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

对男男性行为者进行前额淋病检测：PIONEER 实用随机对照试验

• 批准号: 10185281
• 负责人: Joseph David Tucker
• 金额: $ 63.88万
• 依托单位: UNIV OF NORTH CAROLINA CHAPEL HILL
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-03-19 至 2026-02-28
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10185281
• 关键词: Address; Affect; Antibiotic Resistance; Antimicrobial Resistance; Centers for Disease Control and Prevention (U.S.); Characteristics; China; Cities; Clinic; Clinical Trials; Communities; Data; Development; Diagnosis; Diagnostic; Diagnostic tests; Early Diagnosis; Effectiveness; Feeling; Fees; Financial Hardship; Gifts; Gonorrhea; Government; Health; Health Services; Healthcare; Individual; Infection; Infrastructure; Intervention; Measures; Methods; Mission; Molecular; National Institute of Allergy and Infectious Disease; North Carolina; Observational Study; Participant; Persons; Pharmaceutical Preparations; Population; Preventive service; Price; Province; Public Health; Public Sector; Randomized; Randomized Controlled Trials; Reach, Effectiveness, Adoption, Implementation, and Maintenance; Recommendation; Research; Research Infrastructure; Resistance; Resources; Risk; Sexual Health; Sexually Transmitted Diseases; Site; Testing; Time; Translating; Translations; Universities; Vaccines; Work; World Health Organization; arm; authority; azithromycin resistance; base; community engagement; community partnership; cost; effectiveness testing; evidence base; health service use; implementation research; implementation strategy; implementation study; improved; innovation; intervention mapping; low and middle-income countries; male health; men; men who have sex with men; novel strategies; point of care; point-of-care diagnostics; programs; public health relevance; scale up; screening; service uptake; sexual minority; testing services; testing uptake; theories; transmission process; treatment arm

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.

大多数与男性发生性关系（MSM）的男性未接受淋病测试，导致延迟治疗 并可能扩大抗菌素的耐药性。 性病测试和最少的社区参与。 增强MSM的淋病测试。 淋病测试）和该证明是送礼物的机会（在这种情况下，资金支持淋病 对另一个人进行测试。 谁会受到某人的帮助，他们会感到“温暖的光芒”，使主题可能会帮助他人。 被用来鼓励人们向他人捐款。 基于上游互惠的两个层次的含义策略的有效性以激发礼物 接受淋病的接收者，我们将比较标准的付费效果。 策略最少鼓励接受测试和社区参与的付费策略 除了控制剧院自己的性病测试的控制臂。 城市发现，付费额会大大增加了对控制臂的淋病测试（56％ 我们的飞行员数据ALSOSO的付费臂，有18％ 参与度（例如，MSM参与性活动以创建测试消息）增加了对 计划，加强了社区参与实施方式可以激活上游的假设 互惠的测试可能会降低我们的UNC Project-Chana。 中国的研究基础设施，我们提出了付费促销的淋病测试RCT（Pioneer） 研究具有以下具体目的：（1）使用三臂群集随机对照试验进行比较 淋病测试在标准付款策略臂中的吸收 策略部门和一个反映当前实践的控制臂； 不同的付费策略会激活上游互惠，以影响淋病测试和捐赠； （3）检查增强的淋病测试对基于淋病的发展的影响。 在我们的先前工作中，我们假设由共同参与的付费策略将增加淋病 与标准策略相比，测试吸收率，并且总体上的付费优势优于。 当前的付费测试实践。 支持淋病测试，测试实施策略以增强该机制的有效性， 并将主要有关增加测试与您之间关系的更多详细信息 抗菌素抵抗的发展对交付具有重大的公共卫生影响 低收入和中等收入国家的性少数民族卫生服务，与Niaid的使命保持一致。