(P352) How Pay-it-Forward Works: A Qualitative thematic analysis of the of the participant experience in an approach to facilitate STI testing in gay, bisexual and other men who have sex with men

Wednesday, July 26, 2023

16:00 – 18:00 CST

Primary Presenter(s)

Gifty Marley, MMed, PhD (she/her/hers)

Post-doctoral Fellow
University of North Carlolina at Chapel Hill - Project China, Guangdong, China (People's Republic)

Co-Author(s)

MB

Maggie Byrne

Graduate Research Assistant
University of North Carolina at Chapel Hill
Rochester, New York, United States

Co-author(s)

Rayner Kay Jin Tan, PhD

Postdoctoral Fellow
University of North Carolina Project-China, United States
RM

Rong Mu

Sesh Global, United States
DW

Dan Wu, PhD

London School of Hygiene & Tropical Medicine, United States
JT

Joseph D. Tucker

Department of Medicine, Division of Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA; Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK, United States
TW

Tong Wang

Sesh Global, United States
QS

Qilei Sheng

Sesh Global, United States
WT

Weiming Tang

Department of Medicine, Division of Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA, United States

Background: The pay-it-forward approach is an effort to increase rates of gonorrhea and chlamydia testing among gay, bisexual and other men who have sex with men (GBMSM). In the pay-it-forward approach, the participant is given the gift of an STD test, paid for by a member in their community. The participant is then given the opportunity to pay for another individual’s STD test. We conducted a pay-it-forward feasibility study to increase gonorrhea and chlamydia testing among GBMSM. This study aims to understand the participant experience in the pay-it-forward approach and the mechanism by which it motivates testing.

Methods: Semi-structured interviews were conducted at two different STD testing sites in Guangzhou, China. The responses were translated verbatim, and a coding framework was developed based on the questions and responses we were receiving. We conducted a theoretical thematic analysis to form overall themes and overarching factors from each of the two clinics. The responses were analyzed to thematically describe the experience of the participants at four steps of implementation. We sought to understand the pay-it-forward related barriers and facilitators to test uptake and donating money or writing a message.

Results: 31 MSM were interviewed. We identified four sequential steps in implementation: before participation, PIF impression, receiving and/or writing the postcard, decision to pay it forward. The themes that emerged from this analysis were worry surrounding STD testing, detachment from the LGBTQ community, unspecified gratitude, connection to the recipient, and a sense of social responsibility and altruism.

Conclusions: Based on this thematic analysis, we conclude that the pay-it-forward model highlights the need for connection, support, and health services for gay men in China. The pay-it-forward model has the potential to be effective in increasing rates of STD testing, and this qualitative analysis provides a deeper understand for how participation affects these men.