Date Published: July 20, 2017
Publisher: Public Library of Science
Author(s): Wen Chen, Fangjing Zhou, Brian J. Hall, Joseph D. Tucker, Carl Latkin, Andre M. N. Renzaho, Li Ling, Dena L. Schanzer.
Achieving high coverage of HIV testing services is critical in many health systems, especially where HIV testing services remain centralized and inconvenient for many. As a result, planning the optimal spatial distribution of HIV testing sites is increasingly important. We aimed to assess the relationship between geographic distance and uptake of HIV testing services among the general population in Guangzhou, China. Utilizing spatial epidemiological methods and stratified household random sampling, we studied 666 adults aged 18–59. Computer-assisted interviews assessed self-reported HIV testing history. Spatial scan statistic assessed the clustering of participants who have ever been tested for HIV, and two-level logistic regression models assessed the association between uptake of HIV testing and the mean driving distance from the participant’s residence to all HIV testing sites in the research sites. The percentage of participants who have ever been tested for HIV was 25.2% (168/666, 95%CI: 21.9%, 28.5%), and the majority (82.7%) of participants tested for HIV in Centres for Disease Control and Prevention, public hospitals or STIs clinics. None reported using self-testing. Spatial clustering analyses found a hotspot included 48 participants who have ever been tested for HIV and 25.8 expected cases (Rate Ratio = 1.86, P = 0.002). Adjusted two-level logistic regression found an inverse relationship between geographic distance (kilometers) and ever being tested for HIV (aOR = 0.90, 95%CI: 0.84, 0.96). Married or cohabiting participants (aOR = 2.14, 95%CI: 1.09, 4.20) and those with greater social support (aOR = 1.04, 95%CI: 1.01, 1.07) were more likely to be tested for HIV. Our findings underscore the importance of considering the geographical distribution of HIV testing sites to increase testing. In addition, expanding HIV testing coverage by introducing non-facility based HIV testing services and self-testing might be useful to achieve the goal that 90% of people living with HIV knowing their HIV status by the year 2020.
Globally, the general population and at-risk populations comprised approximately 64% and 36% of the 1.9 million new adult HIV infections in 2014 respectively . In many countries, a high prevalence of risky sexual behaviours among the general population has been reported. For example, in the United States, China, and South Africa, the prevalence of multiple sexual partnerships has been estimated at around 15% [2–4]. In India, the prevalence of inconsistent condom use with non-regular sex partners in the last 12 months was estimated at 58% . In addition, emerging evidence suggests that increased global immigration in recent years may have facilitated the spread of the human immunodeficiency virus (HIV) infection [6–8]. As a critical linkage pathway to HIV care and antiretroviral treatment, HIV testing services (HTS) have been recognized as highly cost effective in reducing transmission among at-risk populations [9,10] and the general population . Increasing HTS access decreases morbidity and mortality among people living with HIV [12,13].
Out of the 1215 attempted surveys, 14 were partial completions, 368 were refusals, and 82 were non-responses, resulting in 751 full completions and a response rate was 62%, which is favourable for household surveys conducted in Mainland China . The sample used in this paper included only participants reporting their HIV testing history. There were 85 participants who did not to answer questions related to HIV testing, resulting in 666 persons were included; 666 surveys included 323 (48.5%) at 18 subdistricts in Yuexiu district and 343 (51.5%) at 21 subdistricts in Tianhe district, respectively.
HIV testing is essential to achieve the goal that 90% of people living with HIV knowing their HIV status  and our data show the percentage of participants who have ever been tested for HIV was 25.2% (95%CI: 21.9%, 28.5%), female participants reported a higher percentage (29.1%, 95%CI: 24.3%, 34.0%) than males (21.2%, 95%CI: 16.7%, 25.6%). The HIV testing rates were lower than self-reported figures found in other studies of the general population conducted in the United States (the overall percentage of ever being tested was 45%, and 50% of females and 40% of males) , Italy (32.8% of women, and 27.0% of men) , Kenya (34%) , and Botswana (48%) . Different HIV testing policies in other countries, such as expanding HIV testing into community and nonclinical settings [46,47], and high HIV prevalence in African countries  may contribute to the difference.
Using population-representative survey data of adults in Guangzhou, China, we found that greater geographic distance was associated with lower likelihood of HTS utilization in the general population. In addition, couples and partners may play an important role in facilitating utilization of HTS. The results inform future HIV testing services planning and delivery in China and elsewhere with similar HIV epidemiological context and testing policies to increase access to and coverage of HTS and reach the first goal of the UNAIDS 90-90-90 target.