Association between expanded HIV testing and late diagnosis in older adults living with HIV: Evidence from Southwest China

OBJECTIVES: We examined the characteristics and time trends of late diagnosis among people living with HIV (PLWH) aged ≥50 years in southwest China from 2010 to 2023, and assessed the impact of the expanded HIV testing strategy and associated factors. METHODS: We retrospectively analyzed cross-sectional data from 26,233 newly diagnosed older PLWH in southwest China between 2010 and 2023, from the Chinese Comprehensive Response Information Management System for HIV/AIDS (CRIMS). A multilevel logistic regression model was used to identify factors associated with late diagnosis, with latent class analysis as a sensitivity analysis to test the robustness of the results. RESULTS: The late diagnosis rate declined from 2010 to 2023 (p for trend <0.05). Compared with the pre-strategy period (2010-2017), the post-strategy period (2018-2023) was associated with lower odds of late diagnosis (adjusted odds ratio [aOR] = 0.900, 95% CI: 0.854-0.950). Across all age groups (50-59, 60-74, and ≥75 years), primary education or below was associated with lower odds of late diagnosis (aOR range: 0.804-0.892). Late diagnosis rates were higher than the overall average for HIV testing approaches (i.e., the specific route or setting through which HIV was diagnosed) including testing of other patients (i.e., provider-initiated testing in general medical settings), testing at sexually transmitted infection clinics, and pre-testing of receiving blood/products. CONCLUSIONS: Targeted health education should focus on high-risk subgroups including males and married individuals, and community-based testing should be promoted. The higher odds with facility-based testing underscore the need to integrate routine HIV testing into healthcare services.