Adaptations made to implementation strategies to deliver two-way texting (2wT) for voluntary male medical circumcision (VMMC), adopted from Framework for Reporting Adaptations and Modifications in Evidence-based Implementation Strategies (FRAME-IS)
| Description of the adaptation | Goal of the adaptation | When was the adaptation done? | What was adapted? | Who? | Level of adaptation |
| To recruit more VMMC clients, the team decided to conduct camps on selected weekends to recruit and perform MCs at the same time | Increase the reach of 2wT (the number of patients receiving 2wT) (rigour/fidelity) | Implementation | Context | VMMC team | Implementer level |
| During COVID-19 lockdowns, the rural VMMC team conducted circumcision as a mobile outreach service visiting patients in their communities | Improve feasibility of implementation in rural areas (relevance/adaptation) | Implementation (COVID-19 lockdown) | Context | The Department of Health | Organisational level |
| Two urban sites were added to increase the recruitment of VMMC clients | Improve urban engagement and implementation (relevance/adaptation) | Implementation | Context, local setting | Principal investigator (PI) | Implementer level |
| The use of WhatsApp, check-in calls three times a week, weekly project update calls with all implementing teams (PI, technical and VMMC teams) to improve communication between implementation and research teams | Increase reach, engagement or implementation (rigour/fidelity) | Implementation | Communication | PI, research manager | Implementer level |
| During COVID-19 lockdowns, the team used virtual meetings and digital technology to implement 2wT remotely | Improve acceptability, appropriateness and feasibility, engagement and implementation of the 2wT (rigour/fidelity) | Pilot and implementation | Context | PI, project manager and VMMC team | Organisational level |
| The clinical team drew a duty roster to allocate one clinician to be available to communicate with clients on weekends and public holidays | Improve feasibility, engagement and implementation of the 2wT (relevance/adaptation) | Pilot | Context, personnel implementing 2wT | Project manager and VMMC team leaders | Clinician or researcher level |
| Adding local language translations (Setswana and isiZulu) in the usability survey | Increase engagement and feasibility of 2wT and to improve the fit between the implementation effort and the needs of those receiving 2wT (rigour/fidelity) | Pilot | Context and format of 2wT | PI, research manager | Clinician or researcher level |
| To fit the 2wT intervention into routine care, the research partner contributed a portion towards the salary of the implementing staff | To increase equity and decrease disparities in the delivery of 2wT and routine care (relevance/adaptation) | Implementation | Context | PI, project manager and VMMC team | Organisational and implementer levels |
| Two rural clinics were purposively excluded as recruitment sites to reduce costs and improve the effectiveness of the 2wT of the 2wT strategy | Decrease costs of the implementation effort (relevance/adaptation) | Implementation | Context, local setting | PI | Organisational and implementer levels |
| The PIs implemented additional data quality checks to ensure the validity of the data. | Improve the sustainability of 2wT and increase the chances that 2wT remains in practice (rigour/fidelity) | Implementation | Context and format of the intervention | PI, research team | Organisational level |
| Non-clinical counsellors were trained to help enrol clients and capture them on the Medic system. | Increase the effectiveness of the clinical outcomes of the patients receiving 2wT (relevance/adaptation) | Implementation | Training and evaluation | Research manager and VMMC team | Organisational and implementer levels |
| Retraining of staff members on recruitment, recording and follow-ups in the rural site with high staff turnover | Increase adoption or number of clinicians recommending and patients using 2wT (rigour/fidelity) | Pilot and Implementation | Training and evaluation | Research manager | Organisational and implementer levels |
| Enabling the system to accommodate enrolment of VMMC clients to the 2wT platform using both primary and alternative phone numbers | Improve fidelity or the extent to which 2wT is delivered as intended (relevance/adaptation) | Implementation | Context | Technical and research team | Organisational and implementer levels |
Sources: Adapted from Miller et al17 and Kirk et al.21