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Abstract：
WHO recommends that men who have sex with men (MSM) receive gonorrhoea and chlamydia testing, but many evidence-based preventive services are unaffordable. The pay-it-forward strategy offers an individual a gift (eg, a test for sexually transmitted diseases) and then asks whether they would like to give a gift (eg, a future test) to another person. This study examined the effectiveness of a pay-it-forward programme to increase gonorrhoea and chlamydia testing among MSM in China.
We did a randomised controlled superiority trial at three HIV testing sites run by MSM community-based organisations in Guangzhou and Beijing, China. We included MSM aged 16 years or older who were seeking HIV testing and met indications for gonorrhoea and chlamydia testing. Restricted randomisation was done using computer-generated permuted blocks. 30 groups were randomised into three arms (1:1:1): a pay-it-forward arm in which men were offered free gonorrhoea and chlamydia testing and then asked whether they would like to donate for testing of prospective participants, a pay-what-you-want arm in which men were offered free testing and given the option to pay any desired amount for the test, and a standard-of-care arm in which testing was offered at ¥150 (US$22). There was no masking to arm assignment. The primary outcome was gonorrhoea and chlamydia test uptake ascertained by administrative records. We used generalised estimating equations to estimate intervention effects with one-sided 95% CIs and a prespecified superiority margin of 20%. The trial is registered with ClinicalTrials.gov, NCT03741725.
Between Dec 8, 2018, and Jan 19, 2019, 301 men were recruited and included in the analysis. 101 were randomly assigned to the pay-it-forward group, 100 to the pay-what-you-want group, and 100 to the standard-of-care group. Test uptake for gonorrhoea and chlamydia was 56% (57 of 101 participants) in the pay-it-forward arm, 46% (46 of 100 participants) in the pay-what-you-want arm, and 18% (18 of 100 participants) in the standard-of-care arm. The estimated difference in test uptake between the pay-it-forward and standard-of-care group was 38·4% (95% CI lower bound 28·4%). Among men in the pay-it-forward arm, 54 of 57 (95%) chose to donate to support testing for others.
The pay-it-forward strategy can increase gonorrhoea and chlamydia testing uptake among Chinese MSM and could be a useful tool for scaling up preventive services that carry a mandatory fee.
US National Institute of Health; Special Programme for Research and Training in Tropical Diseases, sponsored by UNICEF, UNDP, World Bank, and WHO; the National Key Research and Development Program of China; Doris Duke Charitable Foundation; and Social Entrepreneurship to Spur Health.
We did a randomised controlled superiority trial at three HIV testing sites run by MSM community-based organisations in Guangzhou and Beijing, China. We included MSM aged 16 years or older who were seeking HIV testing and met indications for gonorrhoea and chlamydia testing. Restricted randomisation was done using computer-generated permuted blocks. 30 groups were randomised into three arms (1:1:1): a pay-it-forward arm in which men were offered free gonorrhoea and chlamydia testing and then asked whether they would like to donate for testing of prospective participants, a pay-what-you-want arm in which men were offered free testing and given the option to pay any desired amount for the test, and a standard-of-care arm in which testing was offered at ¥150 (US$22). There was no masking to arm assignment. The primary outcome was gonorrhoea and chlamydia test uptake ascertained by administrative records. We used generalised estimating equations to estimate intervention effects with one-sided 95% CIs and a prespecified superiority margin of 20%. The trial is registered with ClinicalTrials.gov, NCT03741725.
Between Dec 8, 2018, and Jan 19, 2019, 301 men were recruited and included in the analysis. 101 were randomly assigned to the pay-it-forward group, 100 to the pay-what-you-want group, and 100 to the standard-of-care group. Test uptake for gonorrhoea and chlamydia was 56% (57 of 101 participants) in the pay-it-forward arm, 46% (46 of 100 participants) in the pay-what-you-want arm, and 18% (18 of 100 participants) in the standard-of-care arm. The estimated difference in test uptake between the pay-it-forward and standard-of-care group was 38·4% (95% CI lower bound 28·4%). Among men in the pay-it-forward arm, 54 of 57 (95%) chose to donate to support testing for others.
The pay-it-forward strategy can increase gonorrhoea and chlamydia testing uptake among Chinese MSM and could be a useful tool for scaling up preventive services that carry a mandatory fee.
