Obstacles to Biosimilar Acceptance and Uptake in Oncology: A Review.

Importance: Biosimilar drugs provide cost-effective yet clinically indistinguishable replications of target drugs. During initial development, this class of biologic medicines was expected to revolutionize pharmaceutical markets; however, following US Food and Drug Administration approval of the first biosimilar drug in 2015, the commercialization of biosimilars has been limited. The lack of biosimilar use may be especially salient in oncology, given that biosimilar distribution in this particularly high-cost area of medicine would bring savings on the order of many billions of dollars. Observations: While researchers have focused on salient economic barriers to biosimilar uptake in the US, the present review provides insight regarding noneconomic barriers. This review discusses psychological, attitudinal, and educational factors among both health care professionals and payers in the US that may play a role in slowing biosimilar uptake. More specifically, these factors include a lack of health care professional education, concerns of safety and efficacy, and overly complex product naming systems. Conclusions and Relevance: The pathway to biosimilar use has been obstructed by economic elements as well as attitudinal and psychological factors. For biosimilar drugs to achieve their potential in decreasing treatment costs and thus increasing patient access, it will be essential for both economic and noneconomic factors to be identified and systematically addressed.

Integrating PROMIS Measures in a Treat-to-Target Approach to Standardize Patient-Centered Treatment of Rheumatoid Arthritis.

OBJECTIVE: To evaluate the effect of a patient-centered rheumatoid arthritis (RA) treat-to-target (T2T) disease management approach on patient outcomes and patient satisfaction with care. METHODS: In this longitudinal, observational pilot study, rheumatologists implemented a modified T2T approach that integrated Patient Reported Outcomes Measurement Information System (PROMIS) measures for depression, fatigue, pain interference, physical function, and social function into RA care. Study participants selected 1 PROMIS domain to target treatment and completed quarterly follow-up assessments. Participants were classified as improved if their Clinical Disease Activity Index (CDAI) changed by > 5 points. Change in PROMIS t scores was examined for the group with improved CDAI, and then compared to those with unchanged or worsened CDAI. Satisfaction with care was assessed using multiple measures, including the Functional Assessment of Chronic Illness Therapy-Treatment Satisfaction-Patient Satisfaction Scale. RESULTS: The analytical sample (n = 119, median age 57 years, 90.8% female) was split between those with CDAI > 10 (n = 63) and CDAI ≤ 10 (n = 53). At 1 year, there was improvement in CDAI by > 5 points in 66% and 13% of individuals with baseline CDAI > 10 and baseline CDAI ≤ 10, respectively. Across all participants, improvement in CDAI by > 5 points correlated with improvements in the 5 PROMIS domains. Satisfaction with RA treatment also increased. CONCLUSION: The integration of PROMIS measures into the T2T approach for RA care was associated with improvements in disease activity, and improvement in disease activity was associated with improvements in PROMIS measures.

Medical Oncologists' Knowledge and Perspectives on the Use of Biosimilars in the United States.

PURPOSE: Despite increasing availability of biosimilar cancer treatments, little is known about oncologists' knowledge and concerns regarding biosimilar use in the United States. We surveyed medical oncologists to examine their knowledge, attitudes, and experience with biosimilars. METHODS: Oncologists recruited via the ASCO Research Survey Pool completed a 29-question survey in 2020 designed with input from clinical and health care system experts and literature review. RESULTS: Of the 269 respondents, most treated patients with biosimilars (n = 236, 88%) and reported that biosimilars were required at their institution (n = 168, 63%). Approximately half (n = 140, 52%) of oncologists correctly responded that biosimilars were not the same as generic medicines. Commonly reported barriers to use of biosimilars included concerns regarding a perceived lack of relevant research (n = 85, 33% reporting quite a bit/very much), the potential for extrapolation (n = 83, 33%), and efficacy limitations (n = 77, 30%). More oncologists from university hospitals (n = 36, 22%) than from community/private hospitals (n = 28, 38%) or private practices (n = 13, 38%) were concerned about biosimilar efficacy. A high proportion of oncologists reported that information on safety (n = 259, 99%) and efficacy (n = 255, 99%) is important when considering whether to use biosimilars. Less than half reported that their institution provided education about biosimilars (n = 108, 40%). CONCLUSION: In this sample of medical oncologists, knowledge about basic features of biosimilars was limited and access to information about biosimilars was insufficient. The present study determined that educational programs on biosimilars for oncologists are needed and identified priorities for such efforts.

