Comparing Implementation and Effectiveness Outcomes for Two Implementation Strategies of the Keep It Up! Digital HIV Prevention Program: A Type 3 Hybrid Effectiveness-Implementation Trial.

Abstract

This study sought to compare implementation and effectiveness outcomes for two delivery strategies of a digital HIV prevention intervention: community-based organization (CBO) versus direct-to-consumer (DTC). A type III hybrid effectiveness-implementation trial compared two implementation strategies of Keep It Up! (KIU! ) for young men who have sex with men (YMSM) (n = 2124). Data were collected at baseline and 12-weeks in 2019-2023. DTC enrolled more participants, but CBO recruited more Black (11.7% vs. 21.7%) and Latino YMSM (27.3% vs. 32.9%). CBO enrollees were at higher HIV risk based on condomless anal sex (p < .05) and rectal Gonorrhea rates (p < .01). Although pre-exposure prophylaxis (PrEP) use with adherence was 1.94 times higher at follow-up vs. baseline (p < .0001) across arms, PrEP increase was 1.60 times higher in CBO vs. DTC (p < .0001). CBO delivery averted more HIV infections per 100 people-years than DTC (1.65 vs. 0.62), but the cost of averting an HIV infection was higher in CBO than DTC ($983,029 vs. $173,313). Although CBOs were able to reach participants at higher HIV risk, the DTC strategy was estimated to cost less per infection averted and below established thresholds for cost savings. Findings must be interpreted within the context of data collection during the COVID-19 epidemic. More information about KIU! can be found at https://kiu.northwestern.edu/ .Trial registration: NCT03896776 (date of registration: 04/01/2019).