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

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Identifying temporal shifts in testing behavior and positivity is vital to inform 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 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 declined by nearly 75% during the COVID-19 pandemic but rebounded to 255,051 tests by 2023. Although fewer than 5% of national HIV tests were performed in PHCs, they identified 28.3% of newly diagnosed HIV infections in 2023. In that year, the overall HIV seroprevalence at PHCs was 0.165%, with elevated positivity among foreign nationals (0.677%), men (0.430%), individuals in their 20s (0.251%), and those undergoing anonymous (1.148%) or named (0.711%) client-initiated testing. Multivariable logistic regression revealed that male sex (adjusted odds ratio [aOR] = 9.48), foreign nationality (aOR = 6.22), voluntary testing (aOR = 7.67), and residence in metropolitan areas (aOR = 2.50) 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 Despite accounting for a small proportion of national HIV testing, PHCs consistently contributed a disproportionately large proportion of new diagnoses—especially among high-risk groups, such as men, foreign nationals, young adults, urban residents, and individuals, who actively seek confidential 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. HIV testing Seroprevalence Key populations Voluntary testing HIV surveillance Figures Figure 1 Figure 2 Background Human immunodeficiency virus (HIV) infection and acquired immunodeficiency syndrome (AIDS) remain major global health concerns despite decades of prevention and treatment efforts. In 2021, an estimated 1.65 million new HIV infections occurred worldwide, with disproportionately high incidence and mortality reported in regions with a low Sociodemographic Index, particularly in Sub-Saharan Africa [ 1 ]. Although global projections indicate a gradual decline in incidence and mortality by 2030, the persistence of substantial regional disparities underscores the ongoing challenge of reducing the global burden of HIV/AIDS. Early diagnosis is essential, as delayed detection is associated with higher morbidity and mortality and facilitates continued transmission within communities. Prompt antiretroviral therapy initiation halts disease progression and, by achieving viral suppression, renders transmission virtually impossible (“U = U”) [ 2 – 4 ]. In line with the UNAIDS 95-95-95 targets, many high-income countries have achieved high diagnostic coverage, with over 85% of people living with HIV (PLHIV) aware of their HIV status [ 5 ]. In the Republic of Korea, access to HIV testing has expanded over the past decade, and diagnostic timeliness has improved. Modelling studies have suggested that the median time from infection to diagnosis has shortened from approximately 7 years for individuals infected in 2009–2015 to about 5.4 years in 2020–2022 [ 6 , 7 ]. However, not all PLHIV are diagnosed in a timely manner, which limits the effectiveness of treatment programs and hampers efforts to reduce transmission. This ongoing diagnostic gap may be attributed to a historical focus on provider-initiated and mandatory screening, along with a relatively low uptake of voluntary testing services [ 8 – 10 ]. Strengthening client-initiated testing and expanding access to low-threshold services remain important priorities for improving early diagnosis. Although the overall prevalence of HIV in Korea remains low (approximately 0.04%), the country reports a stable annual incidence of around 1,000 new cases. The epidemic is largely driven by sexual transmission and disproportionately affects men, who account for over 90% of new diagnoses [ 11 ]. In recent years, the epidemiological landscape has shifted, with an increasing proportion of new diagnoses occurring among foreign nationals (rising from 9.2% in 2014 to 25.5% in 2023) and younger age groups, particularly individuals aged under 40 years [ 12 ]. These trends highlight the need for responsive and inclusive testing strategies that reflect the evolving characteristics of affected populations. Public health centers (PHCs) have played a central role in the Korean national HIV testing strategy since the introduction of free and anonymous testing in 1989, which was later institutionalized through the Prevention of Acquired Immunodeficiency Syndrome Act in 2008 [ 13 , 14 ]. PHCs provide targeted screening for high-risk populations—including individuals with sexually transmitted infections (STIs), sex workers, men who have sex with men (MSM), partners of PLHIV, and those seeking anonymous testing—while also offering low-threshold, walk-in services to underserved and low-income groups [ 10 , 13 , 15 ]. Although PHCs perform only 3–5% of the 8–10 million annual HIV screening tests performed nationally (approximately 400,000 tests) [ 16 , 17 ], they consistently diagnose 20–25% of new infections, with 28.3% of PHC-based newly diagnosed HIV infections in 2023 [ 12 ]. This four- to five-fold diagnostic yield underscores their strategic value for case-finding among high-risk and self-referred populations. PHC effectiveness is further enhanced by the Public Health Information System (PHIS), which records testing purpose, age, sex, nationality, and test results. Analyses of PHIS data show that men tested at PHCs are six times more likely to test positive than women, and foreign nationals have a 3.8-fold higher seroprevalence than Korean nationals; positivity is highest among persons tested after suspected exposure and lowest during routine screening [ 15 ]. Innovations in PHC practice demonstrate the impact of low-threshold services. In a 2014 pilot program in Seoul, four PHCs introduced point-of-care rapid HIV tests for anonymous screening; the mean monthly test volume increased nine-fold and confirmed positives quadrupled. Ninety-six percent of participants cited the 20-min turnaround time as the primary advantage, and 2.6% valued the avoidance of venous blood sampling [ 18 ]. Rapid testing has since been adopted by most PHCs nationwide, facilitating earlier case detection in hidden subpopulations and advancing progress toward the UNAIDS 95-95-95 targets. Although PHCs constitute a fundamental component of Korea’s national HIV response infrastructure, rigorous longitudinal evaluations of their screening performance remain limited. Prior research has predominantly focused on selected subpopulations or restricted temporal scopes, resulting in an incomplete understanding of epidemiological trends and testing efficacy within PHC-based programs. To address these limitations, the present study conducted a 13-year analysis (2011–2023) of national HIV screening data from PHCs, examining temporal dynamics, testing indications, and demographic distributions. By delineating testing contexts and subgroups with elevated diagnostic yield, the findings provide an evidence base to optimize HIV screening strategies, promote earlier case detection, and support efforts to curtail HIV transmission in Korea. Methods HIV testing system in Korea In Korea, HIV testing is organized as a two-stage system comprising an initial screening phase and a subsequent confirmatory phase. When a reactive result is obtained during the screening stage, the specimen is referred to a confirmatory testing facility for final diagnosis. Screening is conducted in a variety of settings, including hospitals, clinics, commercial laboratories, PHCs, blood donation centers, and military conscription examination sites. Confirmatory testing is performed by the Korea Disease Control and Prevention Agency (KDCA) and 17 regional Institutes of Health and Environment [ 19 ]. Since April 2025, medical institutions with board-certified laboratory medicine specialists have also been authorized to perform confirmatory testing. Confirmatory testing is performed on specimens that yield reactive results in screening tests (e.g., enzyme-linked immunosorbent assay and rapid tests) using HIV RNA testing and antibody-based western blot assays. When referring specimens from screening to confirmatory institutions, personal identifiers are not used; instead, a unique serial code (“HIV confirmatory specimen identification code”) is assigned to each specimen. Confirmatory test results are entered into the centralized “Test Result Input System,” which is operated and managed by the KDCA. Among these, data for specimens confirmed as HIV-positive are automatically transferred and stored in the HIV/AIDS Supporting Network System (HASNet), which is managed by the Division of HIV/AIDS Prevention and Control of the KDCA. The HASNet maintains individual-level information on confirmed HIV cases, including the confirmatory specimen identification code and test results recorded at the time of diagnosis. Data collection All PHCs in Korea record and manage clinical services and laboratory test results, including HIV testing, through an electronic information system called the PHIS. Each year, the 260 PHCs extract HIV test data from the PHIS for the previous year and submit the data to the KDCA in January of the following year. The submitted HIV test data include HIV test results linked to specimen identification codes; however, personal identifying information of tested individuals is not included. For specimens that were reactive in screening tests at PHCs, data submission also included the confirmatory specimen identification code, confirmatory test results, and the HASNet management code. The HIV confirmatory specimen identification code used at PHCs follows the format of “year-region code-PHC name + month-center specimen number,” which allows identification and removal of potential duplicate tests performed at the same institution. The HIV test data provided by PHCs include the following variables: institution name, specimen code (including confirmatory specimen code for reactive cases), HIV test result (including confirmatory result for reactive cases), sex, age, nationality (domestic or foreign), date of testing, and HIV testing purpose. HIV testing purposes were classified into nine categories: voluntary anonymous testing, voluntary named testing, antenatal testing, medical consultation visitors, health checkups, foreign resident screening, routine STI screening, correctional facility administration screening, and contact tracing of HIV-positive individuals. HIV testing indicators To evaluate HIV testing patterns and outcomes, several key indicators were calculated: HIV testing proportion, HIV positivity, HIV-positive proportion, and HIV seroprevalence. - HIV testing proportion was defined as the proportion of HIV tests performed in each testing category (e.g., voluntary testing, routine screening, or other specified categories) relative to the total number of HIV tests conducted during the study period. The formula was: HIV testing proportion (%) = (Number of tests in the category / Total number of HIV tests) × 100. - HIV positivity (positivity rate) was defined as the proportion of HIV-positive cases among individuals tested within each specific category, reflecting the diagnostic yield in that category. The formula was: HIV positivity (%) = (Number of HIV-positive cases in the category / Number of tests in the category) × 100. - HIV-positive proportion was defined as the proportion of HIV-positive cases identified in each testing category relative to the total number of HIV-positive cases detected across all categories. The formula was: HIV-positive proportion (%) = (Number of HIV-positive cases in the category / Total number of HIV-positive cases) × 100. - HIV seroprevalence was defined as the proportion of HIV-positive cases among all individuals tested at PHCs during the given year. HIV seroprevalence was analyzed by sex, age group, and nationality (domestic vs. foreign). All indicators were calculated on an annual basis and stratified by testing category to assess the temporal trends in testing utilization and the distribution of HIV-positive cases. Operational definitions of HIV testing purposes HIV testing purposes were categorized based on the primary reason or setting for testing, as follows: - Voluntary anonymous testing : HIV testing conducted anonymously, where personal identifiers are not collected and a temporary identifier chosen by the examinee is used. - Voluntary named testing : HIV testing voluntarily sought by individuals who provide personal identifying information. This category includes client-initiated testing, self-requested testing, self-check testing, and testing among MSM. - Health checkups : HIV testing performed as part of general health examinations, occupational health screenings, or pre-employment medical evaluations. - Medical consultation visitors : HIV testing provided to individuals attending PHCs for medical consultations other than antenatal care. - Antenatal testing : HIV testing conducted for pregnant women and newlywed couples as part of prenatal care services. - Correctional facility administration screening : Mandatory HIV testing for individuals entering correctional facilities, conducted in accordance with national legal regulations. - Contact tracing of HIV-positive individuals : HIV testing performed for family members and sexual partners of persons already diagnosed with HIV infection. - Routine STI screening : HIV testing required by law (Regulation on Health Examinations for STIs and AIDS) for individuals employed in occupations subject to periodic health examinations, such as adult entertainment venues, massage parlors, bars, and similar establishments. - Foreign resident screening : HIV testing provided to refugees, individuals undergoing visa application or extension procedures, and foreign nationals utilizing HIV testing services supported by local governments. Statistical analysis Prior to analysis, data cleaning procedures were performed, including verification of missing values and correction of errors. For the analysis of HIV seroprevalence (positivity), only cases that were both reactive on screening tests and confirmed positive on confirmatory tests were included. To ensure that duplicate positive cases were not counted, HIV-positive test results reported by PHCs were cross-referenced with confirmatory specimen identification codes obtained from the HASNet, maintained by the Division of HIV/AIDS Prevention and Control. This matching process involved comparing specimen codes reported by PHCs with confirmatory specimen codes registered in the HASNet for confirmed HIV cases. Temporal trends in the number of HIV tests performed, seroprevalence, and testing patterns were analyzed across the 13-year period. More detailed analyses were conducted for the 2023 data. Variables included in the analyses were sex, age group, region, nationality (domestic or foreign), and HIV testing purpose. All statistical analyses were conducted using R software (version 4.4.0; R Core Team, R Foundation for Statistical Computing, Vienna, Austria) and SPSS (version 28.0). Differences between groups were assessed using the chi-square test, with a significance level of 5%. When significant overall differences were detected, Bonferroni-corrected post-hoc tests were applied to adjust for multiple comparisons, with a significance level of 5% used throughout. Associations between explanatory variables and HIV positivity were evaluated using logistic regression analysis to estimate odds ratios (ORs) with 95% confidence intervals (CIs). Temporal trends over the 13-year study period were analyzed using the Mann–Kendall trend test, with Kendall’s tau and p -values calculated at a 5% significance level. Results HIV testing trends at PHCs (2011–2023) An annual average of 443,609 HIV screening tests were conducted at PHCs nationwide between 2011 and 2019. The Kendall’s tau value was 0.556, with a p -value of 0.047, indicating a statistically significant monotonic increasing trend in the number of tests performed. In addition, the Pettitt test was conducted to assess potential change points in the time series data. The test suggested that 2019 represented a possible change point, as the distribution of test volumes after 2019 differed from that of prior years ( p = 0.0748). During the COVID-19 pandemic (2020–2022), the number of HIV tests conducted at PHCs declined sharply. Annual testing volumes for 2020, 2021, and 2022 were 178,653, 104,621, and 141,992 tests, respectively—representing reductions of 59.7%, 76.4%, and 69.3% compared to the pre-pandemic annual average from 2011 to 2019. Following the stabilization of the COVID-19 pandemic, HIV testing activity began to recover. In 2023, 255,051 HIV tests were conducted, reflecting a 79.9% increase from 2022. Following the policy change in May 2023, when the national infectious disease crisis alert level was lowered from “Orange (Alert)” to “Yellow (Attention),” HIV testing volumes began to increase more noticeably. In particular, metropolitan regions—where testing volumes had markedly declined during the pandemic—showed partial recovery, with year-over-year increases of approximately 25% compared to the 2022 testing