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Currently submitted to: JMIR Research Protocols

Date Submitted: Nov 9, 2025
Open Peer Review Period: Nov 10, 2025 - Jan 5, 2026
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Pay-it-forward to Promote HBV/HCV Testing among International Migrants from LMICs in China: Protocol for a Cluster Randomized Controlled Trial

  • Cheng Wang; 
  • Mingzhou Xiong; 
  • Gifty Marley; 
  • Alikesi Muheyati; 
  • Mengqi Gao; 
  • Honghua Cao; 
  • Kimberly Enders; 
  • Shujie Huang; 
  • Joseph Tucker

ABSTRACT

Background:

Hepatitis B virus (HBV) and hepatitis C virus (HCV) are significant global health concerns, particularly prevalent in low- and middle-income countries (LMICs). In China, a significant number of international migrants from LMICs reside, many of whom are at high risk of HBV/HCV infection with few test utilization. Previous studies presented Pay-it-forward (PIF) strategy has proven effective in promoting sexually transmitted infections (STIs) test in various populations. This study aims to evaluate the effectiveness of a PIF intervention in promoting HBV/HCV testing among international migrants from LMICs in China.

Objective:

Aims to evaluate the impact of a pay-it-forward (PIF) intervention in promoting hepatitis B virus (HBV) and hepatitis C virus (HCV) testing among international migrants from low- and middle-income countries (LMICs) residing in China.

Methods:

A two-arm cluster randomized controlled trial will be conducted in Guangzhou, China. Participants will be recruited from a public hospital serving a large migrant community. Eligible participants will be randomly assigned to either the PIF intervention arm or the control arm in a 1:1 ratio. Participants in the intervention arm will receive free HBV/HCV tests donated by previous participants and will have the opportunity to donate to support future tests. The control arm will receive standard medical services with self-paid testing. The primary outcome is the proportion of participants tested for both HBV and HCV. Data will be collected through a self-administered questionnaire and hospital records, and analyzed using generalized estimating equations to account for clustering effects.

Results:

The data collection has been completed, and the information of 100 participants was included to the data analysis.

Conclusions:

This study is innovative in targeting international migrants from LMICs in China and employing the PIF strategy to promote HBV/HCV testing. The PIF intervention is expected to increase testing rates by addressing financial barriers and fostering a sense of community support. The findings will contribute to the understanding of HBV/HCV testing promotion among this understudied population, with potential implications for public health policy and practice. Clinical Trial: ChiCTR2400082560. Registered on 1st April 2024.


 Citation

Please cite as:

Wang C, Xiong M, Marley G, Muheyati A, Gao M, Cao H, Enders K, Huang S, Tucker J

Pay-it-forward to Promote HBV/HCV Testing among International Migrants from LMICs in China: Protocol for a Cluster Randomized Controlled Trial

JMIR Preprints. 09/11/2025:87165

DOI: 10.2196/preprints.87165

URL: https://preprints.jmir.org/preprint/87165

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