From the Department of Medicine, Massachusetts General Hospital, Boston, MA.
Sun Yat-sen University, Guangzhou, China.
Sex Transm Dis. 2020 Jun;47(6):395-401. doi: 10.1097/OLQ.0000000000001161.
Gonorrhea and chlamydia are common among Chinese men who have sex with men (MSM), but testing rates are low. We developed a pay-it-forward program where men receive a free gonorrhea/chlamydia test and can then donate toward future participants' tests. This study aims to investigate drivers of testing uptake and donation using a mixed methods approach.
We used a sequential explanatory design to explore drivers of testing uptake and donation unique to pay-it-forward through a quantitative cross-sectional survey and a qualitative thematic analysis of semistructured interviews. We collected data on sociodemographics and perceived benefits of pay-it-forward among men offered the pay-it-forward interventionand analyzed testing uptake and donations using descriptive statistics and logistic regression. We then conducted 30 semistructured interviews with men and coded interview data to identify themes.
Three hundred and one MSM were offered pay-it-forward and 55% (165/301) received gonorrhea/chlamydia testing. Ninety-one percent (150 of 165) donated any amount with a mean of 58.31 ± 53.39 RMB (US $8.61 ± 7.88), or 39% of the standard price of gonorrhea/chlamydia testing. Getting tested was not associated with income, but donations were higher in the highest income bracket (adjusted odds ratio, 7.12; 95% confidence interval, 1.61-31.52). Fifty-eight percent (94 of 162) selected "more MSM can get tested," and 54% (88 of 162) selected "I can help someone else" as benefits of pay-it-forward. Qualitative themes for drivers of testing and donation included flexible pricing, generosity and reciprocity, and MSM community identity.
Quantitative and qualitative results suggest that this pay-it-forward program may increase gonorrhea/chlamydia testing by reducing cost barriers, leveraging generosity and reciprocity, and mobilizing community altruism.
淋病和衣原体是男男性行为者（MSM）中常见的疾病，但检测率较低。我们开发了一个“先付后得”计划，让男性接受免费的淋病/衣原体检测，然后可以为未来参与者的检测捐款。本研究旨在通过混合方法研究来探索“先付后得”计划下检测参与和捐赠的驱动因素。
我们使用顺序解释设计，通过横断面调查定量和半结构化访谈的主题分析，探索“先付后得”计划下检测参与和捐赠的独特驱动因素。我们收集了接受“先付后得”干预的男性的社会人口统计学和“先付后得”感知益处的数据，并使用描述性统计和逻辑回归分析了检测参与和捐赠情况。然后，我们对 30 名男性进行了 30 次半结构化访谈，并对访谈数据进行了编码，以确定主题。
301 名 MSM 接受了“先付后得”计划，其中 55%（165/301）接受了淋病/衣原体检测。91%（150/165）的人捐赠了任何金额，平均为 58.31 ± 53.39 人民币（8.61 ± 7.88 美元），占淋病/衣原体检测标准价格的 39%。检测与收入无关，但在最高收入群体中捐赠更高（调整后的优势比，7.12；95%置信区间，1.61-31.52）。58%（162 人中有 94 人）选择“更多的 MSM 可以接受检测”，54%（162 人中有 88 人）选择“我可以帮助别人”作为“先付后得”的好处。检测和捐赠的驱动因素的定性主题包括灵活的定价、慷慨和互惠以及 MSM 社区身份。
定量和定性结果表明，这种“先付后得”计划可能通过降低成本障碍、利用慷慨和互惠以及调动社区利他主义来增加淋病/衣原体检测。
