Pay-it-forward Gonorrhea and Chlamydia Testing Among Men in China

IGHID 12118 - Pay-it-forward Gonorrhea and Chlamydia Testing Among Men in China: The PIONEER Pragmatic Randomized Controlled Trial

PIONEER is a three-arm, programmatic cluster randomized controlled trial (RCT) to compare effectiveness of three implementation strategies, followed by a mixed-methods implementation evaluation study

The study will be implemented at 12 clinics in Guangdong, China, which will be randomly assigned to one of the intervention arms for delivering gonorrhea testing: a standard pay-it-forward implementation strategy with minimal encouragement to get tested, a community-engaged pay-it-forward strategy, and a control arm in which men pay for their own sexually transmitted disease (STD) test. Data sources will include survey data on acceptability of intervention, intervention appropriateness, feelings and attitudes towards interventions among participants, administrative data about test uptake, treatment rate, and donations, as well as qualitative data to gain insights about men's perceptions and attitudes towards the pay-it-forward interventions strategies, mechanisms driving uptake and donating behaviors. Both survey and qualitative interviews with implementers and organizers about fidelity and adherence to protocol, intention to continue and maintain a pay-it-forward intervention, and barriers and facilitators of implementing the intervention will be conducted.

400 men who have sex with men (MSM) at 4 clinics will be enrolled. The standard pay-it-forward arm will include free point-of-care gonorrhea testing, as well as a passive community engagement component (such as viewing postcards and materials written by others encouraging gonorrhea testing).

400 MSM at 4 clinics will be enrolled. The community engaged pay-it-forward arm will include free point-of-care gonorrhea testing, as well as an active community engagement component (such as multi-stakeholder co-creation activities to develop essential components of the intervention and implementation strategies; writing postcards; opportunity to donate to support others)

400 MSM at 4 clinics will be enrolled. The control arm will include a fee-based point-of-care gonorrhea testing (approximately 20 USD per test) and no community engagement component

gonorrhea test uptake will be ascertained by administrative review of records from participating clinics

syphilis test uptake will be ascertained by administrative review of records from participating clinics

The cost associated with respective interventions per individual who reported testing for gonorrhea and chlamydia following the intervention

6 Items; Lowest score of 0, highest of 6 (higher scores indicate higher levels of community engagement)

7 Items; Lowest score of 7, highest of 28 (higher scores indicate higher levels of community connectedness)

10 Items; Lowest score of 10, highest of 40 (higher scores indicate higher levels of community cohesion)

11 Items; Lowest score of 11, highest of 55 (higher scores indicate higher levels of internalized homophobia)

Inclusion Criteria: at least 18 years old have had sex over the past year have not been tested for gonorrhea and chlamydia in the past year reside in the city in the past three months speak Mandarin Chinese or Cantonese mentally capable of providing informed consent to test for gonorrhea and chlamydia own a mobile phone Exclusion Criteria: < 18 years of age

Dermatology Hospital, Institute for Global Health and Sexually Transmitted Diseases, Southern Medical University, China

Deidentified individual data that supports the results will be shared beginning 9 to 36 months following publication provided the investigator who proposes to use the data has approval from an Institutional Review Board (IRB), Independent Ethics Committee (IEC), or Research Ethics Board (REB), as applicable, and executes a data use/sharing agreement with UNC.

Investigator who proposes to use the data has approval from an IRB, IEC, or REB and an executed data use/sharing agreement with UNC.