US National Institute of Health; Special Programme for Research and Training in Tropical Diseases, sponsored by UNICEF, UNDP, World Bank, and WHO; the National Key Research and Development Program of China; Doris Duke Charitable Foundation; and Social Entrepreneurship to Spur Health.
摘要：
世卫组织建议男男性行为者（MSM）接受淋病和衣原体检测，但是许多基于证据的预防服务负担不起。预付策略为个人提供礼物(例如，性传播疾病的测试)，然后询问他们是否愿意送礼物(例如，未来的测试)给另一个人。这项研究检查了在中国MSM中增加淋病和衣原体检测的预付计划的有效性。
我们在广州和北京的MSM社区组织运营的三个HIV检测地点进行了一项随机对照优势试验，中国。我们纳入了16岁或以上的MSM，他们正在寻求HIV检测，并符合淋病和衣原体检测的适应症。使用计算机生成的置换块进行限制性随机化。30组被随机分为三组（1：1：1）：一个向前支付的手臂，其中男性获得免费的淋病和衣原体测试，然后询问他们是否愿意捐赠用于潜在参与者的测试，一种按需付费的手臂，可以为男性提供免费测试，并可以选择支付任何所需的测试费用，和一个标准的护理臂，其中测试的价格为150日元（22美元）。手臂分配没有屏蔽。主要结局是淋病和衣原体试验摄取，由管理记录确定。我们使用广义估计方程来估计单侧95%CI和20%预设优势的干预效果。该试验已在ClinicalTrials.gov注册，NCT03741725。
在2018年12月8日至2019年1月19日之间，招募了301名男性并将其纳入分析。101人被随机分配到预付小组，100分给你想要的付费小组，和100个标准护理组。淋病和衣原体的测试摄取为56％（101名参与者中的57名），46％（100名参与者中的46名）在按需支付的手臂中，18％（100名参与者中的18名）在标准护理组中。预付护理组和标准护理组之间测试摄取的估计差异为38·4%(95%CI下限28·4%)。在领着前薪的男人中，57人中有54人（95％）选择捐赠以支持他人的测试。
预付制策略可以增加中国MSM对淋病和衣原体检测的吸收，并且可能是扩大强制性收费的预防服务的有用工具。
美国国立卫生研究院；热带病研究和培训特别计划，由儿童基金会赞助，UNDP,世界银行,和世界卫生组织；中国国家重点研究与发展计划；多丽丝·杜克慈善基金会；社会企业家精神促进健康。
我们在广州和北京的MSM社区组织运营的三个HIV检测地点进行了一项随机对照优势试验，中国。我们纳入了16岁或以上的MSM，他们正在寻求HIV检测，并符合淋病和衣原体检测的适应症。使用计算机生成的置换块进行限制性随机化。30组被随机分为三组（1：1：1）：一个向前支付的手臂，其中男性获得免费的淋病和衣原体测试，然后询问他们是否愿意捐赠用于潜在参与者的测试，一种按需付费的手臂，可以为男性提供免费测试，并可以选择支付任何所需的测试费用，和一个标准的护理臂，其中测试的价格为150日元（22美元）。手臂分配没有屏蔽。主要结局是淋病和衣原体试验摄取，由管理记录确定。我们使用广义估计方程来估计单侧95%CI和20%预设优势的干预效果。该试验已在ClinicalTrials.gov注册，NCT03741725。
在2018年12月8日至2019年1月19日之间，招募了301名男性并将其纳入分析。101人被随机分配到预付小组，100分给你想要的付费小组，和100个标准护理组。淋病和衣原体的测试摄取为56％（101名参与者中的57名），46％（100名参与者中的46名）在按需支付的手臂中，18％（100名参与者中的18名）在标准护理组中。预付护理组和标准护理组之间测试摄取的估计差异为38·4%(95%CI下限28·4%)。在领着前薪的男人中，57人中有54人（95％）选择捐赠以支持他人的测试。
预付制策略可以增加中国MSM对淋病和衣原体检测的吸收，并且可能是扩大强制性收费的预防服务的有用工具。
美国国立卫生研究院；热带病研究和培训特别计划，由儿童基金会赞助，UNDP,世界银行,和世界卫生组织；中国国家重点研究与发展计划；多丽丝·杜克慈善基金会；社会企业家精神促进健康。
