Pay-it-forward gonorrhea and chlamydia testing among men who have sex with men: A pragmatic, quasi-experimental study in Guangzhou, China

Speaker: Katherine Li
Cornell Medical
Human Nature Lab collaborator in China on pay-it-forward experiments

Talk Summary: Gonorrhea and chlamydia are common among men who have sex with men (MSM), but Chinese MSM rarely receive testing. Pay-it-forward is a cooperative arrangement in which people who have benefited from others pass on the favor to future beneficiaries. The purpose of this pilot study was to evaluate a pay-it-forward strategy applied to gonorrhea/chlamydia testing among MSM.

Methods: We used a quasi-experimental pragmatic study design to compare a pay-it-forward model to standard of care at two free HIV testing sites operated by MSM community-based organizations in Guangzhou, China. 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 behavior, and previous STD testing. Descriptive statistics and multivariable logistic regression were used to analyze gonorrhea/chlamydia test uptake and pay-it-forward contributions.

Results: Overall, 410 men responded to the survey and were included in this study. 204 men were offered pay-it-forward, and 206 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) 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 costs associating with testing.

Conclusion: Pay-it-forward may be a sustainable model for expanding integrated STD/HIV testing services among MSM in China.

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