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，这导致了治疗的延误 并有可能放大抗菌素耐药性。测试理解能力差往往与以下方面的成本有关 性病检测和最低限度的社区参与。我们已经开发了一种Pay-It-Forward干预措施 加强男男性接触者的淋病检测。Pay-It-Forward指的是个人收到礼物(在本例中为 淋病测试)，然后有机会赠送礼物(在这种情况下，是支持淋病的钱 测试)发送给另一个人。转账是上游互惠理论的一个例子，该理论认为，人们 那些被别人帮助的人感觉到了一种“温暖的光芒”，这让他们更有可能帮助别人。Pay-It-Forward拥有 被用来鼓励人们把东西捐给另一个人。但在这项研究中，我们将测试 基于上游互惠的两个层面的实施策略对激励赠与的有效性 接受者接受淋病检测。具体地说，我们将比较标准的Pay-It-Forward实施 最少鼓励参加测试的策略和社区参与的实惠策略 旁边还有一个控制臂，男性可以在其中为自己的性病检测买单。我们的试点随机对照试验分为两个阶段 各城市发现，与对照组(56%)相比，付费服务显著增加了淋病检测 Pay-It-Forwarding ARM，控制ARM的18%)。我们的试点数据还表明，更大的MSM社区 参与(例如，MSM参与创建测试消息的活动)增加了对 计划，强化了社区参与的实施战略可以激活上游的假设 互惠。加强检测还可以降低抗生素耐药性。在北卡罗来纳大学项目的基础上再接再厉-中国 在中国的研究基础上，我们提出了支付式淋病检测RCT(开创性)。这个 研究有以下具体目的：(1)采用三臂整群随机对照试验进行比较 淋病检测在标准的付费策略部门进行，这是一个社区参与的付费策略 战略臂和反映当前实践的控制臂；(2)确定通过哪些机制 不同的支付策略会激活上游互惠，从而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。基座 在我们之前的工作中，我们假设社区参与的转账策略会增加淋病。 测试摄取率与标准策略的比较，并且总体上交付优于 目前付费测试的做法。我们的建议是创新的，因为它提供了一种新的融资机制 支持淋病检测，测试实施策略，以提高这一机制的有效性， 并将提供更详细的信息，说明增加测试与 抗菌素耐药性的发展。这项提议对分娩具有重大的公共卫生影响 在低收入和中等收入国家提供的性少数群体保健服务，并与NIAID的使命相一致。

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.