Preferences Among Physicians and Men Who Have Sex with Men (MSM) for a Long-Acting, Removable Implant for HIV Prevention: A Discrete Choice Study.

A longer acting, removable implant for HIV prevention has the potential to improve uptake of HIV pre-exposure prophylaxis (PrEP) by removing the need for daily adherence to an oral tablet, reducing potential side effects, and eliminating concerns about residual drug following injections. To end the HIV epidemic, we must understand the needs and preferences of groups most affected by HIV (e.g., men who have sex with men; MSM), and the physicians who prescribe PrEP to them. This article describes a discrete choice experiment to estimate the preference share for the implant within a competitive context of other PrEP products (including the oral tablet, dissolvable implant, and injection) and evaluate the impact of potential implant attributes. Physicians who had prescribed oral PrEP (n = 75) and MSM at risk for HIV (n = 175) completed a web-based survey that prompted decision-making about PrEP product preferences. The findings from both physicians and MSM demonstrated that the removable implant could capture a meaningful portion of the preference share, making it feasible to advance in the development pipeline as an important addition to the biomedical HIV prevention toolkit. Among MSM, specifically, the cost of treatment was the most important attribute impacting product preference. Our findings inform implant developers and future payers (e.g., commercial manufacturers, insurance companies) about specific device attributes that will likely affect MSM's willingness to use and physicians' willingness to prescribe this HIV prevention strategy.

Implementation and evaluation of patient navigation in Chicago: Insights on addressing the social determinants of health and integrating HIV prevention and care services.

Patient navigation is a primary element in linkage to HIV pre-exposure prophylaxis (PrEP) care and linkage to or re-engagement in HIV care, depending on the HIV status of the individual. However, there is a dearth of literature describing navigation services in these areas. In the context of Chicago Project PrIDE, this project conducted process and implementation evaluations with eight agencies leading demonstration projects to address these gaps. The evaluation team conducted semi-structured, individual interviews with agency staff (N = 20) assessing navigation implementation and fit, as well as project successes and challenges. Additionally, agency staff collected patient surveys (N = 300) assessing services provided, service quality, and satisfaction. The interview transcripts were coded and analyzed thematically and descriptive analyses were performed on the survey data. Analyses indicated that screening for social determinants of health, providing healthcare engagement guidance, and providing service referrals were frequently cited navigation activities. Most staff members indicated that navigation fits well within their agencies, and that limited staff and clinic capacity were often barriers to navigation. Patient navigation to support engagement in HIV prevention and care services is critical due to the extensive support provided by navigators to address social determinants of health impacting HIV disparity populations.

Network Analysis of Organizations Providing HIV Services in Chicago: Toward an Integrated Response to the HIV Epidemic.

