ACOS is high, ads have been running for 3–4 months with little progress. How should I restructure? (data included)

You have price and rating advantages, but you’re not running ASIN targeting or display ads. Those can be good for picking up sales when your organic traffic isn’t stable.
To diagnose ACOS:
First, figure out which campaigns are driving the high ACOS. Then drill down to which keywords. Then look at whether the problem is placement or search term relevance.
If you have multiple keywords in one campaign, it’s hard to optimize without them competing. For example, in your screenshot:

• One keyword has low CTR
• Another seems fine
• A third has very low conversion

You’d want to pull out the worst‑performing keyword and run it separately to see if it improves. For the low‑CTR keyword, test placement adjustments.
Also, don’t judge performance on a single week. Give campaigns at least a month to stabilize.

One more angle: since you’re seeing organic orders increase, your listing is gaining traction. That’s the goal — ads are supposed to eventually give way to organic.
Don’t be afraid to reduce spend on terms where organic is already ranking. Use ad budget to “defend” positions you want to keep, not to compete against your own organic listing.
If ACOS is still high after 3–4 months, it may be that your category is just too competitive at your current price point. Consider whether you need to adjust price or differentiate further.

A few practical steps:
Layer your campaigns:

• Broad match on head terms — for discovery, not main spend
• Exact match on proven converting long-tail terms — moderate bids, focus on profitable terms
• ASIN targeting on competitors where you have price/rating advantage

Daypart your budget — if your peak hours aren’t converting, shift budget to times that do.
Use placement reports. If your ad spends most of its budget on product pages but converts better on top of search, increase top‑of‑search placement adjustments.
Why ads degrade over time: Without enough conversion data, Amazon lowers your ad quality score. You either need to improve CTR/conversion or accept that you’ll need higher bids to maintain the same visibility.

I’ve been in a similar spot. Here’s what helped:
Check your business report — is traffic down or conversion down? That tells you where to focus.
Compare your conversion to category average — use Brand Analytics or your ad console. If you’re below average, work on:

• Pricing structure (coupons, deals, strikethrough)
• Reviews — 30 is okay but not strong
• Listing quality — images, bullets, A+, video
• Deals — if you have a BD or LD, run it

On the ad side:

• Exact match on terms that already convert — start with modest bids, focus on placements that actually convert
• Use negative keywords to cut irrelevant clicks
• Test ASIN targeting — your price and rating are better than some competitors; that can convert well

Placement matters: If most of your clicks are on product pages, CTR will be low. Test top‑of‑search placement adjustments and see if conversion improves.

Your CTR is too low — under 0.3%. That’s usually either ad position or image/title issue.
If CTR is low but conversion is decent: push bids or add placement adjustments to get higher visibility. Top of search usually has higher CTR and conversion.
On “performance gets worse over time with no changes”:
New campaigns often get a slight traffic boost in the first 1–2 weeks. After that, performance depends on ad quality score (CTR × conversion × historical data). If your CTR and conversion are below average, impressions will drop over time.

Options:

• Increase bids to get better placement
• If that’s too expensive, pause underperforming terms and focus on what works
• If you’re seeing more organic orders, you can afford to reduce ad spend on terms where organic is already ranking