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Contagious Kindness Through Pay-it-Forward Gonorrhea and Chlamydia Testing Among Men Who Have Sex with Men in China: A Pragmatic, Quasi-Experimental Study
30 Pages Posted: 25 Aug 2018
More...Abstract
Background: Chinese MSM rarely receive gonorrhea or chlamydia testing. The purpose of this pilot study was to evaluate a pay-it-forward strategy to increase gonorrhea/chlamydia testing among MSM.
Methods: We used a quasi-experimental pragmatic study to compare a pay-it-forward model to standard of care at two free HIV testing sites for MSM. A pay-it-forward gonorrhea/chlamydia dual testing program was implemented for three months, during which men were offered free testing and given the option of donating money toward testing for future participants. Both sites then switched to standard of care for two months, offering dual testing at the standard price of $24 USD. All men completed a survey reporting sociodemographic characteristics, sexual behaviors, and previous STD testing.
Findings: 408 men were included in this study. 203 men were offered pay-it-forward, and 205 were offered standard of care. Gonorrhea/chlamydia testing uptake was 53·7% (109/203) in the pay-it-forward group and 5·9% (12/205) in the standard of care group (aOR=19·74, 95%CI 10·03-38·85, p<0·001). This was a first gonorrhea or chlamydia test for 80% (97/121) and 86% (104/121) of total testers, respectively. 4% (5/121) were diagnosed with gonorrhea, and 12% (15/121) were diagnosed with chlamydia. 89% (97/109) of men in the pay-it-forward group donated any amount, and the mean contribution was $10 USD. Donations accrued through pay-it-forward supported 80% of the cost of testing.
Interpretation: Pay-it-forward may be a sustainable model for expanding integrated STD/HIV testing services among MSM in China.
Funding: National Institutes of Health, Southern Medical University Dermatology Hospital, Doris Duke Charitable Foundation
Conflict of Interest: JDT and WT are on the advisory board for SESH Global, which was involved in organizing the study. All other authors declare no competing interests
Ethical Approval Statement: Ethical approval for this study was obtained from the institutional review board at the University of North Carolina-Chapel Hill.
Keywords: MSM; China; gonorrhoea; chlamydia; screening; generosity
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