R01AI158826

Pay-It-Forward Gonorrhea Testing Among Men Who Have Sex with Men: The Pioneer Pragmatic Randomized Controlled Trial

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 being 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.

University Of North Carolina At Chapel Hill

TO ASSIST PUBLIC AND PRIVATE NONPROFIT INSTITUTIONS AND INDIVIDUALS TO ESTABLISH, EXPAND AND IMPROVE BIOMEDICAL RESEARCH AND RESEARCH TRAINING IN INFECTIOUS DISEASES AND RELATED AREAS, TO CONDUCT DEVELOPMENTAL RESEARCH, TO PRODUCE AND TEST RESEARCH MATERIALS. TO ASSIST PUBLIC, PRIVATE AND COMMERCIAL INSTITUTIONS TO CONDUCT DEVELOPMENTAL RESEARCH, TO PRODUCE AND TEST RESEARCH MATERIALS, TO PROVIDE RESEARCH SERVICES AS REQUIRED BY THE AGENCY FOR PROGRAMS IN INFECTIOUS DISEASES, AND CONTROLLING DISEASE CAUSED BY INFECTIOUS OR PARASITIC AGENTS, ALLERGIC AND IMMUNOLOGIC DISEASES AND RELATED AREAS. PROJECTS RANGE FROM STUDIES OF MICROBIAL PHYSIOLOGY AND ANTIGENIC STRUCTURE TO COLLABORATIVE TRIALS OF EXPERIMENTAL DRUGS AND VACCINES, MECHANISMS OF RESISTANCE TO ANTIBIOTICS AS WELL AS RESEARCH DEALING WITH EPIDEMIOLOGICAL OBSERVATIONS IN HOSPITALIZED PATIENTS OR COMMUNITY POPULATIONS AND PROGRESS IN ALLERGIC AND IMMUNOLOGIC DISEASES. BECAUSE OF THIS DUAL FOCUS, THE PROGRAM ENCOMPASSES BOTH BASIC RESEARCH AND CLINICAL RESEARCH. SMALL BUSINESS INNOVATION RESEARCH (SBIR) PROGRAM EXPANDS AND IMPROVES PRIVATE SECTOR PARTICIPATION IN BIOMEDICAL RESEARCH. THE SBIR PROGRAM INTENDS TO INCREASE AND FACILITATE PRIVATE SECTOR COMMERCIALIZATION OF INNOVATIONS DERIVED FROM FEDERAL RESEARCH AND DEVELOPMENT, TO INCREASE SMALL BUSINESS PARTICIPATION IN FEDERAL RESEARCH AND DEVELOPMENT, AND TO FOSTER AND ENCOURAGE PARTICIPATION OF SOCIALLY AND ECONOMICALLY DISADVANTAGED SMALL BUSINESS CONCERNS AND WOMEN-OWNED SMALL BUSINESS CONCERNS IN TECHNOLOGICAL INNOVATION. THE SMALL BUSINESS TECHNOLOGY TRANSFER (STTR) PROGRAM STIMULATES AND FOSTERS SCIENTIFIC AND TECHNOLOGICAL INNOVATION THROUGH COOPERATIVE RESEARCH AND DEVELOPMENT CARRIED OUT BETWEEN SMALL BUSINESS CONCERNS AND RESEARCH INSTITUTIONS, TO FOSTER TECHNOLOGY TRANSFER BETWEEN SMALL BUSINESS CONCERNS AND RESEARCH INSTITUTIONS, TO INCREASE PRIVATE SECTOR COMMERCIALIZATION OF INNOVATIONS DERIVED FROM FEDERAL RESEARCH AND DEVELOPMENT, AND TO FOSTER AND ENCOURAGE PARTICIPATION OF SOCIALLY AND ECONOMICALLY DISADVANTAGED SMALL BUSINESS CONCERNS AND WOMEN-OWNED SMALL BUSINESS CONCERNS IN TECHNOLOGICAL INNOVATION. RESEARCH CAREER DEVELOPMENT AWARDS SUPPORT THE DEVELOPMENT OF SCIENTISTS DURING THE FORMATIVE STAGES OF THEIR CAREERS. INDIVIDUAL NATIONAL RESEARCH SERVICE AWARDS (NRSAS) ARE MADE DIRECTLY TO APPROVE APPLICANTS FOR RESEARCH TRAINING IN SPECIFIED BIOMEDICAL SHORTAGE AREAS. IN ADDITION, INSTITUTIONAL NATIONAL RESEARCH SERVICE AWARDS ARE MADE TO ENABLE INSTITUTIONS TO SELECT AND MAKE AWARDS TO INDIVIDUALS TO RECEIVE TRAINING UNDER THE AEGIS OF THEIR INSTITUTIONAL PROGRAM.

93.855 - Allergy and Infectious Diseases Research

National Institute of Allergy and Infectious Diseases (NIAID) [HHS - NIH]

Chapel Hill, North Carolina 27599 United States

Single Zip Code

Dissemination and Implementation Research in Health (R01 Clinical Trial Optional) (PAR-19-274)

Amendment Since initial award the total obligations have increased 388% from $638,835 to $3,115,633.