Cost and cost-effectiveness of online recruitment to increase HIV self-testing among Black and Hispanic/Latino men who have sex with men in the United States, 2020-2021.

Abstract

Background: Black or African American and Hispanic/Latino gay, bisexual, and other men who have sex with men (BMSM and HLMSM) in the United States (US) are disproportionately affected by HIV. We analyze the cost and cost-effectiveness of HIV self-testing through online recruitment of BMSM and HLMSM into an HIV self-testing study.

Setting: 11 US states, February 2020-February 2021.

Methods: BMSM and HLMSM aged ≥18 years without previous HIV diagnosis or current pre-exposure prophylaxis use were recruited through dating and general interest websites/apps (sites). Using the healthcare provider perspective and a 16-month timeframe, we assessed economic costs (2022 US Dollars) of online recruitment, HIV self-test (HIVST) distribution, and participant support. A time-motion study tracked staff time spent on study implementation activities. We reported incremental program cost, cost per HIVST used, and cost per new HIV diagnosis comparing recruitment via dating versus general interest sites.

Results: The total cost was $275,776 to enroll 1,306 participants through dating sites, and support 1,005 MSM who used an HIVST (11.74% positivity). The total cost was $168,099 to enroll 600 participants through general interest sites, and support 511 MSM who used an HIVST (5.48% positivity). Recruitment via dating versus general interest sites was more costly and more effective, with incremental cost-effectiveness ratios (ICERs) of $218/HIVST used and $1,196/new diagnosis, relatively low cost per new HIV diagnosis compared with those estimated in other HIV testing interventions. ICERs were higher for HLMSM versus BMSM.

Conclusions: HIV self-testing through dating and general interest site recruitment may be an effective and cost-effective approach to increase new HIV diagnoses.