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PLoS Med. 2018 Aug 28;15(8):e1002645. doi: 10.1371/journal.pmed.1002645. eCollection 2018 Aug.

Crowdsourcing to expand HIV testing among men who have sex with men in China: A closed cohort stepped wedge cluster randomized controlled trial.

Tang W1,2,3,4,5, Wei C2,6, Cao B1,2,7, Wu D1,2, Li KT1,2,8, Lu H2,3,9, Ma W10, Kang D11, Li H1,2,10, Liao M11, Mollan KR2,3,9, Hudgens MG9, Liu C1,2,12, Huang W1,2, Liu A1,2, Zhang Y1,2,4, Smith MK13, Mitchell KM14, Ong JJ2,15, Fu H16, Vickerman P17, Yang L2,4, Wang C4, Zheng H4, Yang B4, Tucker JD1,2,3,15.

Author information

University of North Carolina Project-China, Guangzhou, China.
Social Entrepreneurship to Spur Health (SESH) Global, Guangzhou, China.
Institute for Global Health and Infectious Diseases, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America.
Dermatology Hospital, Southern Medical University, Guangzhou, China.
School of Public Health, Southern Medical University, Guangzhou, China.
Social and Behavioral Health Sciences, School of Public Health, Rutgers University, Piscataway, New Jersey, United States of America.
School of Media and Communication, Shenzhen University, Shenzhen, China.
Weill Cornell Medical College, New York, New York, United States of America.
Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, United States of America.
Shandong University School of Public Health, Jinan, China.
Shandong Center for Disease Control and Prevention, Jinan, China.
Department of Sociology, University of California San Diego, La Jolla, California, United States of America.
Department of Epidemiology and Community Health, University of Minnesota Twin Cities, Minneapolis, Minnesota, United States of America.
Department of Infectious Disease Epidemiology, Imperial College London, London, United Kingdom.
Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom.
Division of Community Health and Research, Eastern Virginia Medical School, Norfolk, Virginia, United States of America.
School of Social and Community Medicine, University of Bristol, Bristol, United Kingdom.



HIV testing rates are suboptimal among at-risk men. Crowdsourcing may be a useful tool for designing innovative, community-based HIV testing strategies to increase HIV testing. The purpose of this study was to use a stepped wedge cluster randomized controlled trial (RCT) to evaluate the effect of a crowdsourced HIV intervention on HIV testing uptake among men who have sex with men (MSM) in eight Chinese cities.


An HIV testing intervention was developed through a national image contest, a regional strategy designathon, and local message contests. The final intervention included a multimedia HIV testing campaign, an online HIV testing service, and local testing promotion campaigns tailored for MSM. This intervention was evaluated using a closed cohort stepped wedge cluster RCT in eight Chinese cities (Guangzhou, Shenzhen, Zhuhai, and Jiangmen in Guangdong province; Jinan, Qingdao, Yantai, and Jining in Shandong province) from August 2016 to August 2017. MSM were recruited through Blued, a social networking mobile application for MSM, from July 29 to August 21 of 2016. The primary outcome was self-reported HIV testing in the past 3 months. Secondary outcomes included HIV self-testing, facility-based HIV testing, condom use, and syphilis testing. Generalized linear mixed models (GLMMs) were used to analyze primary and secondary outcomes. We enrolled a total of 1,381 MSM. Most were ≤30 years old (82%), unmarried (86%), and had a college degree or higher (65%). The proportion of individuals receiving an HIV test during the intervention periods within a city was 8.9% (95% confidence interval [CI] 2.2-15.5) greater than during the control periods. In addition, the intention-to-treat analysis showed a higher probability of receiving an HIV test during the intervention periods as compared to the control periods (estimated risk ratio [RR] = 1.43, 95% CI 1.19-1.73). The intervention also increased HIV self-testing (RR = 1.89, 95% CI 1.50-2.38). There was no effect on facility-based HIV testing (RR = 1.00, 95% CI 0.79-1.26), condom use (RR = 1.00, 95% CI 0.86-1.17), or syphilis testing (RR = 0.92, 95% CI 0.70-1.21). A total of 48.6% (593/1,219) of participants reported that they received HIV self-testing. Among men who received two HIV tests, 32 individuals seroconverted during the 1-year study period. Study limitations include the use of self-reported HIV testing data among a subset of men and non-completion of the final survey by 23% of participants. Our study population was a young online group in urban China and the relevance of our findings to other populations will require further investigation.


In this setting, crowdsourcing was effective for developing and strengthening community-based HIV testing services for MSM. Crowdsourced interventions may be an important tool for the scale-up of HIV testing services among MSM in low- and middle-income countries (LMIC).


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