Assessing three-decade HIV testing transformation: TOPSIS-radar evaluation of tiered health system performance in...

China's expanded HIV testing program (since 2015) necessitates longitudinal evaluation of healthcare institution (HCI) performance, which provides critical evidence to enhance the precision and effectiveness of focused testing interventions, to optimize service delivery.

We analyzed HIV surveillance data from 202 HCIs in Nanning, China (1989-2020), characterizing: 1) HCI infrastructure distribution, 2) newly reported HIV/AIDS cases and testing volumes, and 3) test positivity rates. Spatiotemporal trends were geo-visualized (ArcGIS 10.7). TOPSIS synthesized case reports and test positivity rates (2010-2020) into composite indices, with radar mapping identifying regional disparities.

Reporting shifted from CDC-dominated systems (99.9%, 1989-2004) to hospital-led models (75.6%, 2015-2020). While annual testing volume and case reports increased significantly, test positivity rates declined. Distinct hospital-level stratification emerged: County/township HCIs served primarily local residents (96.2%) and older patients (≥ 50 years; 65.7%). Municipal/provincial HCIs reported higher non-local residents (48.6%) and younger patients (15-49 years; 53.4%). Geospatial diffusion showed progression from urban to rural areas. Regions with integrated AIDS treatment centers and robust primary care networks demonstrated enhanced case-finding performance.

Tiered hospitals and primary care centers may provide complementary case-finding functions. Geographically stratified interventions, which leveraged primary networks for localized epidemics and referral hospitals for mobile populations, represent evidence-based strategies for regions with suboptimal performance.