CONTEXT: The public health response to the HIV epidemic has increasingly centered on the uptake of and adherence to biomedical interventions (eg, pre-exposure prophylaxis [PrEP], treatment as prevention [TasP]). Traditionally, various community and health care organizations have worked to address different stages of PrEP or TasP care. OBJECTIVE: To understand the importance of how HIV prevention organizations providing these services interact to provide the comprehensive care needed for successful HIV and PrEP continuum outcomes. DESIGN: Utilizing an Organizational Network Survey, network ties were examined between formal and informal partnerships among community agencies. SETTING: This study examined community agencies in the current HIV prevention system in Chicago. PARTICIPANTS: Seventy-two community agencies across the Chicago metropolitan area. MAIN OUTCOME MEASURES: Using network analysis, this study examined ties between community agencies and assessed perceptions of collaboration and competitiveness in the current HIV prevention system in Chicago. RESULTS: Overall, respondents reported that the current environment of HIV prevention in Chicago was extremely (18.8%), moderately (37.5%), or somewhat collaborative (37.5%) and extremely (68.8%) or moderately competitive (25.0%). The majority of partnerships reported were informal, with less than a quarter being formalized. That said, those who reported formal partnerships reported being satisfied with those relationships. There was a significantly negative association between density and perceived collaboration-grantees experiencing a more collaborative also reported less dense networks. CONCLUSION: These findings indicate that, despite perceived competitiveness, agencies are willing to work together and create a cohesive HIV prevention and treatment system. However, more work should be done to foster an environment that can support the formation of partnerships, to improve a coordinated response to providing HIV care, and sustain mutually beneficial relationships.

Conjoint Analysis of User Acceptability of Sustained Long-Acting Pre-Exposure Prophylaxis for HIV.

Long-acting delivery modalities of HIV pre-exposure prophylaxis (PrEP), such as subdermal implants, are in development. To facilitate end-user uptake and sustained use, it is critical to understand potential consumers' and physician prescribers' preferences about, interest in, and relative importance of different implant features. The ordered identification of these key attributes allows implant developers to incorporate this feedback into product design, which theoretically improves acceptability, feasibility, and user experience with the device. In this study, n = 75 PrEP-prescribing physicians and n = 143 men having sex with men (MSM) at risk for HIV completed web-based surveys that directly compared the importance of eight to nine different implant features, respectively. Conjoint analysis determined the importance of these features, relative to each other. Implants presented in the study were well received, with a majority of physicians and MSM indicating that they were likely to recommend or use them. The implant was perceived as unique, reliable, and convenient, as well as able to deliver better compliance. The attributes most critical to the adoption of the implant among physicians and MSM were (1) the chance of becoming infected with HIV while on implant treatment, (2) the length of protection and size of the implant, and (3) the side effect advantages over current PrEP oral pill treatment. Some concerns about the implant included side effects and the product's safety (among MSM) and the cost or insurance coverage level for the implant (both physicians and MSM). There was also some resistance to the implantation procedure itself.

Awareness and Knowledge of Pre-exposure Prophylaxis Among Sexual and Gender Minority Adolescents Assigned Male at Birth in the United States.

Sexual and gender minority (SGM) adolescents assigned male at birth are at increased risk for HIV infection. Pre-exposure prophylaxis (PrEP) is a daily pill taken to prevent HIV, which the United States Food and Drug Administration approved for minors under age 18 years weighing at least 77.5 lb in 2018. A lack of awareness and knowledge of PrEP are barriers to uptake among adults and adolescents, but SGM adolescents' awareness and knowledge about PrEP remain underexplored and no studies have assessed SGM adolescents' informational needs. We collected data on 59 SGM adolescents' (ages 14-18 years) awareness, knowledge, and questions about PrEP in an online survey and six online focus groups. Although a majority of SGM adolescents (83.1%) were aware of PrEP before the study, many wanted more information about side effects and how to navigate potential barriers to PrEP initiation. Findings can inform public health efforts to promote PrEP knowledge and uptake among SGM adolescents.

Perspectives on and preferences for on-demand and long-acting PrEP among sexual and gender minority adolescents assigned male at birth.

