Background Improving adolescent health and well-being is a key policy priority in countries with a high HIV burden, because adolescents have lower rates of treatment coverage, viral load suppression and survival compared with others. This study aimed to identify innovative ideas from young people (aged 10–30 years) on how adolescent health and well-being can be improved in communities most affected by HIV. Methods We organized a global crowdsourcing open call for ideas from young people on how to improve adolescent HIV outcomes and well-being in countries with a high HIV burden. At least three independent judges assessed each submission based on prespecified criteria. We then conducted a thematic analysis of eligible submissions to identify key themes to inform HIV programming and policy. Results We received 357 submissions from 37 countries. Of 107 eligible submissions, 91 (85%) described new ideas. Seventy-one (66%) participants were aged 20–30 years, and 30 (28%) were aged 10–19 years. Major themes suggested that edutainment interventions linking entertainment and education could increase adolescent uptake of HIV services. Digital interventions adapted for analog cellphone users (e.g. unstructured supplemental service delivery) could increase the reach of HIV information and engage remote, rural participants. Peer-based interventions could improve feelings of social inclusion among adolescents. Conclusions Adolescents and young people in countries with a high HIV burden can create innovative and feasible ideas for improving health and well-being. Exceptional ideas were presented to senior leadership at UNICEF/WHO/UNAIDS as part of a multi-sectoral HIV strategic planning exercise.