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Biomedical and Behavioral Outcomes of Keep It Up!: An eHealth HIV Prevention Program RCT

  • Brian Mustanski
    Correspondence
    Address correspondence to: Brian Mustanski, PhD, Department of Medical Social Sciences, Feinberg School of Medicine and Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, 625 N Michigan Avenue, Suite 1400, Chicago IL 60611
    Affiliations
    Department of Medical Social Sciences, Feinberg School of Medicine and Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, Chicago, Illinois
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  • Jeffrey T. Parsons
    Affiliations
    Center for HIV Educational Studies and Training, Hunter College and the Graduate Center of the City University of New York, New York, New York
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  • Patrick S. Sullivan
    Affiliations
    Department of Epidemiology and Biostatistics, University at Albany School of Public Health, State University of New York, Rensselaer, New York

    Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, Georgia
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  • Krystal Madkins
    Affiliations
    Department of Medical Social Sciences, Feinberg School of Medicine and Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, Chicago, Illinois
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  • Eli Rosenberg
    Affiliations
    Department of Epidemiology and Biostatistics, University at Albany School of Public Health, State University of New York, Rensselaer, New York
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  • Gregory Swann
    Affiliations
    Department of Medical Social Sciences, Feinberg School of Medicine and Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, Chicago, Illinois
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      Introduction

      HIV diagnoses among young men who have sex with men are increasing, but few effective HIV prevention interventions exist for this population. An RCT was conducted of the online Keep It Up! intervention to determine if it significantly reduced condomless anal sex and sexually transmitted infections compared with an HIV knowledge condition.

      Study design

      From May 2013 to March 2017, a total of 901 participants were enrolled in a double-blinded RCT of Keep It Up! with 1-year follow-up. After completing baseline surveys and sexually transmitted infection testing, participants were randomized by an eHealth platform to the intervention or control condition.

      Setting/participants

      HIV-negative men who have sex with men reporting condomless anal sex, aged 18–29 years, were recruited through advertising and from HIV testing sites and outreach in Atlanta, Georgia; Chicago, Illinois; and New York, New York.

      Intervention

      Multimedia was used to address HIV knowledge and motivate safer behaviors. The control condition reflected existing online HIV information.

      Main outcome measures

      Primary outcomes were incident gonorrhea or chlamydia at 12-month follow-up and self-reported condomless anal sex with casual partners at 3-, 6-, and 12-month follow-up.

      Results

      In 2017, data were analyzed from 445 (49%) participants randomized to the intervention and 456 (51%) to the control. Participants were primarily racial/ethnic minorities (63%). Sexually transmitted infections at Month 12 was 40% lower for intervention participants (risk ratio=0.60, 95% CI=0.38, 0.95, p=0.01). For the primary behavioral outcome, both arms showed reductions over time with 44% of control and 37% of intervention participants reporting condomless anal sex at Month 12 (prevalence ratio=0.83, 95% CI=0.70, 0.99, p=0.04).

      Conclusions

      The Keep It Up! intervention resulted in significantly lower sexually transmitted infection incidence and a small but significant decrease in condomless anal sex 12 months post-intervention relative to an online HIV knowledge condition. In addition, this study demonstrated the feasibility and acceptability of at-home sexually transmitted infection testing as part of an eHealth intervention.

      Trial registration

      This study is registered at www.clinicaltrials.gov NCT01836445.
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