Table 6 KIU! value, appeal, and limitations

Appeal

Staff noted that KIU! allows clients to access the intervention wherever, whenever, and on any device they want, and this convenience provides a level of privacy that may help to mitigate stigma associated with coming into an HIV-focused CBO.

KIU! engages clients through eye-catching graphics and skits, entertaining and interactive games, and attention-keeping videos. This level of engagement was viewed as highly appealing to young people.

KIU!’s realistic, sex-positive, harm reductionist, and non-paternalistic approach to sexual health and substance use was also a crux of its appeal.

“It was the videos. I mean it was a story. Um, in that being an entire series, I felt like I was watching a Netflix special.” (HIV Peer Advocate at a large CBO)

“How realistic it is. I mean, literally, the part where you’re at a club and you’re dancing and it’s keeping track of how many drinks you’re having when you go to the bathroom, and the situation with drugs. I mean, the trials and tribulations that we face on a day-to-day basis being LGBTQ folks, especially of color.” (HIV/STI Prevention Coordinator at a medium-size CBO)

Value

Identified values of KIU! included the innovation serving as an extension of their organization’s prevention, testing, education, and PrEP referrals/retention services, and enabled them to extend services clients who did not want patient-facing services. This extension in services was possible due to KIU! being an eHealth intervention that enabled CBOs to provide additional services that they otherwise would not be able to due to staffing and/or time constraints.

For many, KIU!’s value lay in its compatibility with their current workflows, programming, services, missions, and values, and its easy integration into their organizational structure.

Finally, many found value in the novelty of KIU, noting that their CBO had never implemented an eHealth innovation before.

“I think there was a 20% or 30% decrease in HIV and STI transmission rates because of KIU!. And I understand that environments are different…but when we found out about that, you know, why not give that a try? Who knows? This may possibly be that situation.” (HIV/STI Prevention Coordinator at a medium-size CBO)

“It really created a sense of community even within our organization… we would sit together, in our lobby or conference room and we would go over, you know, ‘Oh, did you see this? Did you see that? Oh, wasn't this funny? Oh, isn't this great?’” (PrEP Navigation & Testing Programs Lead at a large CBO)

Limitations

Identified limitations included the double-edged swords of the convenience and length of the intervention. The ability to access KIU! from anywhere at any time also meant that clients could put off the intervention or not deeply engage with the content.

The online nature of the intervention meant little to no human interaction limited CBOs’ ability to build rapport with clients and clients’ ability to build community with other clients in the intervention.

Inequities in access to technology and the internet, as well as inaccessibility for clients who have learning disabilities, are Deaf, Hard-of-Hearing, and/or blind, and non-English speakers were identified as limitations.

While the target population of the study provided services for an underserved population, it also excluded utilization for transmasculine MSM.

“The program is extremely long. And so, when I myself was doing this, I wasn’t sure how um successful I was going to be getting from the beginning to the end and then retaining the information, because it was a lot of info.” (Clinical Services Coordinator at a medium-size CBO)

“It’s not necessarily gonna address our transsexual population. It’s not going to address the Latino population very well, just because there’s not necessarily a connection there for that.” (Associate Director of Prevention at a small CBO)

“We do work with that population, they might be homeless or so impoverished where they might have the technology but they don’t have service on their phone or Wi-Fi.” (Assistant Director of Health Services at a medium-size CBO)