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

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

doi:10.1016/S1473-3099(18)30556-5

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

Lancet Infect Dis. 2019 Jan;19(1):76-82. doi: 10.1016/S1473-3099(18)30556-5.

Authors

Katherine T Li¹, Weiming Tang², Dan Wu³, Wenting Huang³, Feng Wu⁴, Amy Lee³, Henry Feng⁵, Stephen W Pan⁶, Larry Han⁷, Vincent Mak⁸, Ligang Yang⁹, Joseph D Tucker¹⁰

Affiliations

¹ Weill Cornell Medical College, New York, NY, USA; University of North Carolina Project-China, Guangzhou, China; SESH (Social Entrepreneurship to Spur Health) Team, Guangzhou, China.
² University of North Carolina Project-China, Guangzhou, China; SESH (Social Entrepreneurship to Spur Health) Team, Guangzhou, China; Dermatology Hospital, Southern Medical University, Guangzhou, China; School of Public Health, Southern Medical University, Guangzhou, China; University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
³ University of North Carolina Project-China, Guangzhou, China; SESH (Social Entrepreneurship to Spur Health) Team, Guangzhou, China.
⁴ University of North Carolina Project-China, Guangzhou, China; SESH (Social Entrepreneurship to Spur Health) Team, Guangzhou, China; Sun Yat-sen University, Guangzhou, China.
⁵ University of North Carolina Project-China, Guangzhou, China; SESH (Social Entrepreneurship to Spur Health) Team, Guangzhou, China; Duke University, Durham, NC, USA.
⁶ Xi'an Jiaotong-Liverpool University, Suzhou, China.
⁷ University of North Carolina Project-China, Guangzhou, China; SESH (Social Entrepreneurship to Spur Health) Team, Guangzhou, China; University of Cambridge Judge Business School, Cambridge, UK.
⁸ University of Cambridge Judge Business School, Cambridge, UK.
⁹ Dermatology Hospital, Southern Medical University, Guangzhou, China.
¹⁰ SESH (Social Entrepreneurship to Spur Health) Team, Guangzhou, China; University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK. Electronic address: jdtucker@med.unc.edu.

Abstract

Background: Chinese men who have sex with men (MSM) rarely receive gonorrhoea and chlamydia testing. The purpose of this pilot study was to evaluate a pay-it-forward strategy to increase uptake of gonorrhoea and chlamydia testing among MSM.

Methods: We performed a quasi-experimental pragmatic study to compare a pay-it-forward model with standard of care at two HIV testing sites for MSM in Guangzhou, China: an STD clinic for MSM and a local MSM community-based organisation. All men who arrived at the STD clinic or the community-based organisation were invited to participate. In the pay-it-forward programme, men were offered free gonorrhoea and chlamydia testing and given the option of donating money toward testing for future participants. In the standard-of-care group, men were offered gonorrhoea and chlamydia testing at the standard patient price of ¥150 (about US$21·50). The pay-it-forward programme was implemented for 3 months, after which both sites switched to standard of care offering dual testing for 3 months. The primary outcome for this study was uptake of dual gonorrhoea and chlamydia testing, which we compared using χ² test and logistic regression, reported as crude odds ratios (cOR) and adjusted odds ratios (aOR), by adjusting for nationality, marital status, income, and site of testing.

Findings: The pay-it-forward programme took place from Dec 2, 2017, to Feb 3, 2018, and the standard-of-care control took place from March 11, 2018, to May 1, 2018. 408 men were included in this study. 203 men were offered pay-it-forward, and 205 were offered standard of care. Overall, 109 (54%) of 203 men in the pay-it-forward group and 12 (6%) of 205 men in the standard-of-care group received gonorrhoea and chlamydia testing (cOR 18·65, 9·78-35·54; p<0·0001; aOR 19·73, 95% CI 10·02-38·85; p<0·0001). Of all 121 men who tested, this was the first gonorrhoea test for 97 (80%) men and the first chlamydia test for 104 (86%) men. Five (4%) of these 121 men were diagnosed with gonorrhoea and 15 (12%) were diagnosed with chlamydia. 97 (89%) of 109 men who received testing in the pay-it-forward group donated some money toward testing for future participants.

Interpretation: Pay-it-forward might be a sustainable model for expanding integrated HIV testing services among MSM in China.

Funding: National Institutes of Health, Southern Medical University Dermatology Hospital, Doris Duke Charitable Foundation.

Publication types

Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

MeSH terms

Adult
China
Chlamydia / genetics
Chlamydia Infections / diagnosis*
Chlamydia Infections / microbiology
Gonorrhea / diagnosis*
Gonorrhea / microbiology
HIV / immunology
HIV Infections / diagnosis
HIV Infections / virology
Homosexuality, Male*
Humans
Logistic Models
Male
Mass Screening / economics*
Mass Screening / methods*
Neisseria gonorrhoeae / genetics
Non-Randomized Controlled Trials as Topic
Odds Ratio
Pilot Projects
Pragmatic Clinical Trials as Topic
Sexual and Gender Minorities*

Abstract

Publication types

MeSH terms

Grants and funding