STBBI Research - Ayel L. R. Batac
SEXUALLY TRANSMITTED AND BLOOD-BORNE INFECTIONS
\(~\)
Sexually transmitted and blood-borne infections (STBBIs) continue to represent a major global public health challenge. Despite increasing awareness, testing rates for infections such as gonorrhoea and chlamydia remain low worldwide, particularly among marginalised populations including men who have sex with men (MSM). Asymptomatic infections frequently go undiagnosed, delaying treatment and hindering effective prevention and control.
In many low- and middle-income countries (LMICs), stigma, financial barriers, and limited access to culturally appropriate services contribute to low testing uptake. Structural exclusion and social marginalisation often prevent MSM and other key populations from engaging with formal health systems, perpetuating inequalities in access to care.
\(~\)
Ongoing Research and Evidence Generation
My current research evaluates the effectiveness and implementation of the pay-it-forward approach among MSM in China through a randomised controlled trial (RCT). Key areas of focus include:
- Uptake of STBBI testing across different behavioural intervention arms
- Giving behaviours as indicators of community engagement and reciprocity
- Clinic-level and demographic determinants of testing outcomes
- Adaptation of a digital, self-sampling version of the pay-it-forward approach to enhance accessibility in low-resource contexts
This research contributes to the growing global evidence base on how social innovation and behavioural science can strengthen health systems, improve testing coverage, and address the needs of populations most affected by stigma and inequity.
Methodological Approach
The research applies a mixed-methods design to capture both impact and implementation outcomes:
- Quantitative analysis: Randomised controlled trials assess behavioural and clinical outcomes, including testing uptake and donation patterns.
- Qualitative inquiry: In-depth interviews with participants and providers explore motivations, perceived barriers, and emotional responses.
- Process evaluation: Implementation fidelity, feasibility, and scalability are assessed under real-world conditions.
This comprehensive approach supports both rigorous evidence generation and context-sensitive insights that inform adaptation and scale-up.
Contribution to Public Health
The pay-it-forward approach demonstrates how social innovation can advance equity, inclusion, and sustainability within public health systems. Evidence from ongoing research highlights its potential to:
- Expand access to essential health services through community-driven and decentralised financing models
- Promote stigma-sensitive and culturally responsive testing practices tailored to the experiences of MSM and other key populations
- Strengthen the interface between health systems and communities by embedding social innovation within service delivery
- Contribute to global efforts toward universal health coverage and equitable access to sexual and reproductive health services
By framing STBBI testing as a collective act of care, the pay-it-forward approach aligns with broader global health goals to build inclusive, resilient, and people-centred systems for sexual health and well-being.
\(~\)
\(~\)
Stay tuned — publications and data visualisations related to this work will be made available here soon.
Social Innovation for Health: The Pay-It-Forward Approach
The pay-it-forward approach is a social innovation that links public health service delivery with prosocial behaviour. Within STBBI prevention and testing, it offers individuals free diagnostic services—such as testing for gonorrhoea and chlamydia—and then invites them to support another person’s access to testing through voluntary contributions or messages of encouragement.
The approach is grounded in three key principles:
Unlike traditional fee-for-service or centrally funded systems, the pay-it-forward approach promotes solidarity and empowerment within communities. It provides a practical model for improving access to essential services in settings where stigma, financial constraints, or mistrust of institutions restrict care.