Pay-it-forward gonorrhoea and chlamydia testing among men who have sex with men in China: a randomised controlled trial

Abstract

Background Many evidence-based preventive services are unaffordable. Pay-it-forward offers an individual a gift (e.g. a test for sexually transmitted diseases) and then asks whether they would like to give a gift (e.g. a future test) to another person. This study examined the effectiveness of a pay-it-forward program to increase gonorrhea and chlamydia testing among men who have sex with men (MSM) in China. Methods We conducted a randomized controlled superiority trial at three HIV testing sites run by MSM community-based organizations between November 2018 to January 2019. We included MSM aged 16 and older seeking HIV testing who met indications for gonorrhea and chlamydia testing. Restricted randomization was employed using computer-generated permuted blocks. Thirty groups were 1:1:1 randomized into three arms: a pay-it-forward arm where men were offered free gonorrhea and chlamydia testing and then asked whether they would like to donate others' tests; a pay-what-you-want arm where men were offered free testing and given the option to pay any desired amount for the test; and a standard-of-care arm where testing was offered at 150RMB (US$22). There was no masking to arm assignment. The primary outcome was gonorrhea and chlamydia test uptake ascertained by administrative records. We used generalized estimating equations to estimate intervention effect with one-sided 95% confidence intervals and a pre-specified superiority margin, 20%. The trial was registered (NCT03741725). Findings Three hundred and one men were recruited and included in the analysis: 101 were randomized to pay-it-forward, 100 to pay-what-you-want, and 100 to standard-of-care. Test Interpretation Pay-it-forward strategy can increase gonorrhea and chlamydia testing among Chinese MSM and may be a useful tool for scaling up preventive services that carry a mandatory fee.

Social innovation research checklist: A crowdsourcing open call and digital hackathon to develop a checklist for research to advance social innovation in health

“…Entries were judged in three categories: (1) relevance to inform a standardized framework or research checklist, (2) creativity, and (3) the participant’s experience in the field of social innovation. Scores were assigned between “1” and “10” in each category and then averaged for a final score of the entry.…”

“…For example, social innovations have expanded private sector pharmacy-based services to manage childhood illnesses in Uganda(1), designed eco-health and community-based approach for Chagas control in Guatemala,(2) and increased gonorrhoea and chlamydia testing among sexual minorities in China. (3) While these social innovations have shown promise, research is needed to test, implement, adapt and scale up innovations and their impact. (1)…”

Lack of sexual behavior disclosure may distort STI testing outcomes

“…These tests would likely not have been done if the study had not happened, as Chinese MSM have low gonorrhea and chlamydia testing rates [15]. Our parent RCT increased gonorrhea and chlamydia testing rates and reduced cost, with the control being the community standard of care [20].…”

“…We conducted secondary analysis of baseline data from a cross sectional survey collected through an RCT that sought to improve on STI testing rates in MSM from December 2018 January 2019 in China [20]. This RCT is henceforth referred to the parent RCT, from which we drew data to conduct secondary analysis to evaluate how outness can affect STI test uptake.…”

“…The study was approved by the Human Subjects Committee at the University of North Carolina at Chapel Hill (IRB 18-2142), Southern Medical University Dermatology Hospital (China) and Yale University. The parent RCT [20] was registered on ClinicalTrials.gov (NCT03741725). Written informed consent was obtained from all participants.…”