Curr HIV/AIDS Rep (2010) 7:185–193 Table 1 ADAPT-ITT questions to ask when adapting HIV interventions Phase A = Assess D = Decide A = Adapt P = Production T = Topic Experts I = Integrate T = Train T = Test Questions to ask when adapting HIV interventions for populations in general What target population is at risk for HIV/AIDS? Which evidence-based intervention (EBI) is being selected for adaptation? How are you documenting the adaptation? (a) How is the intervention being adapted? (b) Why is the text being adapted? (c) What is being adapted? (d) Where did most of the modifications occur? and (e) What is the extent of the modification (ie, all sections of the intervention)? Are you producing drafts of the intervention that reflect changes in the: (a) Core elements? (b) Logic model? (c) Theoretical framework? or (d) Study mediators facilitating behavior change? Are topic experts from the university involved in adapting the intervention? Is text being integrated from the target population? Can facilitators implement the adapted intervention with fidelity? Is the intervention feasible, efficacious, and cost effective? CBPR—community-based participatory research that vary in culture, fiscal, and agency resources, and organizational capacity [42]. This “top-to-bottom” approach to implementation with researchers instructing community agencies is a well-entrenched method of instituting behavior change among high-risk populations, which has limitations. While it is an almost implicit assumption that EBI will have to be adapted for real-world settings, researchers are challenged in making this translation. As a solution, community-based participatory research (CBPR) has been proposed. As defined by the Agency for Healthcare Research and Quality in 2004, CBPR is “a collaborative research approach that is designed to ensure and establish structures for participation by communities affected by the issue being studied, representatives of organizations, and researchers in all aspects of the research process to improve health and well-being through taking action, including social change” [43]. The strength of CBPR is that it respectfully integrates culturally and practice-based evidence and indigenous research methodologies. However, 189 Questions to ask when adapting HIV interventions for African Americans Which particular African American subpopulation is at risk for HIV/AIDS? Which EBI is most appropriate to adapt for this African American subpopulation? How are you documenting the adaptation? (a) How is the intervention being adapted (ie, are culturally relevant themes being introduced?)? (b) Why is the text being adapted (ie, is sexual behavior being contextualized?)? (c) What is being adapted (ie, do materials need to be adapted so they are culturally appropriate?)? (d) Where did most of the modifications occur (ie, culturally tailoring vignettes, discussion questions, data)? and (e) What is the extent of the modifications (ie, text and materials need to be tailored)? Are you producing drafts of the intervention that reflect changes in the: (a) Core elements (ie, to be more culturally congruent)? (b) Logic model (ie, to acknowledge culture)? (c) Theoretical frameworks (ie, to include culturally appropriate models [ie, CBPR, empowerment theory])? or (d) Mediators addressing culturally appropriate mediators (ie, African American community involvement)? Are topic experts from the African American community involved in adapting the intervention? Is text being integrated that is appropriate for the subpopulation’s reading level? Are facilitators culturally competent? Is the intervention acceptable to the African American subpopulation? many of the practices and programs promoted by communities have not been formally evaluated. Also, CBOs may not possess the scientific knowledge and skills to adapt supported interventions [42, 44]. A second challenge to translational research is obtaining community “buy-in” to programs that may not include culturally congruent beliefs, practices, and theories. CBOs have significant access to and rapport with the target population and without their support, interventions may not be accepted, endorsed, or reach the community in the form that they were initially developed. In order to develop a mutually respectful and equitable relationship with community agencies, community partners must be included at all stages of the intervention development process and not only in the translational stage [45 , 46]. Recognition of the diverse community partners must be acknowledged and not simply limited to HIV/AIDS service providers. African American churches and other spiritual and civic organiza- tions are often asked to endorse community health