volumes. Sociodemographic characteristics of individuals tested for HIV at PHCs in 2023 Among the individuals tested in 2023, 69.3% were women and 30.7% were men. Foreign nationals accounted for 4.3% of all individuals tested. The majority of tests (83.2%) were conducted among individuals in their 20s to 40s. Regarding testing purposes, antenatal screening accounted for the largest proportion of tests (35.8%), followed by general health checkups (24.9%), routine STI screening (17.9%), voluntary anonymous testing (7.4%), correctional facility screening (3.8%), foreign resident screening (3.6%), and voluntary named testing (3.5%). Age-stratified analysis showed that individuals in their 20s accounted for the highest proportion of voluntary anonymous testing (39.0%) ( p general health checkups (69.6%) > voluntary named testing (46.9%) ≈ foreign resident screening (44.9%). These findings suggest that antenatal care was the primary driver of HIV testing among women in their 30s. For routine STI screening, the proportions of individuals in their 40s (28.1%), 50s (28.5%), and 60s (16.7%) were higher than for other testing purposes ( p < 0.001) (Fig. 1 a). A sex-specific analysis showed that men comprised the majority of individuals who underwent voluntary anonymous testing (82.7%), correctional facility screening (82.1%), and voluntary named testing (60.5%), whereas women predominated in antenatal screening (92.9%), routine STI screening (84.1%), and foreign resident screening (67.8%) ( p < 0.001) (Fig. 1 b). HIV positivity was significantly higher in metropolitan areas than in small city and rural regions, highlighting regional disparities in HIV burden ( p < 0.001). HIV seroprevalence by nationality and testing purpose at PHCs in 2023 In 2023, the overall HIV seroprevalence among individuals tested at PHCs was 0.165%, indicating an increase compared to the 5-year average from 2018 to 2022 (0.129%). When disaggregated by sex, men had a significantly higher seroprevalence (0.430%, 95% CI: 0.386–0.480) than women (0.026%, 95% CI: 0.020–0.035) ( p < 0.001). By nationality, the seroprevalence among foreign nationals was 0.676%, which was 4.8 times greater than that observed in Korean nationals (0.142%) ( p < 0.001). Among men, the seroprevalence rate in foreign nationals was 1.237% (95% CI: 0.926–1.646), compared to 0.386% (95% CI: 0.343–0.435) in Korean nationals—a 3.2-fold difference. Among women, the gap was more pronounced, with a seroprevalence of 0.367% (95% CI: 0.245–0.545) in foreign nationals versus 0.012% (95% CI: 0.007–0.019) in Korean nationals, representing a 30.6-fold higher rate ( p < 0.001). Age-specific analysis revealed the highest seroprevalence in individuals in their 20s (0.251%). Within this group, foreign nationals had a prevalence of 0.526%, which was more than twice the rate in Korean nationals (0.224%) ( p < 0.001). Notable variations in testing purpose were also observed. Voluntary anonymous testing yielded the highest seroprevalence (1.148%), followed by voluntary named testing (0.711%)—approximately 7.0 and 4.3 times higher than the overall average (0.165%), respectively. Among voluntary anonymous testers, foreign nationals had a prevalence of 7.650%, compared to 1.084% among Korean nationals, indicating a 7.1-fold disparity ( p < 0.001). Similarly, in voluntary named testing, seroprevalence among foreign nationals (3.182%) was 6.2 times higher than that among Korean nationals (0.516%) ( p < 0.001) (Table 1 ). Table 1 HIV seroprevalence by nationality and testing purpose among attendees of public health centers, 2023 Study variables Total HIV Results HIV Seroprevalence Number (%) Negative Positive (n, %) HPR * (95% CI) † 255051 254630 421 ** 0.165% (0.150–0.183) Korean nationals 243959 (95.7) 243613 346 (82.2) § 0.142% (0.128–0.157) Foreign nationals 11092 (4.3) 11017 75 (17.8) 0.676% (0.533–0.854) Overall Missing values 193 (0.1%), Korean nationals 105, Foreign nationals 88 Valid 254858 (99.9%), Korean nationals 243854, Foreign nationals 11004 χ2 = 1671.575; df ‡ = 9; p < 0.001 All 254858 (100) 254439 419 (100) 0.164 (0.149–0.181) Medical consultation visitors 7771 (3.0) 7737 34 (8.1) 0.438 (0.308–0.618) Antenatal testing 91347 (35.8) 91344 3 (0.7) 0.003 (0.001–0.010) Health checkups 63386 (24.9) 63336 50 (11.9) 0.079 (0.059–0.105) Voluntary named testing 8998 (3.5) 8934 64 (15.3) 0.711 (0.553–0.913) Voluntary anonymous testing 18732 (7.4) 18517 215 (51.3) 1.148 (1.002–1.313) Foreign resident screening 9239 (3.6) 9202 37 (8.8) 0.400 (0.286–0.558) Correctional facility admission screening 9727 (3.8) 9720 7 (1.7) 0.072 (0.032–0.155) Contact tracing of known HIV-positive individuals 6 (0.0) 5 1 (0.2) 16.667 (0.876–63.518) Routine STI screening 45577 (17.9) 45569 8 (1.9) 0.018 (0.008–0.036) Others 75 (0.0) 75 0 (0.0) - Korean nationals Subtotal 243854 (100) 243510 344 (100) § 0.141 (0.127–0.157) Medical consultation visitors 7634 (3.1) 7601 33 (9.6) 0.432 (0.303–0.614) Antenatal testing 91347 (37.5) 91344 3 (0.9) 0.003 (0.001–0.010) Health checkups 63227 (25.9) 63177 50 (14.5) 0.079 (0.059–0.105) Voluntary named testing 8338 (3.4) 8295 43 (12.5) 0.516 (0.378–0.701) Voluntary anonymous testing 18549 (7.6) 18348 201 (58.4) 1.084 (0.942–1.246) Foreign resident screening 2 (0.0) 2 - - Correctional facility admission screening 9560 (3.9) 9553 7 (2.0) 0.073 (0.032–0.158) Contact tracing of known HIV-positive individuals 6 (0.0) 5 1 (0.3) 16.667 (0.876–63.518) Routine STI screening 45120 (18.5) 45114 6 (1.7) 0.013 (0.005–0.031) Others 71 (0.0) 71 - - Foreign nationals Subtotal 11004 (100) 10929 75 (100) 0.682 (0.540–0.858) Medical consultation visitors 137 (1.2) 136 1 (1.3) 0.730 (0.038–4.604) Antenatal testing - - - - Health checkups 159 (1.4) 159 0 (0.0) - Voluntary named testing 660 (6.0) 639 21 (28.0) 3.182 (2.030–4.905) Voluntary anonymous testing 183 (1.7) 169 14 (18.7) 7.650 (4.404–12.757) Foreign resident screening 9237 (83.9) 9200 37 (49.3) 0.401 (0.286–0.558) Correctional facility admission screening 167 (1.5) 167 0 (0.0) - Contact tracing of known HIV-positive individuals - - - - Routine STI screening 457 (4.2) 455 2 (2.7) 0.438 (0.076–1.749) Others 4 (0.0) 4 0 (0.0) - * HPR: HIV positivity rate; † CI: confidence interval; ‡ df: degrees of freedom; HIV: human immunodeficiency virus; PHC: public health center; STI: sexually transmitted infection § Among 346 HIV-positive cases in Korean nationals, 2 were excluded owing to missing HIV testing purpose, leaving 344 cases for analysis. ** According to the national HIV surveillance data in Korea, a total of 1,005 individuals were newly diagnosed with HIV in 2023 [ 10 ]. The reporting institutions included hospitals and clinics (n = 637), PHC (n = 284), and other facilities (n = 84). In the present study, 421 individuals tested positive at PHCs; however, this number likely included 137 cases of duplicate testing, as the official number of cases reported by PHCs was 284, resulting in an estimated duplication rate of 1.48 (284/421). The majority of these duplicate cases were presumed to be among individuals undergoing voluntary anonymous testing. Multivariable logistic regression of factors associated with HIV positivity among individuals tested at PHCs in 2023 To identify the factors independently associated with HIV positivity, a multivariable logistic regression analysis was conducted using 2023 HIV screening data from PHCs. Records with incomplete sociodemographic information were excluded from the analysis. Therefore, 240,552 test records (94.3% of 255,051 tests) and 268 HIV-positive cases (63.7% of 421 confirmed cases) were included in the final analysis. The age distribution of individuals tested was as follows: those in their 30s accounted for the highest proportion (57.3%), followed by individuals in their 40s (13.9%), 20s (12.0%), 50s (7.7%), 60s and older (6.6%), and < 20s (2.5%). Adjusted ORs (aORs) and 95% CIs were calculated for each covariate. Men had significantly higher odds of testing HIV-positive than women (aOR: 9.48; 95% CI: 6.52–13.80; p < 0.001). Similarly, foreign nationals had increased odds of HIV positivity compared to Korean nationals (aOR: 6.22; 95% CI: 4.27–9.07; p < 0.001). Moreover, individuals residing in metropolitan areas had significantly higher odds of testing HIV-positive than those residing in small- to mid-sized cities (aOR: 2.50; 95% CI: 1.93–3.24; p < 0.001). The purpose of HIV testing also showed a significant association with HIV positivity. Individuals who underwent voluntary testing (including both anonymous and named testing) had markedly higher odds