title: A twin response to twin epidemics: integrated HIV/syphilis testing at STI clinics in South China.
abstract: BACKGROUND
  HIV testing is still stigmatized among many high-risk groups in China, whereas routine syphilis testing has been widely accepted at sexually transmitted infection (STI) clinics. This project used the platform of a rapid syphilis screening test to expand HIV test uptake. The objective of this study was to use multilevel modeling to analyze determinants of syphilis and HIV-testing uptake at STI clinics in China.
  
  
  METHODS
  2061 STI patients at 6 clinics in Guangdong Province were offered free rapid syphilis and free rapid HIV testing. Test uptake was defined by patient receipt of results and a multilevel model was used to analyze predictors of uptake.
  
  
  RESULTS
  This was the first syphilis or HIV test for the large majority (1388, 77.7%) of participants. Syphilis test uptake and HIV test uptake were high (1681, 81.6%, syphilis test uptake; 1673, 81.2% HIV test uptake). HIV test uptake was significantly concordant with syphilis test uptake (τb = 0.89, P < 0.001). The most parsimonious model of refusing HIV test uptake included the following variables: being married, having a previous HIV test, being unaccompanied, and participating in the last 2 months of the study.
  
  
  CONCLUSIONS
  STI clinic-based screening for syphilis and HIV represents an excellent opportunity for scaling up integrated services, especially in South China where syphilis and sexually transmitted HIV cases are both rapidly increasing. Effective integration of HIV testing into routine clinical practice requires an understanding not only of individual test uptake but also of the broader social context of HIV testing.
authors.affiliation: STD Control Department, Guangdong Provincial Center for Skin Diseases and STD Control, Guangzhou, China. jtucker4@partners.org
authors.forename: Joseph D
authors.initials: JD
authors.lastname: Tucker
authors.forename: Li-Gang
authors.initials: LG
authors.lastname: Yang
authors.forename: Bin
authors.initials: B
authors.lastname: Yang
authors.forename: He-Ping
authors.initials: HP
authors.lastname: Zheng
authors.forename: Helena
authors.initials: H
authors.lastname: Chang
authors.forename: Cheng
authors.initials: C
authors.lastname: Wang
authors.forename: Song-Ying
authors.initials: SY
authors.lastname: Shen
authors.forename: Zheng-Jun
authors.initials: ZJ
authors.lastname: Zhu
authors.forename: Yue-Pin
authors.initials: YP
authors.lastname: Yin
authors.forename: S V
authors.initials: SV
authors.lastname: Subramanian
authors.forename: Xiang-Sheng
authors.initials: XS
authors.lastname: Chen
authors.forename: Myron S
authors.initials: MS
authors.lastname: Cohen
mesh_terms: D000328:Adult; D002681:China / Q000453:epidemiology; D058872:Epidemics; D005260:Female; D015658:HIV Infections / Q000175:diagnosis* / Q000453:epidemiology* / Q000523:psychology; D006801:Humans; D008297:Male; D010349:Patient Compliance / Q000523:psychology; D013587:Syphilis / Q000175:diagnosis* / Q000453:epidemiology* / Q000523:psychology