Integrated syphilis/HIV screening in China: a qualitative analysis

Area of Science:

• Public health
• Infectious disease epidemiology
• Health systems research

Background:

• Significant advancements in HIV treatment contrast with challenges in implementing scaled-up HIV testing, prevention, and treatment in low-income settings.
• South China is experiencing expanding epidemics of syphilis and sexually transmitted HIV, necessitating an understanding of health system characteristics for effective scaling up of testing services.

Purpose of the Study:

• To define health system characteristics crucial for scaling up syphilis and HIV testing in South China.
• To assess the capacity of public and private STI clinics in South China for integrated syphilis and HIV testing.

Main Methods:

• A purposive sampling strategy was employed to include public, private, and hybrid STI clinics in a South China city.
• Data were collected through key informant interviews with clinic managers and focus group discussions with physicians, covering clinical facilities, laboratory capacity, personnel, physical space, and financial support.

Main Results:

• Public STI clinics demonstrated capacity for free syphilis testing/treatment and essential syphilis/HIV diagnostics.
• Private STI clinics, despite high patient volume, lacked crucial testing capabilities (nontreponemal syphilis testing, HIV testing) and had limited public health infrastructure connections.
• Assistant physicians were more prevalent than physicians, and only one clinic offered onsite voluntary counseling and testing (VCT) services.

Conclusions:

• Public STI clinics in China present a viable platform for expanding integrated syphilis and HIV services.
• Additional health services research is imperative to guide the scale-up of syphilis and HIV testing initiatives in China.