Facility-Level Associations Between Use of a Digital Health Platform for Voluntary Counseling and Testing and HIV Testing Outcomes in the Urban Primary Health Care Centers of Guangzhou, China: Cross-Sectional Study

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 use by primary health care centers (PHCs) and the facility-level associations between WellTest use and HIV testing outcomes remain unclear. OBJECTIVE: This study aimed to assess the use of WellTest at the facility level across PHCs in urban Guangzhou, China, and to explore the associations between WellTest use 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 the PHCs' characteristics. Multilevel negative binomial regression and zero-inflated gamma models were used to examine associations between WellTest use and 2 HIV testing outcomes at the facility level. RESULTS: A total of 81 PHCs across 5 urban districts in Guangzhou were included. WellTest was used for 7997 active consultations and 7969 HIV tests that resulted in 157 newly diagnosed HIV cases, for an overall positivity rate of 2.0%, during 2022. The median share of clients booking via WellTest was 71% (IQR 34%-98%), and 81% (66/81) of PHCs offered online slots on all service days without mandates. PHCs that actively confirmed appointments had significantly lower HIV testing volumes compared with those that took no actions after clients scheduled appointments (incidence rate ratio 0.75, 95% CI 0.58-0.97; P=.03) but exhibited higher HIV positivity rates (β=.39, 95% CI 0.02-0.76; 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 0.82-1.40; P<.001). CONCLUSIONS: WellTest showed substantial use among VCT clients and providers in urban Guangzhou PHCs, with greater use of digital appointments and counselor follow-up linked to increased HIV positivity rates. Strategies to optimize institutional adoption may help address stigma-related barriers, strengthen engagement in HIV testing, and support HIV case finding in primary health care settings.