliation":[{"name":"Independent Consultant","place":["Tannay, Switzerland"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martina","family":"Mchenga","sequence":"additional","affiliation":[{"name":"University of Cape Town","place":["Cape Town, South Africa"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8615-7601","authenticated-orcid":true,"given":"Sian","family":"Floyd","sequence":"additional","affiliation":[{"name":"LSHTM","place":["London, United Kingdom"],"department":["Faculty of Epidemiology and Population Health"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel","family":"Kwaro","sequence":"additional","affiliation":[{"name":"Kenya Medical Research Institute","place":["Kisumu, Kenya"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abdhalah","family":"Ziraba","sequence":"additional","affiliation":[{"name":"African Population and Health Research Centre","place":["Nairobi, Kenya"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3800-3173","authenticated-orcid":true,"given":"Elona","family":"Toska","sequence":"additional","affiliation":[{"name":"University of Cape Town","place":["Cape Town, South Africa"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brendan","family":"Maughan-Brown","sequence":"additional","affiliation":[{"name":"University of Cape Town","place":["Cape Town, South Africa"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5742-6588","authenticated-orcid":true,"given":"Isolde","family":"Birdthistle","sequence":"additional","affiliation":[{"name":"LSHTM","place":["London, United Kingdom"],"department":["Faculty of Epidemiology and Population Health"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2026,9,25]]},"reference":[{"key":"pgph.0006701.ref001","volume-title":"Kenya HIV Estimates Report 2018. 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