Background Gonorrhea and chlamydia testing is poor among Chinese MSM with HIV risk. Furthermore, gonorrhea and chlamydia testing programs are poorly funded and unlinked to HIV testing services. Pay-it-forward offers an individual a gift (e.g. an STD test) and then asks whether they would like to give a gift to another person. This study assesses the effectiveness of a pay-it-forward program in increasing gonorrhea/chlamydia testing among MSM compared to standard of care.
Methods We conducted a cluster randomized controlled trial at three HIV testing sites run by MSM community-based organizations in Beijing and Guangzhou (NCT03741725). We included MSM aged 16 or older who had met indications for testing based on US CDC guidelines. Twenty clusters of 10 men each were randomized into pay-it-forward and standard of care arms. In pay-it-forward, men were offered free testing and then given the option to donate money toward future participants’ tests; in standard of care, testing was offered at the standard price of 150RMB (US$22). The primary outcome was dual gonorrhea/chlamydia test uptake ascertained by administrative record. Generalized estimating equations were used to assess the population-averaged effect of the pay-it-forward intervention. This analysis focuses on the primary comparison between pay-it-forward and standard of care.
Results Overall, 201 participants were recruited. Most participants were younger than 30 years old (67.5%, 127/188) and had college or above education (85.1%, 165/194). 43.1% (69/160) reported condomless anal sex in the last three months. Gonorrhea/chlamydia testing rates were 56.4% (57/101) in pay-it-forward and 18.0% (18/100) in standard of care. Gonorrhea/chlamydia testing rates were three times higher in pay-it-forward compared to standard of care (RR:3.14, p<0.001, 95%CI=1.80–5.45). 94.7% (54/57) of pay-it-forward participants donated toward future participants, with an average amount of 53.6RMB (US$8).
Conclusion Findings suggest that pay-it-forward increases gonorrhea/chlamydia testing and may inform the integration of STD and HIV testing services among MSM.
Disclosure No significant relationships.
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