of being HIV-positive than those tested under routine or mandatory screening programs driven by institutional or public health requirements (aOR: 7.67; 95% CI: 5.76–10.04; p < 0.001) (Table 2 ). Table 2 HIV positivity-associated factors among PHC attendees tested in 2023 based on univariable and multivariable analyses Study variables Category Total HIV Results cOR aOR Number (%) Negative Positive (%) cOR (95% CI) p aOR (95% CI) * p Overall 240552 (100) 240284 268 (100) Sex < 0.001 Male 67827 (28.2) 67593 234 (87.3) 17.58 (12.27,25.20) < 0.001 9.48 (6.52,13.80) < 0.001 Female 172725 (71.8) 172691 34 (12.7) 1 1 Age (years) 0.009 < 20 5906 (2.5) 5903 3 (1.1) 0.80 (0.22,2.91) 0.736 0.43 (0.12,1.61) 0.212 20s (20–29) 28983 (12.0) 28910 73 (27.2) 3.98 (2.05,7.71) < 0.001 1.65 (0.84,3.22) 0.143 30s (30–39) 137912 (57.3) 137799 113 (42.2) 1.29 (0.68,2.47) 0.437 1.28 (0.66,2.46) 0.466 40s (40–49) 33401 (13.9) 33352 49 (18.3) 2.32 (1.17,4.57) 0.016 1.91 (0.96,3.81) 0.064 50s (50–59) 18577 (7.7) 18557 20 (7.5) 1.70 (0.79,3.63) 0.171 1.92 (0.89,4.12) 0.094 ≥ 60 15773 (6.6) 15763 10 (3.7) 1 1 Nationality < 0.001 Korean nationals 229855 (95.6) 229649 206 (76.9) 1 1 < 0.001 Foreign nationals 10697 (4.4) 10635 62 (23.1) 6.50 (4.89,8.64) < 0.001 6.22 (4.27,9.07) < 0.001 Region (Residency) < 0.001 Metropolitan 96724 (40.2) 96564 160 (59.7) 2.20 (1.73,2.81) < 0.001 2.50 (1.93, 3.24) < 0.001 Small city/rural area 143828 (59.8) 143720 108 (40.3) 1 1 HIV testing groups by purpose < 0.001 Public health service-based testing † 162242 (67.4) 162159 83 (31.0) 1 1 Voluntary testing ‡ 13981 (5.8) 13848 133 (49.6) 18.76 (14.26,24.7) < 0.001 7.67 (5.67,10.4) < 0.001 Provider-initiated testing § 18782 (7.8) 18738 44 (16.4) 4.59 (3.18,6.61) < 0.001 1.17 (0.73,1.89) 0.518 Routine STI screening ǁ 45547 (18.9) 45539 8 (3.0) 0.34 (0.17,0.71) 0.004 0.56 (0.26,1.17) 0.122 * CI: Confidence interval; aOR: adjusted odds ratio; cOR: crude odds ratio; HIV: human immunodeficiency virus; PHC: public health center; STI: sexually transmitted infection. † Public health service-based testing: Antenatal testing, health checkups, and medical consultation visitors ‡ Voluntary testing: Voluntary named testing and voluntary anonymous testing § Provider-initiated testing: Foreign resident screening, correctional facility admission screening, and contact tracing of known HIV-positive individuals ǁ Routine STI screening: Individuals in occupations wherein it is legally required to undergo periodic HIV testing (1–2 times per year) Thirteen-year trends in HIV testing demographics, testing purposes, and positivity rates at PHCs in Korea (2011–2023) HIV screening data from PHCs in Korea were analyzed to evaluate demographic trends and testing purposes over the 13-year period between 2011 and 2023. Over this period, individuals in their 30s consistently accounted for the highest proportion of HIV tests (mean: 42.4%), followed by those in their 20s (21.5%) and 40s (13.9%), with individuals aged 20–40 years comprising 77.8% of all test recipients. The Mann–Kendall trend test revealed a significant decreasing trend in testing among individuals aged ≤ 19 years (Kendall’s tau = − 0.615, p = 0.0041) and those in their 20s (Kendall’s tau = − 0.718, p = 0.0079), whereas testing among individuals in their 30s showed a significant increasing trend (Kendall’s tau = 0.821, p < 0.001), likely attributable to the rising number of antenatal screenings. No consistent trend was observed among individuals aged ≥ 40 years (Fig. 2 a). Throughout the study period, women consistently accounted for a greater proportion of tests than men, maintaining a stable ratio of approximately 7:3 (women 70.8%, men 29.2%), with no significant monotonic trend observed in the annual sex distribution ( p = 0.428). Regarding testing purpose, antenatal screening accounted for the largest proportion of tests (mean: 27.6%), followed by general health checkups (25.9%), routine STI screening (21.0%), voluntary named testing (9.0%), voluntary anonymous testing (6.0%), correctional facility screenings (5.4%), and medical consultations (5.1%). Antenatal screening demonstrated a significant upward trend (Kendall’s tau = 0.897, p < 0.001), reflecting the expansion of public health services for women of reproductive age. In 2023, 73,061 women in their 30s underwent antenatal testing (28.6% of all HIV tests that year). Conversely, testing related to medical consultations, correctional facilities, voluntary named testing, and contact tracing of HIV-positive individuals exhibited significant declines over time (all Kendall’s tau < − 0.5). No significant trend was observed for voluntary anonymous testing, health checkups, or routine STI screening (Fig. 2 b). During the most recent 5-year period (2019–2023), voluntary HIV testing—including both anonymous and named tests—accounted for an average of only 12.26% of all tests conducted at PHCs but contributed disproportionately to the total number of confirmed HIV-positive cases, comprising 76.58% overall (56.62% from anonymous testing and 19.96% from named testing) (Fig. 2 c). Since 2019, the HIV positivity rate among individuals undergoing voluntary anonymous testing has consistently increased, underscoring the importance of this subgroup in ongoing HIV surveillance and prevention strategies. Discussion This nationwide study analyzed HIV testing trends and seroprevalence among persons accessing HIV testing services at 260 PHCs in Korea over a 13-year period (2011–2023), with detailed analysis for the year 2023. The findings underscore the ongoing public health value of community-based testing strategies, especially those offering free services to vulnerable groups, including foreign nationals and individuals undergoing routine screenings for STIs. By providing both anonymous and named testing options, the PHC-based testing system plays a vital role in facilitating access to HIV screening for individuals who may otherwise remain undiagnosed [ 3 , 10 , 13 ]. Trend analysis revealed a substantial decrease in testing volume during the COVID-19 pandemic (2020–2022), particularly in metropolitan regions, such as Seoul and Gyeonggi Province, where diagnostic services were temporarily suspended or scaled down. This decline was especially pronounced among younger individuals and those undergoing voluntary testing, contributing to a temporary drop in reported HIV cases [ 12 ]. However, following the easing of pandemic-related restrictions, testing volume rebounded significantly in 2023—rising by approximately 80% compared to 2022—demonstrating the resilience of the public health infrastructure in Korea. Antenatal testing accounted for the largest proportion of all HIV tests throughout the study period and displayed a steady increase, reflecting the expanding role of PHCs in maternal health services for women of reproductive age. Because antenatal HIV screening is now integrated into routine care, sustained support for these programs is essential for early diagnosis and the prevention of vertical transmission [ 10 , 20 ]. By contrast, testing among individuals aged < 30 years has declined, a worrisome trend given rising HIV notifications in younger populations worldwide and in Korea. Younger adults remain a priority for HIV prevention owing to evolving risk behaviors and lower health-seeking tendencies, which can delay diagnosis [ 5 , 21 ]. Therefore, youth-focused outreach—leveraging digital platforms and stigma-free voluntary testing—warrants urgent expansion. Evidence from other settings supports broader routine testing. In the United States, local public health sexually transmitted disease clinics that offered HIV testing as a standard option reported substantial gains in case detection [ 22 ]. Similarly, a population-based cohort study in Taiwan showed that routinely offered, opt-out HIV testing—compared with risk-based, non-routine testing—was associated with markedly lower odds of late diagnosis (aOR, 0.20) and HIV-related mortality (aOR, 0.63) [ 23 ]. These findings have prompted calls to explore opt-out HIV testing in Korean healthcare settings to improve early detection and reduce preventable mortality. In 2023, HIV seroprevalence was higher among men, individuals in their 20s, and foreign nationals. These findings are consistent with previous study findings indicating that certain demographic groups face elevated HIV risks. Foreign nationals, in particular, showed a 4.8-fold higher seropositivity rate than Korean nationals. Structural and systemic factors, such as limited healthcare access and sociocultural or legal