INTRODUCTION: Sexual and gender minority (SGM) adolescents assigned male at birth who have sex with male partners are at increased risk for HIV. Daily oral pre-exposure prophylaxis (PrEP) is available for minor adolescents in the United States, who may have difficulty with adherence. Adolescents' perspectives toward emerging PrEP delivery methods that would not require daily pill-taking have not been well-explored. METHODS: We conducted online surveys and focus groups in November 2018-February 2019 with 59 SGM adolescents assigned male at birth who reported sex with or attraction to male partners. Questions assessed their perspectives on and preferences for biomedical (on-demand, injection, implant) and non-biomedical HIV prevention options (condoms). Data were analyzed thematically. RESULTS: Of all prevention options, the implant and condoms were rated highest, and participants preferred the implant over other biomedical options. Convenience, duration, and ease of access played important roles in adolescents' preferences. Parents were viewed as a barrier to taking PrEP regardless of delivery method due to their role in adolescents' ability to access healthcare. CONCLUSIONS: SGM adolescents are interested in long-acting PrEP, yet also perceive substantial obstacles to using biomedical prevention that reflect adolescents' developmental contexts. POLICY IMPLICATIONS: State laws expanding adolescents' access to HIV preventive services, sex education inclusive of PrEP information, and parent- and provider-initiated PrEP conversations can reduce barriers regardless of PrEP delivery method. Research to accelerate the availability of long-acting implants for adolescents is needed.

Development of the Functional Assessment of Cancer Therapy-Carcinoid Syndrome Symptom Index.

OBJECTIVE: To develop a symptom-focused index to evaluate representative symptoms, treatment side effects, and emotional and functional well-being of patients with carcinoid syndrome (CS). METHODS: The development of the Functional Assessment of Cancer Therapy-Carcinoid Syndrome Symptom Index (FACT-CSI) followed US Food and Drug Administration guidelines for the development of patient-reported outcome (PRO) measures and involved the following: (a) literature review; (b) interviews with 14 CS patients; (c) interviews with 9 clinicians; and (d) instrument development involving input from a range of PRO measure development and CS experts. The resulting draft instrument underwent cognitive interviews with 7 CS patients. RESULTS: Forty-six CS sources were reviewed. Analysis of patient interviews produced 23 patient-reported symptoms. The most frequently endorsed physical symptoms were flushing, diarrhea, abdominal pain, fatigue, and food sensitivity/triggers. Seven priority CS emotional and functional themes were also identified by patients. Expert interviews revealed 12 unique priority symptoms - the most common being diarrhea, flushing, wheezing, edema, abdominal pain/cramping, fatigue, and 8 emotional and functional concerns. Through an iterative process of team and clinical collaborator meetings, data review, item reduction and measure revision, 24 items were selected for the draft symptom index representing symptoms, emotional concerns, global assessment of treatment side effects, and functional well-being. Cognitive interview results demonstrated strong content validity, including positive endorsement of item clarity (>86% across items), symptom relevance (>70% for most items), and overall measure content (86%). CONCLUSIONS: The FACT-CSI is a content-relevant, symptom-focused index reflecting the highest priority and clinically relevant symptoms and concerns of people with CS.

Black Cisgender Women's PrEP Knowledge, Attitudes, Preferences, and Experience in Chicago.

