Contagious Kindness Through Pay-it-Forward Gonorrhea and Chlamydia Testing Among Men Who Have Sex with Men in China: A Pragmatic, Quasi-Experimental Study

Background: Chinese MSM rarely receive gonorrhea or chlamydia testing. The purpose of this pilot study was to evaluate a pay-it-forward strategy to increase gonorrhea/chlamydia testing among MSM. Methods: We used a quasi-experimental pragmatic study to compare a pay-it-forward model to standard of care at two free HIV testing sites for MSM. A pay-it-forward gonorrhea/chlamydia dual testing program was implemented for three months, during which men were offered free testing and given the option of donating money toward testing for future participants. Both sites then switched to standard of care for two months, offering dual testing at the standard price of $24 USD. All men completed a survey reporting sociodemographic characteristics, sexual behaviors, and previous STD testing. Findings: 408 men were included in this study. 203 men were offered pay-it-forward, and 205 were offered standard of care. Gonorrhea/chlamydia testing uptake was 53·7% (109/203) in the pay-it-forward group and 5·9% (12/205) in the standard of care group (aOR=19·74, 95%CI 10·03-38·85, p