A mixed-methods analysis of a pay-it-forward gonorrhea/chlamydia testing program among men who have sex with men in China

Background Neisseria gonorrhoeae and Chlamydia trachomatis are common among Chinese men who have sex with men (MSM), but testing rates are low. We developed a pay-it-forward program, where each man receives a free gonorrhea/chlamydia test and can then choose to donate toward testing for future participants. This study aims to investigate the facilitators of increased gonorrhea/chlamydia testing among MSM in the pay-it-forward program. Methods We collected survey data on socio-demographics and perceived benefits of the pay-it-forward program among men offered the pay-it-forward intervention as part of a quasi-experimental study in Guangzhou, China. We analyzed testing uptake using multivariable logistic regression. We also conducted twelve semi-structured interviews with men who received testing eliciting their perceptions of the program. Interview data were coded to identify themes. Results 204 MSM were offered pay-it-forward and 109 (54%) received gonorrhea/chlamydia testing. Across survey and interview data, the main facilitators of testing were (1) lower cost and (2) care for MSM community. First, 48/204 (24%) participants selected discounted testing as a benefit of pay-it-forward, and receiving testing was not associated with income. In interviews, the majority of participants felt that standard hospital-based testing was prohibitively expensive, especially for students (150 RMB, ∼USD $21.50); pay-it-forward made testing affordable for them. Second, 141/204 (70%) men selected ‘more MSM can get tested’ or ‘I can help someone else’ as benefits of pay-it-forward, and selecting at least one of these options was associated with getting tested (aOR = 2.59, 95% CI = 1.31–5.15). In interviews, some men expressed desire to contribute to the MSM community; others felt that encouraging others to test could also eventually benefit themselves. Conclusion This pay-it-forward program may increase MSM gonorrhea/chlamydia testing rates by reducing barriers due to cost and mobilizing community altruism. This model may be useful for other settings and sexual health services. Disclosure No significant relationships.