BACKGROUND: Although black cisgender women in Chicago continue to disproportionally account for new HIV diagnoses, few are on pre-exposure prophylaxis (PrEP). We used concurrent mixed-methods to understand women's PrEP knowledge, attitudes, experience, and preferences in Chicago. SETTING AND METHODS: We surveyed 370 HIV(-) cisgender women visiting a sexually transmitted infection clinic (n = 120) or emergency department (n = 250). Two focus groups were conducted with PrEP-naive women, and interviews were conducted with 7 PrEP-experienced women. Quantitative data were analyzed using descriptive statistics and multivariable logistic regression, and qualitative data using thematic analysis. RESULTS: Majority of women identified as black (83.0%) and had a regular source of health care (70.0%). In the past 6 months, 84.1% had vaginal or anal sex, most with inconsistent condom use (94.2%). Only 30.3% had heard of PrEP, but once explained, one-quarter considered starting PrEP, with protecting health (76.4%) and reducing HIV worry (58.1%) the most common reasons. Factors associated with considering PrEP included being Latina [adjusted odds ratio (aOR): 3.30, 95% confidence interval (CI): (1.21 to 8.99)], recent sexually transmitted infection [aOR: 2.39, 95% CI: (1.25 to 4.59)], and higher belief in PrEP effectiveness [aOR: 1.85, 95% CI: (1.22 to 2.82)]. Most (81.1%) had concerns about taking PrEP with side effects a common concern. Qualitative themes aligned with survey results, revealing a disconnection from current PrEP marketing, need for community-level PrEP education/outreach, and importance of provider trust. LESSONS LEARNED: Despite significant PrEP implementation work in Chicago, less than one-third of women in our study had heard of PrEP. Once informed, PrEP attitudes and interest were positive. Translating these results into interventions reflecting women's preferences and barriers is critical to increase PrEP uptake by cisgender women in Chicago and elsewhere.

Application of a Multisite Empowerment Evaluation Approach to Increase Evaluation Capacity Among HIV Services Providers: Results From Project Pride in Chicago.

In 2015, the Centers for Disease Control and Prevention (CDC) funded Project PrIDE, a national initiative to implement and evaluate demonstration projects to increase PrEP uptake among HIV-negative individuals and to re-engage HIV-positive individuals in HIV care. Our team served as the Evaluation Center for Project PrIDE organizations in Chicago and used an empowerment evaluation (EE) approach to enhance evaluation capacity at these organizations. To evaluate our approach, we assessed organizations' evaluation capacity and engagement in technical assistance and capacity building activities in 2016 and 2018. Respondents who self-reported higher engagement with the Evaluation Center and who spent a greater number of hours engaged with our evaluators experienced greater increases in evaluation capacity tied to implementation of evaluation activities and technical assistance utilization. These findings demonstrate that multisite EE can be successfully applied to increase the evaluation capacity of organizations providing both HIV prevention and care services.

Transgender Women's Concerns and Preferences on Potential Future Long-Acting Biomedical HIV Prevention Strategies: The Case of Injections and Implanted Medication Delivery Devices (IMDDs).

There are several long-acting biomedical HIV prevention products in the development pipeline, including injections and implanted medication delivery devices (IMDDs). It is critical to understand concerns and preferences on the use of these products in populations that shoulder a disproportionate burden of the HIV epidemic, such as transgender women. This will allow researchers and public health professionals to construct interventions tailored to the needs of these women to promote optimal use of these tools. In studies of other biomedical HIV prevention products (e.g., oral PrEP) it is clear that transgender women have unique concerns related to the use of these strategies. This may have an impact on this group's uptake and sustained use of longacting HIV prevention products. This study conducted four focus groups with N = 18 transgender women in New York City to understand their concerns and preferences on long-acting PrEP injections and IMDDs. Findings showed that participants were overwhelmingly positive about long-acting HIV prevention strategies, though they had some apprehensions. Overall, participants felt that injections and IMDDs could help address adherence challenges, and that transgender-specific needs should be addressed during clinical trials. Also, there were concerns related to injection or IMDD logistics, concerns about injections' or IMDDs' presence in the body, and familiarity with these products affected participants' opinions on them. Findings from this work can be used to inform protocols, measures, materials, and adherence interventions in future initiatives for transgender women using PrEP injections or IMDDs.

Empowerment Evaluation: A Case Study of Citywide Implementation within an HIV Prevention Context.

HIV continues to significantly impact the health of communities, particularly affecting racially and ethnically diverse men who have sex with men and transgender women. In response, health departments often fund a number of community organizations to provide each of these subgroups with comprehensive and culturally responsive services. To this point, evaluators have focused on individual interventions, but have largely overlooked the complex environment in which these interventions are implemented, including other programs funded to do similar work. The Evaluation Center was funded by the City of Chicago in 2015 to conduct a city-wide evaluation of all HIV prevention programming. This article will describe our novel approach to adapt the principles and methods of the Empowerment Evaluation approach, to effectively engage with 20 city-funded prevention programs to collect and synthesize multi-site evaluation data, and ultimately build capacity at these organizations to foster a learning-focused community.

