Crowdsourced Materials Used to Promote Hepatitis Testing Among MSM in China

Care interventions targeting men who have sex with men (MSM) in China are still in development, as same sex relationships have only recently become a subject of national discussion.

A new study in EClinicalMedicine has explored the potential for crowdsourcing as a strategy to develop test promotion materials, focused on hepatitis B (HBV) and hepatitis C (HCV) testing among MSM in China. Investigators found that overall test uptake was similar to previous interventions promoting HBV/HCV testing. The results were further complicated by frequent intervention sharing.

The crowdsourced intervention was developed through a public challenge contest conducted by 13 different organizations, with a total of 168 submissions judged by hepatitis experts and community experts.

Investigators used social media to recruit MSM who had never previously tested for hepatitis B or C. A recruiting announcement was made by a predominately MSM-focused dating app, Blued, as well as several community-based organizations. Men recruited were asked to connect with the study’s profile on WeChat, China’s most widely used mobile phone application.

Participants were required to be male, 16 years of age or older, residents of Mainland China, and to have previously had anal sex with another man to be eligible. They were recruited over 7 days, between May 9-15, 2018.

Those enrolled via WeChat were informed that they would be reimbursed with proof of hepatitis testing over the next 4 weeks, and were subsequently randomized to receive either an online crowdsourced intervention or no testing promotion materials. After 3 weeks, a follow-up survey was sent to all men enrolled through WeChat to assess outcomes.

A total of 2733 individuals initiated the baseline survey. In total, 713 completed surveys met eligibility criteria. After 157 exclusions based on duplicate identifying information or WeChat issues, 556 eligible participants were enrolled. Random allocation assigned 280 men to the intervention arm and 276 to the control arm.

After 4 weeks had passed, 470 (84.5%) of men completed the follow-up survey. A suggestion component of the follow-up survey received 172 eligible suggestions. In the intervention arm, 202 of 280 men saw at least 1 intervention image or video, and 100 of 280 saw all 4 intervention materials used. The intervention materials were shared with others by 148 of 280 men in the intervention arm, and 80 members of the control arm saw at least 1 intervention image or video.

Out of 556 men, 97 reported undergoing HBV and HCV testing for the first time. Among the 346 who did not test for HBV, the most common reasons were not having enough time, not feeling at risk, and not knowing where to undergo testing. Similar reasons were reported for those who did not undergo HCV testing.

In the intervention group, investigators were able to confirm testing for 22 individuals, and the control group also had 22 men confirmed tested. Study authors proposed several potential explanations for why there was not a significant difference between groups.

While investigators put forward the possibility that study materials were not effective in some respects, they also noted that 20% of participants reported first time testing within 4 weeks of enrollment. As an additional explanation, they pointed to the high rates of intervention sharing, noting that the crowdsourced materials were spread to many men in the control group. The authors also noted that offering testing reimbursement to all enrolled men may have promoted testing across both arms of the trial, which could mask the effect of the crowdsourced intervention.

Overall, the study authors concluded that further research could help clarify the effectiveness of crowdsourcing as a community-based testing promotion intervention, and suggested future research be designed to capture the effects of intervention sharing.