Economic Evaluation of Delivering an Evidence-Based Online HIV Prevention Program to MSM via Direct-To-Consumer Marketing Versus Community-Based Organization Recruitment.

PURPOSE

This study, conducted as part of the Keep It Up! (KIU!) 3.0 trial, compares the implementation costs of 2 strategies-centralized direct-to-consumer (DTC) marketing and decentralized distribution through community-based organizations (CBO)-in delivering an evidence-based online HIV prevention program.

METHODS

We conducted interviews and collected data to identify and quantify all costs for both delivery strategies. Costs were then categorized into start-up and ongoing (time-dependent and variable) costs and assigned dollar values based on established microcosting protocols.

RESULTS

In the DTC arm (1468 enrollees), the program was implemented from October 2019 through August 2022. Total ongoing costs including overhead and excluding start-up costs were $735,953, averaging $501 per participant. Start-up costs were $398,384 ($376,393 for content design and development and $21,991 for other costs), time-dependent costs were $219,177 ($149 per participant), and variable costs were $491,658 ($335 per participant). In the CBO arm (656 enrollees across 22 sites), KIU! was implemented for a 2-year period between October 2019 and December 2022. Total ongoing costs including overhead and excluding start-up costs were $2,780,682 ($4239 per participant). Start-up costs were $511,528 ($401,141 for content design and development and $110,386 for other costs), time-dependent costs were $1,926,958 ($2937 per participant), and variable costs were $256,543 ($391 per participant).

CONCLUSIONS

The DTC arm demonstrated a lower overall cost and a lower cost per participant than distribution by the CBO arm. Understanding these cost dynamics is pivotal for guiding decisions on program sustainability and determining funding requirements for future large-scale implementation.