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Background <p>Public health centers (PHCs) in South Korea provide free anonymous and named HIV testing and serve as an essential component of the national testing infrastructure, particularly for populations underserved by conventional healthcare settings. Identifying temporal shifts in testing behavior and positivity is vital for targeted prevention and diagnostic strategies.</p> Methods <p>We analyzed HIV testing data from 260 PHCs nationwide between 2011 and 2023. Temporal trends in the number of tests, testing purposes, and HIV seroprevalence were assessed. Multivariable logistic regression analysis was used to identify independent predictors of HIV positivity, and temporal changes were evaluated using the Mann–Kendall trend test.</p> Results <p>Over the 13-year study period, approximately 4.7&#xa0;million HIV screening tests were completed at PHCs. Annual testing volume sharply declined during the COVID-19 pandemic, reaching 104,621 tests in 2021 (about 24% of the pre-COVID annual average of 443,609), but rebounded to 255,051 tests by 2023. In that year, the overall HIV seroprevalence at PHCs was 0.17%, with elevated positivity among foreign nationals (0.68%), men (0.43%), individuals in their 20s (0.25%), and those undergoing voluntary anonymous (1.15%) or named (0.71%) testing. Multivariable logistic regression revealed that male sex (adjusted odds ratio [aOR] = 9.48, 95% CI: 6.52–13.80), foreign nationality (aOR = 6.22, 95% CI: 4.27–9.07), voluntary testing (aOR = 7.67, 95% CI: 5.67–10.40), and residence in metropolitan areas (aOR = 2.50, 95% CI: 1.93–3.24) were significant independent predictors of HIV positivity (<i>p</i> &lt; 0.001 for all). Trend analysis demonstrated significant increases in testing among individuals aged 30–39 years (Kendall’s tau = 0.821, <i>p</i> &lt; 0.001) and in antenatal care screening (Kendall’s tau = 0.897, <i>p</i> &lt; 0.001), reflecting expanded maternal health services and changing demographic patterns in test uptake.</p> Conclusions <p>Throughout the study period, PHCs performed fewer than 5% of national HIV tests but consistently contributed a disproportionately large share of new diagnoses—28.3% in 2023—particularly among vulnerable groups such as men, foreign nationals, young adults, urban residents, and individuals undergoing voluntary anonymous testing. Strengthening PHC-based services and expanding outreach tailored to these populations will be essential for enhancing early diagnosis and achieving national HIV prevention goals.</p>

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Trends in HIV testing and Seroprevalence among key populations at public health centers in South Korea, 2011–2023: a nationwide analysis

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年11月27日

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  • Jin-Sook Wang,
  • Eun Ji Kim,
  • Gayeong Kim,
  • Seolhui Kim,
  • Heui Man Kim,
  • Na Rae Jo,
  • Tae-Young Heo,
  • Myung-Guk Han

摘要

Background

Public health centers (PHCs) in South Korea provide free anonymous and named HIV testing and serve as an essential component of the national testing infrastructure, particularly for populations underserved by conventional healthcare settings. Identifying temporal shifts in testing behavior and positivity is vital for targeted prevention and diagnostic strategies.

Methods

We analyzed HIV testing data from 260 PHCs nationwide between 2011 and 2023. Temporal trends in the number of tests, testing purposes, and HIV seroprevalence were assessed. Multivariable logistic regression analysis was used to identify independent predictors of HIV positivity, and temporal changes were evaluated using the Mann–Kendall trend test.

Results

Over the 13-year study period, approximately 4.7 million HIV screening tests were completed at PHCs. Annual testing volume sharply declined during the COVID-19 pandemic, reaching 104,621 tests in 2021 (about 24% of the pre-COVID annual average of 443,609), but rebounded to 255,051 tests by 2023. In that year, the overall HIV seroprevalence at PHCs was 0.17%, with elevated positivity among foreign nationals (0.68%), men (0.43%), individuals in their 20s (0.25%), and those undergoing voluntary anonymous (1.15%) or named (0.71%) testing. Multivariable logistic regression revealed that male sex (adjusted odds ratio [aOR] = 9.48, 95% CI: 6.52–13.80), foreign nationality (aOR = 6.22, 95% CI: 4.27–9.07), voluntary testing (aOR = 7.67, 95% CI: 5.67–10.40), and residence in metropolitan areas (aOR = 2.50, 95% CI: 1.93–3.24) were significant independent predictors of HIV positivity (p < 0.001 for all). Trend analysis demonstrated significant increases in testing among individuals aged 30–39 years (Kendall’s tau = 0.821, p < 0.001) and in antenatal care screening (Kendall’s tau = 0.897, p < 0.001), reflecting expanded maternal health services and changing demographic patterns in test uptake.

Conclusions

Throughout the study period, PHCs performed fewer than 5% of national HIV tests but consistently contributed a disproportionately large share of new diagnoses—28.3% in 2023—particularly among vulnerable groups such as men, foreign nationals, young adults, urban residents, and individuals undergoing voluntary anonymous testing. Strengthening PHC-based services and expanding outreach tailored to these populations will be essential for enhancing early diagnosis and achieving national HIV prevention goals.