JMIR Publications

ABSTRACT

Background:

Internet and mobile phones, widely available in Brazil, could be used to disseminate information about HIV prevention. Cisgender gay, bisexual and other men who have sex with men (MSM) are disproportionally affected by HIV infection in Brazil. Although different web-based venues have been used to recruit MSM, there is no Brazilian data evaluating the characteristics of MSM recruited through these strategies and estimating their cost and yield in the country.

Objective:

We aimed to describe the web-based MSM recruitment cascade, to compare the characteristics of MSM recruited to a large HIV prevention service, and to estimate the cost per participant of each strategy in Rio de Janeiro, Brazil.

Methods:

We promoted advertisements on geosocial networking applications (GSN apps) (Hornet/Grindr) and social media (Facebook/Instagram) from March 2018 to October 2019. The advertisements invited viewers to contact a peer educator to schedule a visit at the HIV prevention service. The performance of the web-based recruitment cascade was based on how many MSM (1) were reached by the advertisement; (2) contacted the peer-educator; and (3) attended the HIV prevention service. We used chi-square tests to compare MSM recruited through GSN apps and social media. Estimated advertisement cost to recruit a participant was calculated by dividing the total advertisement costs by the number of participants who attended the service or initiated pre-exposure prophylaxis (PrEP).

Results:

The advertisement reached 1,477,344 individuals; 1270 MSM contacted the peer-educator (86.0 contacts per 100,000 views): 564(44.4%), 401(31.6%) and 305(24.0%) through social media, Grindr and Hornet. Among 1270 individuals who contacted the peer-educator, 36.3% attended the HIV prevention service with similar proportion for each online strategy (social media: 36.0%[203/564], Grindr: 37.9%[152/401], Hornet: 35.1%[107/305]). MSM recruited through GSN apps were older (mean age 30 years vs. 26 years; p<.001), more frequently self-reported white race (44.9% vs. 32.5%; p=0.027) and higher schooling level (post-secondary: 61.8% vs. 48.5%; p=0.007) than MSM recruited through social media. GSN apps recruited MSM with higher HIV risk as measured by PrEP eligibility (86.6% vs. 71.9%; p<.001) than social media, but there was no difference in PrEP uptake between the two strategies (p=0.22). The estimated advertisement costs per participant attending the HIV prevention service were US$28.36 for GSN apps and US$12.17 for social media. The estimated advertisement costs per participant engaging on PrEP were US$58.77 for GSN apps and US$27.75 for social media.

Conclusions:

Social media and GSN apps advertisements were useful to disseminate information on HIV prevention strategies and to recruit MSM to a large HIV prevention service in Brazil. Compared to GSN apps, social media advertisements were less expensive and reached more vulnerable and younger MSM. Digital marketing campaigns should use different and complementary web-based venues to reach a plurality of MSM.