Pay-it-forward incentives for hepatitis virus testing in men who have sex with men: a cluster randomized trial

Zhang Y 1 , Li J 2 , Xie Y 3 , Wu D 4 , Ong J 5 , Marley G 3 Show all authors , Kamarulzaman A 6 , Lu H 7 , Zou F 8 , Smith JS 9 , Tucker JD 3 , Fu G 10 , Tang W 11

Affiliations 

  • 1 Kirby Institute, UNSW Sydney, Sydney, New South Wales, Australia
  • 2 Department of HIV/STI Prevention and Control, Jiangsu Provincial Center for Diseases Prevention and Control, Nanjing, China
  • 3 University of North Carolina Project-China, Guangzhou, China
  • 4 School of Public Health, Nanjing Medical University, Nanjing, China
  • 5 Central Clinical School, Monash University, Melbourne, Victoria, Australia
  • 6 University of Malaysia, Kuala Lumpur, Malaysia
  • 7 Department of Epidemiology of Microbial Diseases, Yale School of Public Health, Yale University, New Haven, CT, USA
  • 8 Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
  • 9 Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
  • 10 Department of HIV/STI Prevention and Control, Jiangsu Provincial Center for Diseases Prevention and Control, Nanjing, China. fugf@jscdc.cn
  • 11 University of North Carolina Project-China, Guangzhou, China. Weiming_tang@med.unc.edu
Nat Med, 2023 Sep;29(9):2241-2247.
PMID: 37640859 DOI: 10.1038/s41591-023-02519-w

Abstract

Pay-it-forward incentives involve having a person receive a free test with community-generated messages and then asking if those who received a free test would like to donate money to support others to receive free testing. Here we undertook a two-arm cluster-randomized trial to evaluate pay-it-forward incentives with active community participation to promote hepatitis B virus (HBV) and hepatitis C virus (HCV) testing among men who have sex with men in China. Men randomized to the pay-it-forward arm received free HBV and HCV testing and were offered a chance to pay-it-forward by donating money to support the testing of another anonymous person. Each participant paid for their HCV and HBV test at 7.7 USD per test in the standard-of-care arm. The primary outcome was the proportion of men who tested for HBV and HCV. Between 28 March and 6 November 2021, 32 groups (10 men per group) of men were randomized to the pay-it-forward (n = 160, 16 clusters) and standard-of-care (n = 162, 16 clusters) arms, respectively. HBV and HCV rapid testing were higher in the pay-it-forward arm (59.4%) than in the standard-of-care arm (25.3%) (proportion difference 35.2%, 95% confidence interval 24.1-46.3%). No adverse events were reported. The community-led pay-it-forward incentives improved HBV and HCV testing among men who have sex with men. Clinical Trial registration: ChiCTR 2100046140.

* Title and MeSH Headings from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.

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