Community-Based Organizations' Approaches to Recruitment and Retention for a Digital HIV Prevention Intervention for Young Men Who Have Sex With Men: A Mixed Methods Study.

Background: Digital health interventions (DHIs) can broaden the reach of HIV prevention interventions and overcome barriers for young cisgender men who have sex with men (YMSM). Community-based organizations (CBOs) have delivered HIV prevention interventions for decades, but few studies have examined how CBOs implement DHIs, including recruitment and retention. Keep It Up! (KIU!) is a Centers for Disease Control and Prevention-designated best-evidence DHI that can promote risk reduction behaviors and reduce sexually transmitted infection incidence. Objective: We sought to descriptively assess CBOs' approaches to recruitment and retention, elucidate lessons learned, and provide examples of recruitment and retention for future implementers. Methods: Twenty-two CBOs in counties with high HIV rates and large proportions of YMSM were selected through a request for proposal process to implement KIU!. Data were extracted from request for proposal applications and notes from monthly calls with CBO staff. Twenty-five staff members across CBOs were interviewed in the middle of implementation. A descriptive thematic analysis of the lessons learned in recruiting and retaining participants was performed. The research team developed an application dashboard for CBO staff to register participants, track participant progress through the intervention, record and track participant contact, and export usage data. CBO logins to the KIU! dashboard were tracked across the implementation. To descriptively compare approaches to recruitment and retention, the study team divided CBOs according to annual HIV testing volume in the 3 years prior to implementation and years of HIV service provision to YMSM. Results: The most frequent modes of recruitment were outreach and community partnerships (21/22, 95%), and the least frequent modes were via hook-up apps (6/22, 27%) and participant referrals (5/22, 23%). CBOs with a low HIV testing volume used online recruitment slightly more frequently, while medium-volume CBOs most frequently used hook-up apps for recruitment. Low-volume CBOs more frequently used phone calls and emails to remind participants to complete intervention modules, while high- and medium-volume CBOs more frequently used text messages. CBOs with more years of HIV service provision to YMSM more frequently had a set reminder schedule for contact with participants. CBO staff identified a need to change how KIU! is pitched to clients by using personalized, recipient-centered language rather than technical jargon. CBOs changed intake forms to ensure that staff remembered to offer KIU! to participants. CBOs had a difficult time retaining participants despite holding in-person events for enrolled participants (eg, raffles and trivia nights) and altering the frequency with which they reminded participants to complete modules. Conclusions: Although CBOs had experience in implementing other evidence-based interventions with YMSM, there was no consensus on successful recruitment and retention strategies for this population. We have presented approaches that future CBOs may use in their own implementation of KIU!.