barriers, may contribute to delayed testing and greater vulnerability among migrants. Expanding culturally appropriate and linguistically accessible testing options for this population is essential. Multivariable logistic regression analysis identified male sex, foreign nationality, residence in metropolitan areas, and voluntary testing as independent predictors of HIV positivity. These findings align with previous research and underscore the importance of targeted interventions for high-risk groups, including migrants, MSM, individuals under the age of 40 years, residents of metropolitan areas, and those actively seeking testing outside routine medical settings [ 10 , 13 , 15 ]. Collectively, the findings emphasize the importance of sustaining and expanding PHC-based HIV testing services accessible to key populations. Public health authorities should continue to support both routine and voluntary testing programs and enhance outreach to under-tested or marginalized groups. Strengthening the role of PHCs—particularly in reaching vulnerable populations—will be critical for achieving the UNAIDS 95-95-95 goals and reducing late HIV diagnosis in Korea. Certain limitations should be taken into account when interpreting the findings of this study. First, although efforts were made to exclude duplicate tests using specimen identification codes, repeated tests performed anonymously may not have been fully identified. This limitation may have resulted in an overestimation of the number of confirmed HIV cases attributed to anonymous testing. Second, records with incomplete sociodemographic information were excluded from the multivariable analysis, resulting in the inclusion of 240,552 out of 255,051 tests (94.3%) and 268 out of 421 confirmed HIV-positive cases (63.7%). A total of 279 voluntary tests were conducted in 2023, but only 133 cases were included in the regression analysis owing to missing epidemiological data in anonymous test records. This underrepresentation may have led to an underestimation of the HIV risk associated with voluntary testing. Individuals in their 20s and 30s accounted for 39.0% and 33.7% of those who underwent voluntary anonymous testing, respectively, and comprised nearly 70% of HIV-positive cases within this group. Their disproportionate exclusion may have resulted in underestimated aORs for these age group. Finally, while HIV testing trends were analyzed over a 13-year period, detailed stratified analyses by demographic variables were limited to data from 2023. These limitations underscore the need to improve the completeness and accuracy of surveillance data, particularly for key subgroups, such as individuals who opted for anonymous testing. Conclusions This study highlights the pivotal role of PHCs in the Korean national HIV prevention strategy, particularly in delivering accessible and equitable testing services to vulnerable and high-risk populations. The findings emphasize the continued necessity of sustaining both voluntary and routine HIV testing programs, while also addressing gaps in data completeness to support robust surveillance and monitoring. Targeted public health interventions aimed at expanding outreach to key populations—such as foreign nationals, men, individuals in their 20s, and those undergoing voluntary testing—will be critical for enhancing early HIV detection and curbing further transmission. These insights provide critical evidence to inform national HIV management policies, optimize resource allocation, and strengthen the overall testing infrastructure to ensure timely diagnosis and linkage to care. Abbreviations PHCs Public health centers aOR adjusted odds ratio HIV human immunodeficiency virus AIDS acquired immunodeficiency syndrome PLHIV people living with HIV STIs sexually transmitted infections MSM men who have sex with men PHIS public health information system KDCA Korea Disease Control and Prevention Agency HASNet HIV/AIDS Supporting Network System OR odds ratio CI confidence interval IRB Institutional Review Board Declarations Ethics approval and consent to participate: This study was conducted in accordance with the ethical principles of the Declaration of Helsinki and its later amendments. Ethical approval was obtained from the Institutional Review Board (IRB) of the KDCA (Approval No. KDCA-2025-02-05-PE-01). The HIV testing data analyzed in this study were obtained from PHCs in an anonymized format using specimen codes, without any personally identifiable information. Consequently, the IRB waived the requirement for written informed consent. Consent for publication: Not applicable Competing interests: The authors declare that they have no competing interests Funding: This research was supported by the Korea Disease Control and Prevention Agency (grant No. 6331-301-210) Author Contribution Authors’ contributions: J.-S.W. and M.-G.H. designed and conceived the study, and M.-G.H. supervised all aspects of its implementation. J.-S.W. wrote the first draft of the manuscript and created the visualizations. E.J.K. and G.K. collected data from public health centers. N.R.J. and T.-Y.H. analyzed the data. S.K. and H.M.K. coordinated funding for the project. All authors have read and approved the final version of the manuscript. Acknowledgement We would like to express our sincere gratitude to the Division of HIV/AIDS Prevention and Control of the KDCA for managing the HIV/AIDS Supporting Network System (HASNet). Data Availability The datasets generated or analysed during the current study are available from the corresponding author upon reasonable request. References Lu Y, Li H, Dong R, Zhang M, Dong X, Yang C, Wang X, Ye J. BMC Public Health. 2025;25(1):1928. https://doi.org/10.1186/s12889-025-23121-4 . Global and regional disease burden of HIV/AIDS from 1990 to 2021 and projections to 2030. World Health Organization, HIV. and AIDS. 2024. https://www.who.int/news-room/fact-sheets/detail/hiv-aids . Accessed 25 Jun 2025. Vermeersch S, Demeester RP, Ausselet N, Callens S, Munter PD, Florence E, et al. A public health value-based healthcare paradigm for HIV. BMC Health Serv Res. 2022;22:13. 10.1186/s12913-021-07371-7 . Rodger AJ, Cambiano V, Bruun T, Vernazza P, Collins S, Degen O, et al. Risk of HIV transmission through condomless sex in serodifferent gay couples with the HIV-positive partner taking suppressive antiretroviral therapy (PARTNER): final results of a multicentre, prospective, observational study. Lancet. 2019;393:2428–38. 10.1016/S0140-6736(19)30418-0 . Joint United Nations Programme on HIV/AIDS (UNAIDS). Global HIV & AIDS statistics-fact sheet. 2024. UNAIDS https://www.unaids.org/en/resources/fact-sheet . Accessed 15 Jul 2025. Lee E, Kim J, Lee JY, Bang JH. Estimation of the number of HIV infections and time to diagnosis in the Korea. J Korean Med Sci. 2020;35:e41. 10.3346/jkms.2020.35.e41 . Lee M, Park WB, Kim ES, Kim Y, Park SW, Lee E, et al. Possibility of decreasing incidence of human immunodeficiency virus infection in Korea. Infect Chemother. 2023;55:451–9. 10.3947/ic.2023.0056 . Choe PG, Park WB, Song JS, Kim NH, Park JY, Song KH, et al. Late presentation of HIV disease and its associated factors among newly diagnosed patients before and after abolition of a government policy of mass mandatory screening. J Infect. 2011;63:60–5. 10.1016/j.jinf.2011.05.002 . Lee JH, Kim GJ, Choi BS, Hong KJ, Heo MK, Kim SS, et al. Increasing late diagnosis in HIV infection in South Korea: 2000–2007. BMC Public Health. 2010;10:411. 10.1186/1471-2458-10-411 . Kee MK, Lee JH, Whang J, Kim SS. Ten-year trends in HIV prevalence among visitors to public health centers under the National HIV Surveillance System in Korea, 2000 to 2009. BMC Public Health. 2012:12:831. 10.1186/1471-2458-12-831 Wang JS, Kim EJ, Kim G, Kim S, Kim HM, Lee YJ, et al. Recent HIV infections and associated risk factors among newly diagnosed individuals in South Korea (2016–2023). Sci Rep. 2025;15:26229. https://doi.org/10.1038/s41598-025-10444-w . Kim K, Kim S, Kim T, Yu J. HIV/AIDS notifications in Korea, 2023. Public Health Wkly Rep. 2024;17:1737–49. https://doi.org/10.56786/PHWR.2024.17.41.3 . Kee MK, Yoo M, Seong J, Choi JY, Han MG, Lee JS, et al. Influence of anonymous HIV testing on national HIV surveillance in the Republic of Korea (2000 to 2015): a retrospective analysis. BMC Public Health. 2019;19:1563. 10.1186/s12889-019-7866-y . Kee MK, Lee JH, Kim EJ, Lee J, Nam JK, Yoo BH, et al. Improvement in survival among HIV-infected individuals in the Republic of Korea: Need for an early HIV diagnosis. BMC Infect Dis. 2009;9:128. 