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.

大多数男男性行为者 (MSM) 没有接受淋病检测，导致治疗延迟 检测采用率低往往与相关成本有关。 性传播疾病检测和最低程度的社区参与我们制定了一项回馈干预措施。 加强 MSM 中的淋病检测 转发涉及个人收到礼物（在本例中为礼物）。 淋病测试），然后有机会赠送礼物（在本例中为支持淋病的金钱） 转发给另一个人是上游互惠理论的一个例子，表明人们 受到他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他人。 被用来鼓励人们向另一个人捐赠一些东西，但在这项研究中，我们将测试它。 基于上游激励礼物互惠的两级策略实施的有效性 具体来说，我们将比较标准的前付实施。 极少鼓励接受测试的策略和社区参与的回馈策略 我们的试点随机对照试验分为两个部分：男性为自己的性病检测付费。 城市发现，与对照组相比，“预付”大大增加了淋病检测（56%） 我们的试点数据还表明，MSM 群体更大）。 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策略可以激活上游的假设 在北卡罗来纳大学中国项目的基础上加强检测也可以减少抗生素耐药性。 为了改善中国的研究基础设施，我们提出了“付费前行淋病测试随机对照试验”（PIONEER）。 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 标准“前付”战略部门（社区参与的“前付”）中淋病检测的采用情况 (2) 确定机制 不同的回馈策略激活上游互惠，影响淋病检测和捐赠； (3)考察加强淋病检测对淋病耐药性发展的影响。 根据我们之前的工作，我们勇敢地相信社区参与的回馈战略将增加淋病的发病率 与标准策略相比测试采用率，并且一般来说，前付策略优于 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，测试实施策略以增强该机制的有效性， 并将提供有关增加测试和 该提案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群体健康服务，并与 NIAID 的使命保持一致。