Adaptation is a key component of climate policy, yet we have limited and fragmented understanding of if and how adaptation is currently taking place. In this paper, we document and characterize the current status of adaptation in 47 vulnerable ‘hotspot’ nations in Asia and Africa, based on a systematic review of the peer-reviewed and grey literature, as well as policy documents, to extract evidence of adaptation initiatives. In total, 100 peer-reviewed articles, 161 grey literature documents, and 27 United Nations Framework Convention on Climate Change National Communications were reviewed, constituting 760 adaptation initiatives. Results indicate a significant increase in reported adaptations since 2006. Adaptations are primarily being reported from African and low-income countries, particularly those nations receiving adaptation funds, involve a combination of groundwork and more concrete adaptations to reduce vulnerability, and are primarily being driven by national governments, NGOs, and international institutions, with minimal involvement of lower levels of government or collaboration across nations. Gaps in our knowledge of adaptation policy and practice are particularly notable in North Africa and Central Asia, and there is limited evidence of adaptation initiatives being targeted at vulnerable populations including socioeconomically disadvantaged populations, children, indigenous peoples, and the elderly.