May 15, 2020
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Pay-it-forward strategy increases chlamydia, gonorrhea testing among MSM

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The pay-it-forward strategy may increase gonorrhea and chlamydia testing among Chinese men who have sex with men, or MSM, according to a study published in The Lancet Infectious Diseases.

The pay-it-forward method offers individuals a gift, such as an STD test, and allows them to contribute to a future test for another individual. The study’s results indicate pay-it-forward may be effective for increasing the availability of preventive services that include a mandatory fee.

“Many sexual health services do not cover the cost of routine STD screening,” Joseph D. Tucker, MD, PhD, associate professor in the division of infectious diseases and director of UNC Project-China at the University of North Carolina School of Medicine, told Healio. “Innovative financing approaches are needed to cover STD testing costs. A pay-it-forward intervention to promote gonorrhea/chlamydia testing among gay/bisexual men substantially increased testing uptake and supported 40% of total costs.”

Tucker and colleagues performed a randomized, controlled superiority trial at three HIV testing sites run by community-based MSM organizations in Guangzhou and Beijing, China. They included MSM aged 16 years or older who were interested in HIV testing and were considered appropriate for chlamydia and gonorrhea testing.

Participants were randomized 1:1:1 into three arms: 101 individuals placed in a pay-it-forward group were offered free chlamydia and gonorrhea testing and asked whether they would like to donate for testing of prospective participants; 100 assigned to a pay-what-you-want-arm in which free testing was offered and participants were given the choice to pay any amount for the test; and 100 were placed in a standard-of-care arm in which testing was offered for $22. Uptake of gonorrhea and chlamydia testing served as the study’s primary outcome.

The pay-it-forward group experienced the greatest uptake in testing, at 56%, while testing uptake was 46% in the pay-what-you-want group and 18% in the standard-of-care group. The difference in testing uptake between the pay-it-forward and standard-of-care group was 38.4% (95% CI, lower bound 28.4%). In the pay-it-forward group, nearly all men — 95% — chose to donate to support testing for others.

“The high rates of paying it forward were quite surprising,” Tucker said. “I did not think that so many men would voluntarily donate to support STD testing for subsequent men.”

He added that further studies may aid in scaling up similar testing interventions.

“The study only examined a limited number of implementation settings in urban areas,” Tucker said. “More implementation research is needed to inform scale-up activities.”