Pay-it-forward gonorrhea and chlamydia testing among men who have sex with men in China: a study protocol for a three-arm cluster randomized controlled trial

Abstract

Background Gonorrhea and chlamydia testing rates are poor among Chinese men who have sex with men (MSM). A quasi-experimental study suggested that a pay-it-forward strategy increased dual gonorrhea/chlamydia testing among MSM. Pay-it-forward offers an individual a gift (e.g., a free test) and then asks the same person if they would like to give a gift to another person. This article reports the protocol of a randomized controlled trial to evaluate dual gonorrhea/chlamydia test uptake and other outcomes among MSM in three arms – a pay-it-forward arm, a pay-what-you-want arm, and a standard of care arm. Methods Three hundred MSM will be recruited at three HIV testing sites in Guangzhou and Beijing. Testing sites include two hospital-based MSM sexually transmitted diseases clinics and one MSM community-based organization. Eligible participants will be born biologically male, aged 16 years or older, reporting previous anal sex with another man, having never participated in the pay-it-forward program, without previous gonorrhea and chlamydia testing in the past 12 months, and residing in China. Following a cluster randomized design, every cluster of ten participants will be randomly allocated into one of three arms: (1) a pay-it-forward arm in which men are offered free gonorrhea and chlamydia testing and then asked whether they would like to donate (“pay it forward”) toward testing for future testers; (2) a pay-what-you-want arm in which men are offered free testing and told to decide how much to pay after receiving the test; (3) a standard of care arm in which men can pay the full price for dual gonorrhoea and chlamydia testing. The primary outcome is dual gonorrhoea/chlamydia testing as verified by administrative records. Secondary outcomes include incremental cost per test, incremental cost per diagnosis, community connectedness, and social cohesion. Primary outcome will be calculated for each arm using intention-to-treat and compared using one-sided 95% confidence intervals with a margin of 20% increase defined as superiority. Discussion This study will examine the pay-it-forward strategy in comparison to the standard of care in improving test uptake for gonorrhea and chlamydia. We will leverage the cluster randomized controlled trial to provide scientific evidence on the potential effect of pay-it-forward. Findings from this study will shed light on novel intervention methods for increasing preventive health service utilization and innovate ways to finance it among communities. Trial registration ClinicalTrials.gov, NCT03741725 . Registered on 12 November 2018. Electronic supplementary material The online version of this article (10.1186/s40249-019-0581-1) contains supplementary material, which is available to authorized users.

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

“…The pilot included a total of 43 men and based on its results, community partners and study staff optimized the standard operating procedure. (20) Second, the name of the program in Chinese was crowdsourced from the public using an open challenge contest. (27) Third, postcards with hand-written notes from earlier participants were presented to subsequent participants in the pay-it-forward arm.…”

“…More details about the study setting are available in the study protocol. (20) The study was approved by ethics review committees at Southern Medical University Dermatology Hospital (China), University of North Carolina at Chapel Hill (USA), and Yale University (USA). This trial was registered on ClinicalTrials.gov (NCT03741725).…”

Uptake and Correlates of Chlamydia and Gonorrhea Testing among Female Sex Workers in Southern China: A Cross-sectional Study

“…Meanwhile, the FSW who had HIV testing tended to have higher awareness of STD testing [28]. Although there are many possible ways for promoting chlamydia and gonorrhea testing, such as home-based testing or self-collection [15], outreach services [29]and pay-it-forward [30], the effect is still not ideal. There are many proven effective strategies around the world in response to the low HIV and syphilis testing, including voluntary counseling and testing (VCT) [31], provider-initiated HIV/syphilis testing and counseling (PITC) [32].…”

Lack of sexual behavior disclosure may distort STI testing outcomes

“…Moreover, home based self testing has had several innovations, such as internet based testing which obviates the need to see a clinician [13] and social entrepreneurship models that promote self testing [14]; 2) Substantial heterogeneity in MSM preferences may drive rectal test uptake [15] along with a range of unaccounted factors such as disclosure of sexual behavior (outness); 3) The broader randomized controlled trial (RCT), from which we drew data to conduct secondary analysis of a cross sectional survey, provided a unique context where all providers were offered rectal testing, allowing us to observe differences in MSM rectal STI uptake [16]. Within these factors, the main barrier for testing is lack of disclosure [17,18].…”