10.1186/1471-2334-9-128 . Kee MK, Lee JH, Chu C, Lee EJ, Kim SS. Characteristics of HIV seroprevalence of visitors to public health centers under the national HIV surveillance system in Korea: cross sectional study. BMC Public Health. 2009:9:123. 10.1186/1471-2458-9-123 Lee JH, Hong KJ, Wang JS, Kim SS, Kee MK. Estimation of hospital-based HIV seroprevalence as a nationwide scale by novel method; 2002–2008 in Korea. BMC Public Health 2010 Nov 30:10739. 10.1186/1471-2458-10-739 Kim Y, Park E, Jung Y, Kim K, Kim T, Kim HS. Impact of COVID-19 on human immunodeficiency virus tests, new diagnoses, and healthcare visits in the Republic of Korea: a retrospective study from 2016 to 2021. Osong Public Health Res Perspect. 2024;15(4):340–52. https://doi.org/10.24171/j.phrp.2024.0123 . Kang CR, Bang JH, Cho SI, Kim KN, Lee H, Lee YH, et al. Implementing the use of rapid HIV tests in public health centers in Seoul: Results of a pilot project, 2014. J Korean Med Sci. 2016;31:467–9. 10.3346/jkms.2016.31.3.467 . Wang JS, Sim HJ, Park SJ, Park GR, Kang C, Chung YS. Effect of a confirmatory testing algorithm on early acute HIV diagnosis in Korea. Med (Baltim). 2021;100:e25632. 10.1097/MD.0000000000025632 . Cardenas MC, Farnan S, Hamel BL, Plazas MCM, Sintim-Aboagye E, Littlefield DR, et al. Prevention of the vertical transmission of HIV: a recap of the journey so far. Viruses. 2023;15:849. 10.3390/v15040849 . Yoo M, Seong J, Yoon JG, Cha JO, Chung YS, Kim K, et al. Characteristics of adolescents and young adults with HIV in the Republic of Korea from 2010 through 2015. Sci Rep. 2020;10:9384. 10.1038/s41598-020-66113-5 . Campos-Outcalt D, Mickey T, Weisbuch J, Jones R. Integrating routine HIV testing into a public health STD clinic. Public Health Rep. 2006;121:175–80. 10.1177/003335490612100212 . Chen YH, Fang CT, Shih MC, Lin KY, Chang SS, Wu ZT, et al. Routine HIV testing and outcomes: a population-based cohort study in Taiwan. Am J Prev Med. 2022;62:234–42. 10.1016/j.amepre.2021.07.010 . Additional Declarations No competing interests reported. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7426511","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":512213628,"identity":"55540f22-8c06-4d8e-a049-fdceb2bfda53","order_by":0,"name":"Jin-Sook Wang","email":"","orcid":"","institution":"Korea Disease Control and Prevention Agency","correspondingAuthor":false,"prefix":"","firstName":"Jin-Sook","middleName":"","lastName":"Wang","suffix":""},{"id":512213629,"identity":"0dc62b01-1c93-4b0b-80ab-f2ffa0600ebc","order_by":1,"name":"Eun Ji Kim","email":"","orcid":"","institution":"Korea Disease Control and Prevention Agency","correspondingAuthor":false,"prefix":"","firstName":"Eun","middleName":"Ji","lastName":"Kim","suffix":""},{"id":512213630,"identity":"57072750-5d7c-4a34-853c-92582a99f07d","order_by":2,"name":"Gayeong Kim","email":"","orcid":"","institution":"Korea Disease Control and Prevention Agency","correspondingAuthor":false,"prefix":"","firstName":"Gayeong","middleName":"","lastName":"Kim","suffix":""},{"id":512213631,"identity":"3af9947e-2c69-43da-a3b0-9ec0757fd27e","order_by":3,"name":"Seolhui Kim","email":"","orcid":"","institution":"Korea Disease Control and Prevention Agency","correspondingAuthor":false,"prefix":"","firstName":"Seolhui","middleName":"","lastName":"Kim","suffix":""},{"id":512213632,"identity":"aa352f99-a45f-4b66-b104-f9bdb1894f1e","order_by":4,"name":"Heui Man Kim","email":"","orcid":"","institution":"Korea Disease Control and Prevention Agency","correspondingAuthor":false,"prefix":"","firstName":"Heui","middleName":"Man","lastName":"Kim","suffix":""},{"id":512213633,"identity":"ae0e0676-e434-49f4-8849-a9de3019fbd4","order_by":5,"name":"Na Rae Jo","email":"","orcid":"","institution":"Chungbuk National University","correspondingAuthor":false,"prefix":"","firstName":"Na","middleName":"Rae","lastName":"Jo","suffix":""},{"id":512213634,"identity":"3fbd73b0-a915-409e-a952-f42d5bc7696e","order_by":6,"name":"Tae-Young Heo","email":"","orcid":"","institution":"Chungbuk National University","correspondingAuthor":false,"prefix":"","firstName":"Tae-Young","middleName":"","lastName":"Heo","suffix":""},{"id":512213635,"identity":"0fd3a1ad-636b-4d09-9b4f-11b40ae8b9ef","order_by":7,"name":"Myung-Guk Han","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAqUlEQVRIiWNgGAWjYFACHiCuSAAzGRuI13KGZC2MbaRo0e1fe/Bz4bw0OfP25geMM/cQocXsxrtk6ZnbcoxlzhwzYNzwjCgtZwykebdVJM6QSDBgfHCAOC3Gv3nnALXIP/9ApJbzPWbSvA05QFt4gA4jzhYeM2ueY2nGEjw5BQdnEGfLGePbPDXJchLsxzc+7CFGC4NEAoJNlAYGBn4i1Y2CUTAKRsEIBgDCFjlNPUqIWQAAAABJRU5ErkJggg==","orcid":"","institution":"Korea Disease Control and Prevention Agency","correspondingAuthor":true,"prefix":"","firstName":"Myung-Guk","middleName":"","lastName":"Han","suffix":""}],"badges":[],"createdAt":"2025-08-21 13:08:16","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-7426511/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7426511/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s12889-025-25641-5","type":"published","date":"2025-11-27T15:58:48+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":91022234,"identity":"fb1450c2-534e-4fc4-825e-dcc935d42990","added_by":"auto","created_at":"2025-09-10 18:57:56","extension":"jpeg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":308416,"visible":true,"origin":"","legend":"\u003cp\u003eDistribution of HIV testing purposes among individuals tested at public health centers in Korea, 2023.\u003c/p\u003e\n\u003cp\u003e(a) HIV testing purposes by age group\u003c/p\u003e\n\u003cp\u003e(b) HIV testing purposes by sex\u003c/p\u003e\n\u003cp\u003eHIV: human immunodeficiency virus; STI, sexually transmitted infection\u003c/p\u003e","description":"","filename":"floatimage1.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-7426511/v1/f8f62bbc1452ff5a0c76c8cc.jpeg"},{"id":91022235,"identity":"d142f136-ad65-4206-b89e-60acf776b681","added_by":"auto","created_at":"2025-09-10 18:57:56","extension":"jpeg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":463626,"visible":true,"origin":"","legend":"\u003cp\u003eHIV testing trends at PHCs in Korea, 2011–2023: age, testing purposes, and HIV positivity.\u003c/p\u003e\n\u003cp\u003e(a) Age group distribution\u003c/p\u003e\n\u003cp\u003e(b) HIV testing purposes\u003c/p\u003e\n\u003cp\u003e(c) HIV testing and HIV positivity (2019–2023)\u003c/p\u003e\n\u003cp\u003eHIV testing proportion indicates the percentage of tests conducted in each testing category (e.g., voluntary testing, routine STI screening) relative to the total number of HIV tests.\u003c/p\u003e\n\u003cp\u003eHIV-positive proportion represents the percentage of HIV-positive cases identified in each category out of all confirmed HIV-positive cases.\u003c/p\u003e\n\u003cp\u003eHIV: human immunodeficiency virus; PHC: public health center; STI: sexually transmitted infection\u003c/p\u003e","description":"","filename":"floatimage2.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-7426511/v1/9d6b44c4d91ab786f076e3b1.jpeg"},{"id":97179576,"identity":"e58b7db2-ebe7-492c-970f-198b493ed8b2","added_by":"auto","created_at":"2025-12-01 16:16:15","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":2233192,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7426511/v1/48ace2d8-c408-4538-9409-47778888cda8.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Trends in HIV testing and seroprevalence among key populations at public health centers in South Korea, 2011–2023: A nationwide analysis","fulltext":[{"header":"Background","content":"\u003cp\u003eHuman immunodeficiency virus (HIV) infection and acquired immunodeficiency syndrome (AIDS) remain major global health concerns despite decades of prevention and treatment efforts. In 2021, an estimated 1.65\u0026nbsp;million new HIV infections occurred worldwide, with disproportionately high incidence and mortality reported in regions with a low Sociodemographic Index, particularly in Sub-Saharan Africa [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Although global projections indicate a gradual decline in incidence and mortality by 2030, the persistence of substantial regional disparities underscores the ongoing challenge of reducing the global burden of HIV/AIDS.