# Adaptations to an implementation study for integrating hypertension management into HIV care in Lagos, Nigeria: application of the FRAME

## TL;DR

This paper describes how hypertension management was adapted for integration into HIV care in Lagos, Nigeria, using the FRAME framework to improve recruitment and training.

## Contribution

The study introduces a modified FRAME framework to document and analyze adaptations in a real-world implementation trial in a low-resource setting.

## Key findings

- Twelve adaptations were identified, including adding feeder sites and increasing training frequency.
- Modifications included reordering recruitment dates and offering patient incentives for follow-up visits.
- 25% of adaptations expanded the intervention structure, and 33% added new elements to strategies.

## Abstract

Implementation strategies are dynamic and multi-faceted, and may require adaptations to fit implementation contexts, especially in lower-and-middle income countries. We report the adaptations for an ongoing late-stage implementation science trial (R01HL147811) that integrates hypertension management into HIV care in Lagos, Nigeria – a country with a high dual-disease burden – through the Task Strengthening Strategy for Hypertension (TASSH) intervention and Practice Facilitation implementation strategy.

FRAME (Framework for Reporting Adaptations and Modifications—Enhanced) modules were used to record adaptations to the intervention (i.e., TASSH) respectively, enhance participant recruitment and retention rates, and increase frequency of trainings. Data collection sources included (not limited to) patient records, nurses’ logs, and minutes of implementation review meetings. Data across these sources was coded retrospectively by trained research staff and triangulated during virtual meeting discussions. Once consensus was reached, data was mapped onto the relevant framework modules using Microsoft Excel.

We modified FRAME to include an additional component on ‘what was originally planned’ for the context of the adaptations. There were twelve adaptations identified during the implementation of the study. The adaptations characterized by using the frameworks included reordering recruitment start dates of study cohorts, providing patients incentives to attend follow-up visits, adding feeder sites to the study sites, and increasing the frequency of training to account for the high nurse turnover in the primary healthcare centers. Overall, 25% of the adaptations involved expanding the structure of the intervention and implementation strategies, and 33% involved adding new elements to the strategies. All adaptations occurred in the implementation phase of the trial.

Based on our experiences, the characterization of the adaptations using FRAME demonstrates their combined applicability to an ongoing trial that can be tailored to fit the local context.

ClinicalTrials.gov ( NCT04704336). Registered on 11 January 2021.

The online version contains supplementary material available at 10.1186/s43058-026-00869-3.