LAUSR

BACKGROUND Under-screening of syphilis in clinical settings is a pervasive problem in resource constrained settings where heavy patient loads and competing health priorities inhibit health providers' ability to meet screening coverage targets. A "detection-based" pay-for-performance (P4P) strategy can incentivize more targeted testing by rewarding providers with a monetary bonus for every confirmed case. METHODS Five clinics in a high transmission setting of China participated in the 6-month pilot intervention. Seropositive proportions during the P4P intervention were compared to those during the pre-intervention phase using multilevel logistic regression models adjusted for age and sex of clinic attendees. RESULTS 8423 patients sought care at one of the 6 clinics over the course of the study. Adjusted odds of a positive syphilis screen were greater during the intervention period compared to the pre-intervention interval (odds ratio, 1.33; 95% confidence interval, 1.14-1.56). Variability in clinic-level effects was substantial given the small number of sites of this pilot study. CONCLUSION Results of this detection-based P4P pilot study demonstrate the feasibility and preliminary effectiveness of this approach for improving syphilis case detection in resource constrained clinical settings. A fully powered randomized trial is needed to inform the full utility of this approach for improving STD detection globally.