{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,1]],"date-time":"2026-11-01T22:46:37Z","timestamp":1793573197811,"version":"4.5.0"},"reference-count":74,"publisher":"American Medical Association (AMA)","issue":"10","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Netw Open"],"abstract":"<jats:sec id=\"ab-zoi251031-4\"><jats:title>Importance<\/jats:title><jats:p>Donation-based prosocial interventions involve someone receiving a free health service and then distributing or donating to support health services for others; examples within the HIV and sexually transmitted infection (STI) literature include secondary distribution of HIV self-tests, secondary syringe exchange, and pay it forward for STI testing. These interventions answer research and policy recommendations to incorporate prosocial behaviors into HIV\/STI services.<\/jats:p><\/jats:sec><jats:sec id=\"ab-zoi251031-5\"><jats:title>Objective<\/jats:title><jats:p>To describe motivations, facilitators, and barriers of donation-based interventions in HIV and STI research using data from qualitative studies.<\/jats:p><\/jats:sec><jats:sec id=\"ab-zoi251031-6\"><jats:title>Evidence Review<\/jats:title><jats:p>In this systematic review, 5 databases (PubMed, CINAHL, Embase, PsycInfo, and Scopus) and references were searched up to January 23, 2024, for qualitative studies of donation-based interventions. Thematic synthesis was used to summarize findings, the Critical Appraisal Skills Programme Qualitative Studies Checklist was used to assess risk of bias among studies, and GRADE-CERQual (Confidence in the Evidence From Reviews of Qualitative Research) was used to assess confidence in review findings.<\/jats:p><\/jats:sec><jats:sec id=\"ab-zoi251031-7\"><jats:title>Findings<\/jats:title><jats:p>Of 374 studies screened, 27 were included, which included 1543 participants, assessing secondary distribution of HIV self-tests (15 studies), secondary syringe exchange among people who inject drugs (10 studies), and pay it forward for STI testing (2 studies). Studies were from low-income (5 studies), middle-income (13 studies), and high-income (12 studies) countries. Givers who distributed health services were motivated by a selfless concern to benefit others (20 studies, moderate confidence) and by the cultivation of a prosocial identity (20 studies, moderate confidence). Social proximity between givers and recipients facilitated distribution (22 studies, moderate confidence), allowing for recipient-tailored strategies to introduce the service, strengthen peer relationships, and promote reciprocal giving. However, secondary syringe distribution could subject people who use drugs to legal harms and encourage them to provide unsupervised clinical care (7 studies, low confidence).<\/jats:p><\/jats:sec><jats:sec id=\"ab-zoi251031-8\"><jats:title>Conclusions and Relevance<\/jats:title><jats:p>This systematic review  identified motivations, facilitators, and barriers of donation-based interventions for HIV\/STI services that could enhance implementation. Donation-based interventions may foster prosocial motivation and responsibility among socially marginalized populations to increase access to HIV\/STI services.<\/jats:p><\/jats:sec>","DOI":"10.1001\/jamanetworkopen.2025.37382","type":"journal-article","created":{"date-parts":[[2025,10,14]],"date-time":"2025-10-14T15:00:23Z","timestamp":1760454023000},"page":"e2537382","source":"Crossref","is-referenced-by-count":2,"title":["Motivations, Facilitators, and Barriers of Donation-Based Interventions in HIV and Sexually Transmitted Infection Research"],"prefix":"10.1001","volume":"8","author":[{"given":"Dorian","family":"Ho","sequence":"first","affiliation":[{"name":"Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ye","family":"Liu","sequence":"additional","affiliation":[{"name":"University of North Carolina Project-China, Guangzhou, China"},{"name":"Dermatology Hospital of South Medical University, Guangzhou, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jamie","family":"Conklin","sequence":"additional","affiliation":[{"name":"Health Sciences Library, University of North Carolina at Chapel Hill, Chapel Hill"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas","family":"Fitzpatrick","sequence":"additional","affiliation":[{"name":"School of Medicine, University of Washington, Seattle"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jiayu","family":"Wang","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases, Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Suzanne","family":"Day","sequence":"additional","affiliation":[{"name":"Department of Medicine, Division of Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Takhona G.","family":"Hlatshwako","sequence":"additional","affiliation":[{"name":"Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rohit","family":"Ramaswamy","sequence":"additional","affiliation":[{"name":"James M. 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