Article Text

Download PDFPDF

P018 Pay-it-forward gonorrhea and chlamydia testing among chinese men who have sex with men: a cluster randomized controlled trial
  1. Tiange Zhang1,
  2. Fan Yang2,
  3. Weiming Tang3,
  4. Wenting Huang3,
  5. Yehua Wang1,
  6. Marcus Alexander4,
  7. Laura Forastiere4,
  8. Navin Kumar4,
  9. Katherine Li3,
  10. Fei Zou5,
  11. Ligang Yang6,
  12. Guodong Mi7,
  13. Amy Lee3,
  14. Weizan Zhu8,
  15. Peter Vickerman9,
  16. Dan Wu3,
  17. Bin Yang6,
  18. Nicholas Christakis4,
  19. Joseph Tucker3
  1. 1University of North Carolina Project-China, Guangzhou, China
  2. 2University of North Carolina Project – China, Guangzhou, China
  3. 3UNC Project-China, Guangzhou, China
  4. 4Yale Institute for Network Science, New Haven, USA
  5. 5University of North Carolina at Chapel Hill, Department of Biostatistics, Chapel Hill, USA
  6. 6Dermatology Hospital, Southern Medical University, Guangzhou, China
  7. 7BlueD, Beijing, China
  8. 8Zhitong Guangzhou LGBT Center, Guangzhou, China
  9. 9University of Bristol, School of Social and Community Medicine, Bristol, UK


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.

  • diagnosis
  • gay bisexual and other men who have sex with men
  • China

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.