Knowledge About Oral PrEP Among Transgender Women in New York City.

This paper grows our understanding about PrEP knowledge in transgender women (TW) to improve PrEP-focused education/outreach. Research took place in New York City. We conducted four focus groups in English or Spanish (N = 18). Discussions focused on participants' perceptions and knowledge of oral PrEP. Most participants knew that PrEP is efficacious and requires consistent use. However, some participants were skeptical of medications; others acknowledged that false assumptions about PrEP exist among TW. Most TW in our focus groups were informed about PrEP through clinics or community-based organizations. Some participants felt that messages about medications were oversimplified, and wanted more information.

Exploring new and existing PrEP modalities among female sex workers and women who inject drugs in a U.S. city.

To address a shortage in research on Pre-Exposure Prophylaxis (PrEP) amongst women at high risk of HIV acquisition, this study explored the attitudes and preferences of female sex workers (FSW) (n = 15) and women who inject drugs (WWID) (n = 16) to existing (e.g., pill) and new (e.g., injection, implant) PrEP modalities, in Baltimore, Maryland, U.S.A. This study reports on seven focus groups conducted between December 2016 and April 2017 and aims to provide new insights into FSW and WWID attitudes and preferences towards three different PrEP delivery methods (i.e., PrEP pill, PrEP implant, PrEP injection). Results draw upon the PrEP care continuum framework and distill existing factors, including lack of control over side effects with new, longer lasting modalities, better privacy with injections, increased adherence with reduced dosing schedules from longer lasting PrEP and new factors such as perceptibility concerns with respect to the PrEP implant relevant to PrEP uptake and adherence among two important overlapping, at-risk populations. The study contributes to a better understanding of barriers and facilitators to uptake and adherence for FSW and WWID around both existing and new PrEP modalities, with implications for future clinical trials and PrEP interventions with at risk-populations.

Barriers and Facilitators to Seeking HIV Services in Chicago Among Young Men Who Have Sex with Men: Perspectives of HIV Service Providers.

Young men who have sex with men (YMSM) are disproportionally impacted by HIV, and continue to lag behind other age groups in the receipt of HIV prevention and care services. To inform the development of interventions to improve pre-exposure prophylaxis and HIV care engagement outcomes among YMSM, a growing number of studies have reported the barriers and facilitators YMSM encounter when accessing HIV services. Few studies, however, have assessed how HIV service providers perceive these facilitators and barriers. In total, 21 interviews were conducted with HIV service providers in Chicago about barriers and facilitators they perceived affected YMSM's engagement in HIV services. Barriers included lack of comprehensive wraparound services, lack of trust of providers, unfamiliarity with seeking HIV services, feelings of invincibility, lack of knowledge of HIV service providers, intersectional and structural concerns (e.g., not thinking the site's services were for YMSM), geography and distance to clinic, and HIV stigma. Facilitators included presence of comprehensive wraparound services, high trust in providers, a clinic's willingness to serve uninsured patients, community engagement, word-of-mouth recommendations from lesbian, gay, bisexual, and transgender (LGBT) friends, intersectionality (e.g., offering LGBT-tailored services), geography and distance, lack of HIV stigma. Axial coding revealed that five conceptual themes cut across multiple barriers and facilitators, including health system characteristics, intersectionality, geography and transportation, community outreach, and stigma. These conceptual themes map closely onto Bronfenbrenner's ecological model. Overall, these findings highlight the importance of a multi-level approach to future intervention development to increase engagement in HIV services among YMSM.

