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. 2023 Jun 20;23(1):1182.
doi: 10.1186/s12889-023-16095-8.

Pay-it-forward gonorrhea and chlamydia testing among men who have sex with men and male STD patients in China: the PIONEER pragmatic, cluster randomized controlled trial protocol

Gifty Marley #  1 , Rayner Kay Jin Tan  1 , Dan Wu #  2 , Tong Wang  1 , Murong Sun  1 , Qilei Sheng  1 , Margaret Elizabeth Holly  3 , Takhona Grace Hlatshwako  3 , Cheng Wang  4 , Weiming Tang  5 , Rohit Ramaswamy  6 , Ligang Yang  4 , Danyang Luo  1 , Sean S Sylvia  5 , Kurt Gray  3 , David Van Duin  3 , Heping Zheng  4 , Joseph D Tucker  7   8
Affiliations

Pay-it-forward gonorrhea and chlamydia testing among men who have sex with men and male STD patients in China: the PIONEER pragmatic, cluster randomized controlled trial protocol

Gifty Marley et al. BMC Public Health. .

Abstract

Background: Gonorrhea and chlamydia are the most common sexually transmitted diseases (STDs) among men who have sex with men (MSM) in China. Previous studies have shown pay-it-forward (PIF) interventions to be associated with a substantial increase in gonorrhea and chlamydia test uptake compared to standard-of-care. We propose a 'pay-it-forward' gonorrhea and chlamydia testing randomized controlled trial (PIONEER). The trial would evaluate the effectiveness of two pay-it-forward strategies in promoting testing uptake compared to the standard of care (in which men pay for their tests out-of-pocket) among MSM and male STD patients in China.

Methods: PIONEER will be a three-armed, pragmatic cluster randomized controlled trial (RCT), conducted across 12 clinics (six MSM-led and six public STD clinics) to compare the effectiveness of three implementation strategies. Each facility will be randomized to a standard pay-it-forward intervention of gonorrhea/ chlamydia testing with minimal encouragement for testing, a community-engaged pay-it-forward arm, or a control arm where men pay for their tests out-of-pockets. The primary outcome will be dual gonorrhea/chlamydia test uptake. Secondary outcomes will include syphilis testing, amount donated in pay-it-forward, number of positive gonorrhea and chlamydia tests, and measures of antimicrobial resistance. A sequential transformative mixed methods design will be used to evaluate the implementation process in type 2 effectiveness-implementation hybrid design. Data sources will include survey on acceptability, and feelings and attitudes towards the interventions among participants; testing and treatment uptake data from clinic records, WeChat records, and qualitative data to gain insights into men's perceptions and attitudes towards the pay-it-forward, mechanisms driving uptake, and donating behaviors. Implementers and organizers will be interviewed about fidelity and adherence to protocol, sustainability of pay-it-forward intervention, and barriers and facilitators of implementing the intervention.

Discussion: PIONEER will substantially increase gonorrhea/chlamydia testing among MSM in China, providing an innovative and new financial mechanism to sustain STD screening among sexual minorities in low- and middle-income countries. This study will answer compelling scientific questions about how best to implement pay-it-forward and the individual and organizational characteristics that moderate it.

Trial registration: The study with identification number NCT05723263 has been registered on clinicaltrials.gov/.

Keywords: Chlamydia; Gonorrhea; Pay-it-forward; Social innovation; Upstream reciprocity; Warm-glow.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Overview of pay-it-forward. The figure summarizes the process underlying the concept of the pay-it-forward concept to be adapted in PIONEER
Fig.2
Fig.2
Pragmatic Cluster RCT design flowchart. The figure shows the process of study sites distribution, participant enrollment and participant randomization for the cluster RCT. Each city will have one MSM-led clinic and one public clinic participating
See this image and copyright information in PMC

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