Preferences for HIV testing services among men who have sex with men in China: a discrete choice experiment

BACKGROUND: HIV testing coverage among men who have sex with men (MSM) in China remains sub-optimal, hindered by stigma, economic burden and low self-perceived HIV risk. To overcome these barriers and enhance testing uptake, it is critical to investigate testing preferences among this population and evaluate how different HIV testing characteristics affect their choice of testing options. METHODS: From March 1 to October 30, 2025, a discrete choice experiment was performed to quantify MSM's preferences across two provinces (Shandong and Guangdong) representing relatively low and high HIV prevalence in northern and southern China, respectively. Respondents were presented with hypothetical testing profiles, varying in service mode, testing accuracy, mortality reduction, testing interval, cost and time to receive test results. Mixed logit models were applied to estimate individual preferences, relative importance, willingness-to-pay (WTP) and predicted testing uptake. RESULTS: Among 553 eligible respondents, 308 (55.7%) were from Shandong, with a mean (SD) age of 33.5 (10.7) years. Overall participants were mainly concerned about cost, with testing frequency, notification time and mortality reduction also playing a crucial role in motivating testing uptake, surpassing the importance of testing accuracy and mode. The highest WTP was observed for increasing the testing frequency from annual to semiannual ($28.0). The estimated testing uptake rose to over 90% if testing cost was substantially reduced. Notably, our findings illustrated complex preference dynamics and highlighted the significance of tailoring strategies. Compared with frequent testers, respondents with low-frequency testing experience showed significantly weaker preferences for health benefits and stronger preferences for higher testing accuracy. However, frequent testers ranked accuracy as the least important attribute and exhibited significantly stronger preferences for free services relative to those with limited testing experience. CONCLUSIONS: Among MSM, the availability of semiannual testing programs led by community-based organization with greater health benefits and shorter waiting time for precise results have the potential to increase HIV testing rates, if provided for free. Our findings enrich the current understanding of testing decision-making and inform differentiated strategies. Furthermore, these results help prioritize health system innovations when resource constraints preclude the use of all strategies.