Background Under-screening of syphilis in clinical settings is a pervasive problem, especially in resource constrained settings where heavy patient loads and competing health priorities inhibit health providers’ ability to meet screening coverage targets. We piloted a “conditional pay-for-performance (P4P) strategy,” which rewarded providers at sexually transmitted disease (STD) clinics a monetary bonus for every confirmed case of syphilis they screened. By tying rewards to the number of cases detected, this strategy seeks to incentivize providers to concentrate their counseling efforts on indicated patients who need it the most.
Methods Five STD clinics in a high syphilis transmission setting of China participated in the 6-month intervention. Data from the pre-intervention period was abstracted from clinic records. Multilevel logistic regression models with random intercepts to account for clustering within clinics were used to compare rates of syphilis case detection (number of confirmed positive cases over the total number of clinic attendees) in the 6-month periods prior to and during the intervention. Estimates were adjusted for age and sex of clinic attendees.
Results A total of 7900 patients (49.0% male; 17.7% under the age of 25) sought care at one of the five STD clinics over the course of the study. Adjusted odds of a positive syphilis screen were greater during the intervention period compared to the pre-intervention interval (odds ratio, 1.33; 95% confidence interval, 1.14–1.56). Variability in clinic-level effects were substantial given the small number of sites of this pilot study.
Conclusion Results of a conditional pay-for-performance pilot study demonstrate the feasibility and preliminary effectiveness of a conditional P4P strategy to improve syphilis case detection in Chinese clinical settings. Plans are underway for a fully powered randomized trial, findings from which could inform the utility of this approach for improving detection of common STDs in other resource constrained settings.
Disclosure No significant relationships.
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