Cultural adaptation of the New Forest Parenting Program (NFPP) for ADHD in HIV-infected children in Uganda: a feasibility and pilot investigation

Attention-Deficit/Hyperactivity Disorder (ADHD) is highly prevalent among children and adolescents living with HIV (CA-HIV) in sub-Saharan Africa. In Uganda, the estimated prevalence of ADHD among CA-HIV is 25.5% (95% CI: 19.8–31.8). Despite this, there are no established interventions targeting ADHD in HIV care settings. This study aimed to adapt the New Forest Parenting Program (NFPP) for the Ugandan context and evaluate its feasibility, acceptability, and preliminary symptom change within a pilot feasibility context in managing ADHD among CA-HIV. This study consisted of two sequential phases. Phase 1 involved participatory cultural adaptation of the NFPP guided by the PREMIUM framework, including structured stakeholder workshops. Phase 2 involved an uncontrolled pre–post feasibility pilot study conducted in two HIV care facilities among nine caregiver–child dyads. The adapted NFPP (NFPP-UG) was evaluated for feasibility, acceptability, perceived effectiveness, and risk of harm using a four-point Likert scale. ADHD symptoms were assessed at baseline and 3 months post-intervention using the CASI-PM-P. Phase 1 – Adaptation: The adapted NFPP (NFPP-UG) was rated feasible (mean score: 2.075), acceptable (mean score: 2.26), and perceived as potentially helpful (mean score: 2.24) by participating stakeholders (n = 17). Phase 2 – Pilot Feasibility Study (pre–post): ADHD symptom scores demonstrated preliminary reductions within a small uncontrolled feasibility sample (n = 9), with median scores decreasing from 10 (IQR: 8–14) to 2 (IQR: 1–7). The follow-up period was three months post-intervention. The adapted NFPP integrated additional components, including stress management techniques and adherence counselling, with cultural adaptation addressing local beliefs about ADHD, enhancing contextual relevance within the Ugandan setting. The NFPP was culturally adapted for use in Uganda and demonstrated feasibility and acceptability within a pilot context. The observed symptom reductions should be interpreted cautiously given the small sample size and absence of a control group. A randomized controlled trial is required to formally evaluate effectiveness. Not applicable (this study was a feasibility pilot without randomization or control group).