JMIR Publications

ABSTRACT

Background:

WellTest, a digital health platform designed to facilitate HIV voluntary counseling and testing (VCT) services, has been widely implemented in Guangzhou, China. However, the extent of its utilization by primary healthcare centers (PHCs) and the facility-level associations between WellTest utilization and HIV testing outcomes remain unclear.

Objective:

To assess the utilization of WellTest at the facility level across PHCs in urban Guangzhou, China and to explore the associations between WellTest utilization and HIV testing outcomes.

Methods:

We obtained data on VCT services visits from the National HIV/AIDS Prevention and Control Information System and the WellTest platform between January 1 and December 31, 2022. Two facility-level HIV testing outcomes— the HIV testing volume and HIV positivity rate were calculated for each PHC. A structured questionnaire collected data on PHCs’ characteristics. Multilevel negative binomial regression and zero-inflated gamma models were used to examine associations between WellTest utilization and two HIV testing outcomes at facility level.

Results:

A total of 81 PHCs across five urban districts in Guangzhou were included, with the utilization of the digital platform WellTest, providing 7,997 consultations and conducting 7,969 HIV tests, resulting in 157 newly diagnosed HIV cases and an overall positivity rate of 2.0% during 2022. The median share of clients booking via WellTest was 71%(IQR 34%-98%), and 81.5% of PHCs offered online slots on all service days without mandates. PHCs that actively confirmed appointments had significantly lower HIV testing volumes compared to those that took no actions after clients scheduled appointments (IRR=0.75, 95% CI 0.58 to 0.97; P=.03), but exhibited higher HIV positivity rates (β=0.39, 95%CI 0.02 to 0.76; P=.04). Additionally, PHCs where ≥50% of clients used WellTest to schedule appointments showed higher HIV positivity rates than those with lower uptake (β=1.11, 95%CI 0.82 to 1.40; P<.001).

Conclusions:

WellTest was widely adopted by VCT clients and providers in urban Guangzhou PHCs, with greater use of digital appointment and counselor follow-up linked to increased HIV positivity rates. Strategies to optimize institutional adoption, such as expanding appointment availability and strengthening counselor support during appointment confirmations, could mitigate stigma-related barriers, strengthen engagement in HIV testing, and improve HIV case finding in primary healthcare setting.