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: 10582704
• 负责人: Weiming Tang
• 金额: $ 60.89万
• 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/10582704
• 关键词: Affect; Antibiotic Resistance; Antimicrobial Resistance; Authorization documentation; Characteristics; China; Cities; Clinic; Clinical Trials; Communities; Data; Development; Diagnosis; Diagnostic; Diagnostic tests; Early Diagnosis; Effectiveness; Equity; 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, Controlled Trials; Reach, Effectiveness, Adoption, Implementation, and Maintenance; Recommendation; Research; Research Infrastructure; Resistance; Resource-limited setting; Risk; Sexual Health; Sexually Transmitted Diseases; Site; Testing; Time; Translating; Translations; Universities; Vaccines; Work; World Health Organization; arm; authority; azithromycin resistance; community engagement; community partnership; comparison control; 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; sexual minority health; 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 并可能扩大抗菌耐药性。测试吸收差通常与与之相关的成本有关 性病测试和最少的社区参与。我们已经开发了一种付款方式干预措施 增强MSM之间的淋病测试。付款方式涉及接收礼物的个人（在这种情况下， 淋病测试），然后获得赠送礼物的机会（在这种情况下，资金支持淋病 测试）给另一个人。付款方式是上游互惠理论的一个例子，表明人们 谁能帮助某人感到“温暖的光芒”，使他们更有可能帮助他人。付款人有 我们被用来鼓励人们向他人捐款。但是在这项研究中，我们将测试 基于上游互惠的两个级别实施策略的有效性以激励礼物 接受淋病的接受者。特别是，我们将比较标准的付款方式实施 策略以最少的鼓励进行测试和社区参与的付费策略 除了一个控制臂，男人为自己的性病测试付费。我们的飞行员随机对照试验在两个 城市发现，与对照组相比，付款方式大大增加了淋病测试 付费臂，控制臂的18％）。我们的飞行员数据还表明，更大的MSM社区 参与度（例如，MSM参与活动以创建测试消息）增加了对 计划，加强了社区参与实施策略可以激活上游的假设 互惠。加强测试也可以降低抗生素耐药性。在我们的UNC Project-China建立基础 中国的研究基础设施，我们提出了付费促进的淋病测试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 淋病测试在标准的付费策略部门中的吸收，这是一个社区参与的付款方式 策略部门和反映当前实践的控制臂； （2）确定通过 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）检查增强淋病测试对淋病耐药性发展的影响。基于 在我们先前的工作中，我们假设社区参与的付费策略将增加淋病 与标准策略相比，测试吸收率，一般的付款方式优于 当前的付费测试实践。我们的建议具有创新性，因为它为 支持淋病测试，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与 抗菌耐药性的发展。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民族卫生服务，与Niaid的使命保持一致。