An Adapted Intervention Mapping Approach to Scaling Digital HIV Care Through Single-Session Design

Although many digital health interventions (DHIs) for HIV prevention have demonstrated feasibility, acceptability, and, to a lesser extent, efficacy, few have achieved widespread dissemination beyond research settings. Reimagining existing multisession DHIs as single-session interventions (SSIs) offers a promising strategy to enhance scalability, given growing evidence that SSIs can effectively bridge treatment and prevention gaps. This study applied the Intervention Mapping (IM) framework, combined with single-session design principles, to adapt Keep It Up! (KIU!), a CDC-designated best-evidence HIV prevention program originally delivered across six months into a single-session format. Using a modified IM approach, we convened an expert and community advisory board (n = 13) to guide the study; across six steps, we prioritized key behavioral outcomes, identified corresponding objectives, and retained KIU!’s core theoretical determinants. The resulting program, Keep It Brief!, comprises three components: a universal HIV module, a tailored PrEP module reflecting users’ PrEP experience, and a relationship module adapted for participants who are single, monogamous, or in open/polyamorous relationships. Usability testing with 15 end users indicated high acceptability, engagement, and usability, supported by qualitative and quantitative feedback. Despite substantial changes from the original intervention, the modified IM approach proved practical in retaining essential mechanisms within a single-session format. We propose that adaptations of multisession interventions should not be evaluated on whether they outperform the original program, but by their ability to reach individuals or settings where multisession formats are infeasible, while producing meaningful change in core mechanisms. We also outline key challenges and recommendations for adapting multisession DHIs into single-session formats.