English


A Mixed Methods Analysis of a Pay-it-forward Gonorrhea/Chlamydia Testing Program among Men Who Have Sex with Men in China



Katherine T Li1, Wenting Huang2,3, Weiming Tang3,4,5, Feng Wu6, Yang Zhao7, Dan Wu8, Fan Yang2,3, Tiange P Zhang2,3,9, Ligang Yang5, and Joseph D Tucker4,8

 

1 Weill Cornell Medical College, New York, NY USA

2 Social Entrepreneurship to Spur Health (SESH) Global, Guangzhou, China

3 University of North Carolina Project-China, Guangzhou, China

4 University of North Carolina at Chapel Hill, Chapel Hill, NC, USA

5 Southern Medical University, Guangzhou, China

6 Sun Yat-sen University, Guangzhou, China

7 School of Social Science, University of Queensland, Brisbane, Australia

8 London School of Hygiene and Tropical Medicine, London, UK

9 Loyola University Stritch School of Medicine, Maywood, Illinois




Objectives:

Neisseria gonorrhea and chlamydia trachomatis are common among Chinese men who have sex with men (MSM), but testing rates are low. We developed a pay-it-forward program for Chinese MSM, where each man receives a free gonorrhea/chlamydia test and can then choose to donate toward testing for future participants. Pay-it-forward was previously implemented through three community-based groups in China with high rates of testing uptake and donation. This study aims to investigate the drivers of testing uptake and donation using a mixed methods approach. 


Methods

We used a sequential explanatory design to explore drivers of testing uptake and donation unique to pay-it-forward. We collected survey data on socio-demographics and perceived benefits of pay-it-forward among men offered the pay-it-forward intervention across three sites in Guangzhou and Beijing, China. We analyzed testing uptake and donations using descriptive statistics and logistic regression. We then conducted thirty semi-structured interviews with men on their motivations for participation and donation. Interview data were coded to identify themes.

 

Results

301 MSM were offered pay-it-forward and 55% (165/301) received gonorrhea/chlamydia testing. 91% (150/165) donated any amount with a mean of 58.31±53.39 RMB ($8.61±7.88 USD). Getting tested was not associated with income, but donations were higher in the highest income bracket (aOR = 7.12, 95% CI = 1.61-31.52). 58% (94/162) selected “more MSM can get tested” and 54% (88/162) selected “I can help someone else” as benefits of pay-it-forward. Qualitative themes for drivers of both testing and donation supported quantitative results and included flexible pricing; generosity and reciprocity; and community identity as MSM.

 

Conclusions:

Both quantitative and qualitative results suggest that this pay-it-forward program may increase MSM gonorrhea/chlamydia testing rates by reducing barriers due to cost, leveraging generosity and reciprocity, and mobilizing community altruism. Pay-it-forward may be a useful model for expanding access to sexual health services.