Pay-it-forward strategy to enhance uptake of dual gonorrhea and chlamydia testing among men who have sex with men in China: a pragmatic, quasi-experimental study

Li, Katherine T.; Tang, Weiming; Wu, Dan; Huang, Wenting; Wu, Fengshi; Lee, Amy; Feng, Henry L.; Pan, Stephen W.; Han, Larry; Mak, Vincent; Yang, Ligang; Tucker, Joseph D.

doi:10.1016/s1473-3099(18)30556-5

Cited by 30 publications

(89 citation statements)

References 25 publications

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“…Sensitive and specific syphilis self-test kits and dual HIV/syphilis self-test kits are available in China and can be used to screen for syphilis [18], similar to the treponemal serological assay commonly used in clinics [19]. Self-testing allows users to choose the location, time, and setting of testing, providing an opportunity for decentralized testing [18,20] and alternative service delivery models [21,22]. Self-testing may also be associated with decreased testassociated stigma [23].…”

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confidence: 99%

Syphilis Self-testing: A Nationwide Pragmatic Study Among Men Who Have Sex With Men in China

Wang

Cheng

et al. 2019

Clinical Infectious Diseases

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Background Syphilis self-testing may help expand syphilis testing among men who have sex with men (MSM). China has rapidly scaled up human immunodeficiency virus (HIV) self-testing, creating an opportunity for integrated syphilis self-testing. However, there is a limited literature on implementing syphilis self-testing. Methods A cross-sectional online survey was conducted among Chinese MSM in 2018. Participants completed a survey instrument including sociodemographic characteristics, sexual behaviors, syphilis self-testing, and HIV self-testing history. Multivariable logistic regression was conducted to identify correlates of syphilis self-testing. We also recorded potential harms associated with syphilis self-testing. Results Six hundred ninety-nine MSM from 89 cities in 21 provinces in China completed the study. A total of 361/699 (51.7%) men tested for syphilis, of whom 174/699 (24.9%) men used syphilis self-testing. Among 174 who had self-tested, 90 (51.7%) reported that the self-test was their first syphilis test and 161 (92.5%) reported that they undertook syphilis self-testing together with HIV self-testing. After adjusting for covariates, syphilis self-testing was correlated with disclosure of sexual orientation to family or friends (adjusted odds ratio [aOR], 1.90; 95% confidence interval [CI], 1.32–2.73), reporting 2–5 male sexual partners (aOR, 1.81; 95% CI, 1.04–3.16), HIV self-testing (aOR, 39.90; 95% CI, 17.00–93.61), and never tested for syphilis in the hospital (aOR, 2.96; 95% CI, 1.86–4.72). Self-reported harms associated with syphilis self-testing were minimal. Conclusions Scaling up syphilis self-testing could complement facility-based testing in China among MSM. Self-testing may increase first-time testing and has limited harms. Our findings suggest that syphilis self-testing could be integrated into HIV self-testing services.

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Syphilis Self-testing: A Nationwide Pragmatic Study Among Men Who Have Sex With Men in China

Wang

Cheng

et al. 2019

Clinical Infectious Diseases

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“…Pay-it-forward (PIF) consists of telling participants that their test was paid for by another MSM and asking the participant how much they would like to contribute to the next participant. [52] Pay-what-you-Want (PW) is a pricing strategy where consumers select a desired amount for a particular product or service. [53] In a solely monetary sense, PW is similar to PIF pricing where consumers select the price for a good or service.…”

Section: Methodsmentioning

confidence: 99%

Lack of Sexual Behavior Disclosure May Distort STI Testing Outcomes

Kumar

Forastiere

Zhang

et al. 2020

Preprint

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Background. To evaluate whether Chinese men who have sex with men (MSM) selectan STI test (rectal vs urethral) appropriate for their sexual behavior (insertive and/orreceptive).Methods. We studied uptake of gonorrhea and chlamydia testing among ChineseMSM (N=431) in a multi-site randomized controlled trial (RCT) (December 2018 toJanuary 2019). We collected socio-demographics, relevant medical and sexual history,and disclosure of sexual behavior (outness). Drawing data from the RCT, we estimatedthe decision to test and test choice, and the extent to which disclosure plays a role indecision-making. Results. Among 431 MSM, mean age was 28 years (SD=7.10) and 65% were outto someone. MSM who indicated versatile sexual behavior and were out to someone hada 26.8% (95%CI=6.1, 47.5) increased likelihood for selecting the rectal test vs the ure-thral test, compared to those versatile and not out. Versatile MSM out to their healthprovider outside of the study context had a 29.4% (95%CI=6.3, 52.6) greater likelihoodfor selecting the rectal STI test vs the urethral test, compared to versatile MSM not outto their health provider. Conclusions. Sexual behavior and outness may affect gonorrhea and chlamydia test-ing provision. Apart from clinicians, community-based efforts may reduce stigma-basedbarriers to testing. Keywords. MSM; Sexual Health; Sexual Behavior Disclosure; China

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“…Sample size calculation (Table 1) is informed by a quasi-experimental study conducted in 2017–2018 at two similar study sites [21] and by a pilot study for the RCT conducted from October to November 2018. In the quasi-experimental study, gonorrhea/chlamydia testing was 53.7% in the pay-it-forward group and 5.9% in the standard of care group.…”

Section: Methodsmentioning

confidence: 99%

“…In light of this need, several community organizations collaborated with public health staff to organize a gonorrhea and chlamydia testing pilot program using a pay-it-forward strategy [21]. In pay-it-forward, one person is offered a gift (e.g., a free test), then they are asked whether they would like to give a gift to another person [22, 23].…”

Section: Introductionmentioning

confidence: 99%

“…One pilot study found that pay-it-forward increased gonorrhea/chlamydia testing 19-fold, with gonorrhea/chlamydia testing received by 53.7% (109/203) in the pay-it-forward group and 5.9% (12/205) in the standard of care group [21]. However, this was not a randomized controlled trial (RCT) and the study only compared two groups of individuals.…”

Section: Introductionmentioning

confidence: 99%

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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

et al. 2019

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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.

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Pay-it-forward strategy to enhance uptake of dual gonorrhea and chlamydia testing among men who have sex with men in China: a pragmatic, quasi-experimental study

Cited by 30 publications

References 25 publications

Syphilis Self-testing: A Nationwide Pragmatic Study Among Men Who Have Sex With Men in China

Syphilis Self-testing: A Nationwide Pragmatic Study Among Men Who Have Sex With Men in China

Lack of Sexual Behavior Disclosure May Distort STI Testing Outcomes

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

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