\u003c/p\u003e\u003cp\u003eEarly diagnosis is essential, as delayed detection is associated with higher morbidity and mortality and facilitates continued transmission within communities. Prompt antiretroviral therapy initiation halts disease progression and, by achieving viral suppression, renders transmission virtually impossible (\u0026ldquo;U\u0026thinsp;=\u0026thinsp;U\u0026rdquo;) [\u003cspan additionalcitationids=\"CR3\" citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. In line with the UNAIDS 95-95-95 targets, many high-income countries have achieved high diagnostic coverage, with over 85% of people living with HIV (PLHIV) aware of their HIV status [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eIn the Republic of Korea, access to HIV testing has expanded over the past decade, and diagnostic timeliness has improved. Modelling studies have suggested that the median time from infection to diagnosis has shortened from approximately 7 years for individuals infected in 2009\u0026ndash;2015 to about 5.4 years in 2020\u0026ndash;2022 [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. However, not all PLHIV are diagnosed in a timely manner, which limits the effectiveness of treatment programs and hampers efforts to reduce transmission. This ongoing diagnostic gap may be attributed to a historical focus on provider-initiated and mandatory screening, along with a relatively low uptake of voluntary testing services [\u003cspan additionalcitationids=\"CR9\" citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. Strengthening client-initiated testing and expanding access to low-threshold services remain important priorities for improving early diagnosis.\u003c/p\u003e\u003cp\u003eAlthough the overall prevalence of HIV in Korea remains low (approximately 0.04%), the country reports a stable annual incidence of around 1,000 new cases. The epidemic is largely driven by sexual transmission and disproportionately affects men, who account for over 90% of new diagnoses [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. In recent years, the epidemiological landscape has shifted, with an increasing proportion of new diagnoses occurring among foreign nationals (rising from 9.2% in 2014 to 25.5% in 2023) and younger age groups, particularly individuals aged under 40 years [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. These trends highlight the need for responsive and inclusive testing strategies that reflect the evolving characteristics of affected populations.\u003c/p\u003e\u003cp\u003ePublic health centers (PHCs) have played a central role in the Korean national HIV testing strategy since the introduction of free and anonymous testing in 1989, which was later institutionalized through the Prevention of Acquired Immunodeficiency Syndrome Act in 2008 [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. PHCs provide targeted screening for high-risk populations\u0026mdash;including individuals with sexually transmitted infections (STIs), sex workers, men who have sex with men (MSM), partners of PLHIV, and those seeking anonymous testing\u0026mdash;while also offering low-threshold, walk-in services to underserved and low-income groups [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eAlthough PHCs perform only 3\u0026ndash;5% of the 8\u0026ndash;10\u0026nbsp;million annual HIV screening tests performed nationally (approximately 400,000 tests) [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e], they consistently diagnose 20\u0026ndash;25% of new infections, with 28.3% of PHC-based newly diagnosed HIV infections in 2023 [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. This four- to five-fold diagnostic yield underscores their strategic value for case-finding among high-risk and self-referred populations.\u003c/p\u003e\u003cp\u003ePHC effectiveness is further enhanced by the Public Health Information System (PHIS), which records testing purpose, age, sex, nationality, and test results. Analyses of PHIS data show that men tested at PHCs are six times more likely to test positive than women, and foreign nationals have a 3.8-fold higher seroprevalence than Korean nationals; positivity is highest among persons tested after suspected exposure and lowest during routine screening [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eInnovations in PHC practice demonstrate the impact of low-threshold services. In a 2014 pilot program in Seoul, four PHCs introduced point-of-care rapid HIV tests for anonymous screening; the mean monthly test volume increased nine-fold and confirmed positives quadrupled. Ninety-six percent of participants cited the 20-min turnaround time as the primary advantage, and 2.6% valued the avoidance of venous blood sampling [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. Rapid testing has since been adopted by most PHCs nationwide, facilitating earlier case detection in hidden subpopulations and advancing progress toward the UNAIDS 95-95-95 targets.\u003c/p\u003e\u003cp\u003eAlthough PHCs constitute a fundamental component of Korea\u0026rsquo;s national HIV response infrastructure, rigorous longitudinal evaluations of their screening performance remain limited. Prior research has predominantly focused on selected subpopulations or restricted temporal scopes, resulting in an incomplete understanding of epidemiological trends and testing efficacy within PHC-based programs.\u003c/p\u003e\u003cp\u003eTo address these limitations, the present study conducted a 13-year analysis (2011\u0026ndash;2023) of national HIV screening data from PHCs, examining temporal dynamics, testing indications, and demographic distributions. By delineating testing contexts and subgroups with elevated diagnostic yield, the findings provide an evidence base to optimize HIV screening strategies, promote earlier case detection, and support efforts to curtail HIV transmission in Korea.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003eHIV testing system in Korea\u003c/h2\u003e\u003cp\u003eIn Korea, HIV testing is organized as a two-stage system comprising an initial screening phase and a subsequent confirmatory phase. When a reactive result is obtained during the screening stage, the specimen is referred to a confirmatory testing facility for final diagnosis. Screening is conducted in a variety of settings, including hospitals, clinics, commercial laboratories, PHCs, blood donation centers, and military conscription examination sites. Confirmatory testing is performed by the Korea Disease Control and Prevention Agency (KDCA) and 17 regional Institutes of Health and Environment [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. Since April 2025, medical institutions with board-certified laboratory medicine specialists have also been authorized to perform confirmatory testing.\u003c/p\u003e\u003cp\u003eConfirmatory testing is performed on specimens that yield reactive results in screening tests (e.g., enzyme-linked immunosorbent assay and rapid tests) using HIV RNA testing and antibody-based western blot assays. When referring specimens from screening to confirmatory institutions, personal identifiers are not used; instead, a unique serial code (\u0026ldquo;HIV confirmatory specimen identification code\u0026rdquo;) is assigned to each specimen. Confirmatory test results are entered into the centralized \u0026ldquo;Test Result Input System,\u0026rdquo; which is operated and managed by the KDCA. Among these, data for specimens confirmed as HIV-positive are automatically transferred and stored in the HIV/AIDS Supporting Network System (HASNet), which is managed by the Division of HIV/AIDS Prevention and Control of the KDCA. The HASNet maintains individual-level information on confirmed HIV cases, including the confirmatory specimen identification code and test results recorded at the time of diagnosis.\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eData collection\u003c/h3\u003e\n\u003cp\u003eAll PHCs in Korea record and manage clinical services and laboratory test results, including HIV testing, through an electronic information system called the PHIS. Each year, the 260 PHCs extract HIV test data from the PHIS for the previous year and submit the data to the KDCA in January of the following year.\u003c/p\u003e\u003cp\u003eThe submitted HIV test data include HIV test results linked to specimen identification codes; however, personal identifying information of tested individuals is not included. For specimens that were reactive in screening tests at PHCs, data submission also included the confirmatory specimen identification code, confirmatory test results, and the HASNet management code. The HIV confirmatory specimen identification code used at PHCs follows the format of \u0026ldquo;year-region code-PHC name\u0026thinsp;+\u0026thinsp;month-center specimen number,\u0026rdquo; which allows identification and removal of potential duplicate tests performed at the same institution.