Pay-it-forward gonorrhea testing among men who have sex with men: The PIONEER pragmatic randomized controlled trial

大多数男男性行为者（MSM）没有接受淋病检测，导致治疗延迟 并潜在地放大抗菌素耐药性。不良的测试吸收通常与相关的成本有关， 性病检测和最低限度的社区参与。我们开发了一种“向前支付”的干预措施， 加强男男性接触者的淋病检测。预付涉及个人收到礼物（在这种情况下， 淋病测试），然后提供机会给一个礼物（在这种情况下，钱，以支持淋病 测试）给另一个人。“向前支付”是上游互惠理论的一个例子， 那些被别人帮助的人会感到一种“温暖的光芒”，这使他们更有可能帮助别人。“向前支付”已经 被用来鼓励人们捐赠给另一个人。但在这项研究中，我们将测试 基于上游互惠的两级实施策略对激励礼物的有效性 接受者接受淋病检测具体来说，我们将比较标准的pay-it-forward实现 最低限度鼓励接受检测的战略和社区参与的“向前推进”战略 另一个对照组是男性自己支付性病检测费用。我们的试点随机对照试验在两个 城市发现，与对照组相比，pay-it-forward大大增加了淋病检测（56%， pay-it-forward臂，对照臂18%）。我们的试点数据还表明， 接合（例如，男男性行为者参与活动，以创建测试信息）增加了对 计划，加强假设，社区参与的实施战略可以激活上游 互惠加强检测也可以减少抗生素耐药性。基于我们的可持续项目-中国 研究基础设施，我们提出了支付-它-前瞻性gORrhEa测试RCT（PIONEER）。的 本研究的具体目的如下：（1）采用三组随机对照试验， 淋病测试在标准的支付它转发战略手臂，社区参与支付它转发 战略部门和反映现行做法的控制部门;（2）确定机制， 不同的“向前支付”战略激活上游互惠，影响淋病检测和捐赠; (3)研究加强淋病检测对淋病耐药性发展的影响。基于 在我们之前的工作中，我们假设社区参与的“向前支付”策略会增加淋病的发病率， 测试吸收率相比，标准的战略，并支付它向前一般是上级的 目前的收费测试。我们的建议是创新的，因为它提供了一个新的融资机制， 支持淋病检测，测试执行战略，以提高这一机制的有效性， 并将提供更多关于增加测试和 抗菌素耐药性的发展。这一建议对交付具有重大的公共卫生影响， 在低收入和中等收入国家的性少数群体健康服务，并与NIAID的使命一致。

Most men who have sex with men (MSM) do not receive gonorrhea testing, contributing to delayed treatment and potentially amplifying antimicrobial resistance. Poor test uptake is often related to costs associated with STD testing and minimal community engagement. We have developed a pay-it-forward intervention to enhance gonorrhea testing among MSM. Pay-it-forward involves an individual receiving a gift (in this case, a gonorrhea test) and then be provided the opportunity to give a gift (in this case, money to support gonorrhea testing) to another person. Pay-it-forward is an example of upstream reciprocity theory suggesting that people who are helped by someone feel a “warm glow” that makes them more likely to help others. Pay-it-forward has been used to encourage people to donate something to another person. But in this study, we will test the effectiveness of two levels of implementation strategies based on upstream reciprocity to motivate gift recipients to get tested for gonorrhea. Specifically, we will compare a standard pay-it-forward implementation strategy with minimal encouragement to get tested and a community-engaged pay-it-forward strategy alongside a control arm in which men pay for their own STD test. Our pilot randomized controlled trial in two cities found that pay-it-forward substantially increased gonorrhea testing compared to the control arm (56% in the pay-it-forward arm, 18% in control arm). Our pilot data also suggests that greater MSM community engagement (e.g., MSM participatory activities to create testing messages) increases donations to the program, reinforcing the hypothesis that a community-engaged implementation strategy can activate upstream reciprocity. Intensified testing could also decrease antibiotic resistance. Building on our UNC Project-China research infrastructure in China, we propose the Pay-It-forward gONorrhEa tEsting RCT (PIONEER). The study has the following specific aims: (1) to use a three-arm cluster randomized controlled trial to compare gonorrhea testing uptake in a standard pay-it-forward strategy arm, a community-engaged pay-it-forward strategy arm, and a control arm reflecting current practice; (2) to determine mechanisms through which different pay-it-forward strategies activate upstream reciprocity to influence gonorrhea testing and donations; (3) to examine the impact of enhanced gonorrhea testing on the development of gonorrhea resistance. Based on our prior work, we hypothesize that a community-engaged pay-it-forward strategy will increase gonorrhea test uptake rates compared to the standard strategy, and that pay-it-forward in general is superior to the current practice of paid testing. Our proposal is innovative because it provides a new financing mechanism to support gonorrhea testing, tests implementation strategies to enhance the effectiveness of this mechanism, and will provide more detailed information about the relationship between increasing testing and the development of antimicrobial resistance. This proposal has significant public health implications for the delivery of sexual minority health services in low and middle-income countries and is aligned with the mission of NIAID.