Comparing Implementation and Effectiveness Outcomes for Two Implementation Strategies of the Keep It Up! Digital HIV...

Area of Science:

• Public Health
• Digital Health Interventions
• HIV Prevention

Background:

• Digital HIV prevention interventions are crucial for reaching key populations.
• Comparing community-based organization (CBO) versus direct-to-consumer (DTC) delivery models is essential for optimizing implementation and effectiveness.
• Young men who have sex with men (YMSM) are a priority population for HIV prevention efforts.

Purpose of the Study:

• To compare implementation and effectiveness outcomes of two delivery strategies (CBO vs. DTC) for a digital HIV prevention intervention (Keep It Up!).
• To evaluate recruitment, engagement, and HIV risk behaviors among YMSM in both delivery arms.
• To assess the cost-effectiveness of averting HIV infections for each delivery strategy.

Main Methods:

• A type III hybrid effectiveness-implementation trial involving 2124 YMSM.
• Data collected at baseline and 12-week follow-up between 2019-2023.
• Comparison of recruitment demographics, HIV risk factors, pre-exposure prophylaxis (PrEP) use, and cost per infection averted between CBO and DTC arms.

Main Results:

• Direct-to-consumer (DTC) enrolled more participants overall.
• Community-based organization (CBO) recruited a higher proportion of Black and Latino YMSM and participants at higher HIV risk.
• Pre-exposure prophylaxis (PrEP) use increased significantly in both arms, with a greater increase observed in the CBO arm. CBO delivery averted more HIV infections but at a higher cost per infection averted compared to DTC.

Conclusions:

• While CBO delivery effectively reached higher-risk YMSM and increased PrEP use, the DTC strategy demonstrated greater cost-effectiveness in averting HIV infections.
• Findings suggest that DTC digital HIV prevention interventions may be a more cost-efficient approach for broader population reach.
• Implementation and effectiveness should be considered alongside cost in selecting optimal delivery strategies for digital HIV prevention.