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 two strategies - centralized direct-to-consumer (DTC) marketing and decentralized distribution via 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 micro-costing protocols.

Results: In the DTC arm (1,468 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 two-year period between October 2019 and December 2022. Total ongoing costs including overhead and excluding start-up costs were $2,780,682 ($4,239 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 ($2,937 per participant), and variable costs were $256,543 ($391 per participant).

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