Older Men's Preferences for HIV Testing in Primary Care Setting: Evidence from a Best-Worst Scaling Study in China

Human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) among adults aged 50 and older presents an emerging challenge in China, hindered by reasons like insufficient health checks and low self-perceived HIV risk. To overcome these barriers and assist decision-makers in prioritizing interventions, it is critical to investigate HIV testing preferences in this population and identify which service characteristics are the preferred aspects, especially within the primary care setting.

From July 1 to October 30, 2025, a face-to-face, case 1 best-worst scaling (BWS) survey was performed to quantify older men's preferences for HIV testing across five cities in eastern, central and western Guizhou. Guided by the Consolidated Framework for Implementation Research, attributes were selected through prior literature review and qualitative study. We calculated the BWS scores, estimated the relative importance of each attribute and used the coefficients derived from the mixed logit models to calculate share of preference (SP) to interpret final results. Regression analyses were used to explore the heterogeneity of HIV testing preferences across the sample.

A total of seven core attributes were identified in this BWS design. Among 338 respondents (mean age 61.2 ± 7.8 years), 71.3% resided in rural areas. The overall responses demonstrated 'comprehensive care' (SP 22.2%) and 'confidentiality' (SP 18.1%) were the most highly prioritized, followed by 'anxiety alleviation' (SP 14.6%), 'consultation context' (SP 13.5%) and 'clear explanation' (SP 13.1%). The least prioritized attributes were 'incentive' (SP 10.2%) and 'appointment' (SP 8.3%) for HIV testing services. Notably, significant heterogeneity in preferences was observed across subgroups, with demographic and socioeconomic characteristics identified as key sources of variation. Among the sample population, additional testing incentives were perceived as a more important attribute for older participants and those who had never tested before.

Supplementing conventional clinic-based testing with comprehensive service delivery is a promising approach to potentially increase HIV testing uptake among men aged 50 and older in China. People also strongly prioritized the confidentiality of HIV test results in the primary care setting. Our findings provided implications for service providers and policymakers to develop client-centered, differentiated HIV testing strategies in China.