Qualitative Consumer Research on Acceptance of Long-Acting Pre-Exposure Prophylaxis Products Among Men Having Sex with Men and Medical Practitioners in the United States.

Pre-exposure prophylaxis (PrEP) with oral Truvada® prevents HIV infection. However, the adherence to pill taking required for efficacy has sparked interest in developing new antiretroviral delivery systems that decrease such demands. Long-acting formulations, such as injections and implants, represent promising options that require less frequent adherence. It is important, however, that development of these new modalities be driven by understanding of the value seen in them by target users to maximize their uptake. To identify the key product features that impact user acceptance, we used a three-phase marketing research approach. In this study, we describe the results of the first-phase, qualitative focus group research performed in Chicago and San Francisco that explored subjective perceptions of oral versus alternative PrEP modalities among men having sex with men (MSM) and medical practitioners caring for MSM. Data revealed that potential value in long-acting PrEP lies more in simplifying the lives of users rather than in making them more confident in their adherence. The results provide an important guidance for designing and promoting these future long-acting products to enhance their contribution to increasing the current limited uptake of PrEP that will better stem the HIV epidemic.

Evaluation capacity building-Results and reflections across two years of a multisite empowerment evaluation in an HIV prevention context.

As the need for rigorous evidence of program efficacy increases, integrating evaluation activities into program implementation is becoming crucial. As a result, external evaluators are placing increased focus on evaluation capacity building as a practice. However, empirical evidence of how to foster evaluation capacity in different contexts remains limited. This study presents findings from an evaluation capacity survey conducted within a multisite Empowerment Evaluation initiative, in which an external evaluator worked with 20 project teams at diverse community agencies implementing HIV prevention projects. Survey results revealed representatives from project teams (n = 33) reported significantly higher overall evaluation capacity after engaging with the external evaluator on planning and implementing their evaluation. Improvements differed across organization type, intervention type, staff position, and reported engagement on various activities throughout the course of the evaluation. Results indicated empowerment evaluation and other stakeholder-focused evaluation approaches are broadly applicable when evaluation capacity building is a desired outcome, particularly when able to engage project staff in the planning of the evaluation and in delivering technical assistance services. Accordingly, efforts should be made by program funders, staff, and evaluators to encourage active engagement starting in the early stages of program and evaluation planning.

Attrition and HIV Risk Behaviors: A Comparison of Young Men Who Have Sex with Men Recruited from Online and Offline Venues for an Online HIV Prevention Program.

In addition to offline venue-based and time-space sampling, recruitment of young men who have sex with men (YMSM) into HIV surveillance and prevention studies has expanded over time to include Internet-based approaches. Despite broadening recruitment strategies, enrolling racially and ethnically diverse YMSM who are disproportionately impacted by HIV continues to be challenging. Additionally, there is little literature on the impact of recruitment venue on participant characteristics and likelihood to enroll YMSM into online randomized control trials (RCT). This study used data from the multisite RCT, Keep It Up! 2.0, to examine the impact of recruitment venue on participant demographics, behavioral HIV risks, and enrollment. A total of 2984 participants were screened for eligibility from community-based organizations, Facebook, dating apps, and outreach events. There were significant differences by venue in age (χ2[3] = 54.38, p < .001), race/ethnicity (χ2[9] = 110.78, p < .001), sexual orientation (χ2[3] = 7.85, p < .05), relationship status (χ2[6] = 27.71, p < .001), and region of recruitment (χ2[6] = 1480.51, p < .001). There were no significant differences by venue in attrition during the enrollment process. The only difference in attrition was by race/ethnicity. Compared to White participants, eligible Black (OR: 0.35, p < .01) and Latino (OR: 0.46, p < .05) participants were significantly less likely to enroll in the intervention. There were also no significant differences by recruitment venue in sexual risk behaviors among enrolled participants. These findings suggest that recruitment into online HIV interventions from a variety of venues is feasible for diverse YMSM who are at similar risk for HIV infection.