\u003c/p\u003e\u003cp\u003eThe HIV test data provided by PHCs include the following variables: institution name, specimen code (including confirmatory specimen code for reactive cases), HIV test result (including confirmatory result for reactive cases), sex, age, nationality (domestic or foreign), date of testing, and HIV testing purpose. HIV testing purposes were classified into nine categories: voluntary anonymous testing, voluntary named testing, antenatal testing, medical consultation visitors, health checkups, foreign resident screening, routine STI screening, correctional facility administration screening, and contact tracing of HIV-positive individuals.\u003c/p\u003e\n\u003ch3\u003eHIV testing indicators\u003c/h3\u003e\n\u003cp\u003eTo evaluate HIV testing patterns and outcomes, several key indicators were calculated: HIV testing proportion, HIV positivity, HIV-positive proportion, and HIV seroprevalence.\u003c/p\u003e\u003cp\u003e- \u003cb\u003eHIV testing proportion\u003c/b\u003e was defined as the proportion of HIV tests performed in each testing category (e.g., voluntary testing, routine screening, or other specified categories) relative to the total number of HIV tests conducted during the study period. The formula was:\u003c/p\u003e\u003cp\u003eHIV testing proportion (%) = (Number of tests in the category / Total number of HIV tests) \u0026times; 100.\u003c/p\u003e\u003cp\u003e- \u003cb\u003eHIV positivity (positivity rate)\u003c/b\u003e was defined as the proportion of HIV-positive cases among individuals tested within each specific category, reflecting the diagnostic yield in that category. The formula was:\u003c/p\u003e\u003cp\u003eHIV positivity (%) = (Number of HIV-positive cases in the category / Number of tests in the category) \u0026times; 100.\u003c/p\u003e\u003cp\u003e- \u003cb\u003eHIV-positive proportion\u003c/b\u003e was defined as the proportion of HIV-positive cases identified in each testing category relative to the total number of HIV-positive cases detected across all categories. The formula was:\u003c/p\u003e\u003cp\u003eHIV-positive proportion (%) = (Number of HIV-positive cases in the category / Total number of HIV-positive cases) \u0026times; 100.\u003c/p\u003e\u003cp\u003e- \u003cb\u003eHIV seroprevalence\u003c/b\u003e was defined as the proportion of HIV-positive cases among all individuals tested at PHCs during the given year. HIV seroprevalence was analyzed by sex, age group, and nationality (domestic vs. foreign). All indicators were calculated on an annual basis and stratified by testing category to assess the temporal trends in testing utilization and the distribution of HIV-positive cases.\u003c/p\u003e\n\u003ch3\u003eOperational definitions of HIV testing purposes\u003c/h3\u003e\n\u003cp\u003eHIV testing purposes were categorized based on the primary reason or setting for testing, as follows:\u003c/p\u003e\u003cp\u003e\u003cul\u003e\u003cli\u003e\u003cp\u003e- \u003cb\u003eVoluntary anonymous testing\u003c/b\u003e: HIV testing conducted anonymously, where personal identifiers are not collected and a temporary identifier chosen by the examinee is used.\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003e- \u003cb\u003eVoluntary named testing\u003c/b\u003e: HIV testing voluntarily sought by individuals who provide personal identifying information. This category includes client-initiated testing, self-requested testing, self-check testing, and testing among MSM.\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003e- \u003cb\u003eHealth checkups\u003c/b\u003e: HIV testing performed as part of general health examinations, occupational health screenings, or pre-employment medical evaluations.\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003e- \u003cb\u003eMedical consultation visitors\u003c/b\u003e: HIV testing provided to individuals attending PHCs for medical consultations other than antenatal care.\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003e- \u003cb\u003eAntenatal testing\u003c/b\u003e: HIV testing conducted for pregnant women and newlywed couples as part of prenatal care services.\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003e- \u003cb\u003eCorrectional facility administration screening\u003c/b\u003e: Mandatory HIV testing for individuals entering correctional facilities, conducted in accordance with national legal regulations.\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003e- \u003cb\u003eContact tracing of HIV-positive individuals\u003c/b\u003e: HIV testing performed for family members and sexual partners of persons already diagnosed with HIV infection.\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003e- \u003cb\u003eRoutine STI screening\u003c/b\u003e: HIV testing required by law (Regulation on Health Examinations for STIs and AIDS) for individuals employed in occupations subject to periodic health examinations, such as adult entertainment venues, massage parlors, bars, and similar establishments.\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003e- \u003cb\u003eForeign resident screening\u003c/b\u003e: HIV testing provided to refugees, individuals undergoing visa application or extension procedures, and foreign nationals utilizing HIV testing services supported by local governments.\u003c/p\u003e\u003c/li\u003e\u003c/ul\u003e\u003c/p\u003e\u003cdiv id=\"Sec7\" class=\"Section2\"\u003e\u003ch2\u003eStatistical analysis\u003c/h2\u003e\u003cp\u003ePrior to analysis, data cleaning procedures were performed, including verification of missing values and correction of errors. For the analysis of HIV seroprevalence (positivity), only cases that were both reactive on screening tests and confirmed positive on confirmatory tests were included. To ensure that duplicate positive cases were not counted, HIV-positive test results reported by PHCs were cross-referenced with confirmatory specimen identification codes obtained from the HASNet, maintained by the Division of HIV/AIDS Prevention and Control. This matching process involved comparing specimen codes reported by PHCs with confirmatory specimen codes registered in the HASNet for confirmed HIV cases.\u003c/p\u003e\u003cp\u003eTemporal trends in the number of HIV tests performed, seroprevalence, and testing patterns were analyzed across the 13-year period. More detailed analyses were conducted for the 2023 data. Variables included in the analyses were sex, age group, region, nationality (domestic or foreign), and HIV testing purpose.\u003c/p\u003e\u003cp\u003eAll statistical analyses were conducted using R software (version 4.4.0; R Core Team, R Foundation for Statistical Computing, Vienna, Austria) and SPSS (version 28.0). Differences between groups were assessed using the chi-square test, with a significance level of 5%. When significant overall differences were detected, Bonferroni-corrected post-hoc tests were applied to adjust for multiple comparisons, with a significance level of 5% used throughout. Associations between explanatory variables and HIV positivity were evaluated using logistic regression analysis to estimate odds ratios (ORs) with 95% confidence intervals (CIs). Temporal trends over the 13-year study period were analyzed using the Mann\u0026ndash;Kendall trend test, with Kendall\u0026rsquo;s tau and \u003cem\u003ep\u003c/em\u003e-values calculated at a 5% significance level.\u003c/p\u003e\u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec9\" class=\"Section2\"\u003e\u003ch2\u003eHIV testing trends at PHCs (2011\u0026ndash;2023)\u003c/h2\u003e\u003cp\u003eAn annual average of 443,609 HIV screening tests were conducted at PHCs nationwide between 2011 and 2019. The Kendall\u0026rsquo;s tau value was 0.556, with a \u003cem\u003ep\u003c/em\u003e-value of 0.047, indicating a statistically significant monotonic increasing trend in the number of tests performed. In addition, the Pettitt test was conducted to assess potential change points in the time series data. The test suggested that 2019 represented a possible change point, as the distribution of test volumes after 2019 differed from that of prior years (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.0748).\u003c/p\u003e\u003cp\u003eDuring the COVID-19 pandemic (2020\u0026ndash;2022), the number of HIV tests conducted at PHCs declined sharply. Annual testing volumes for 2020, 2021, and 2022 were 178,653, 104,621, and 141,992 tests, respectively\u0026mdash;representing reductions of 59.7%, 76.4%, and 69.3% compared to the pre-pandemic annual average from 2011 to 2019. Following the stabilization of the COVID-19 pandemic, HIV testing activity began to recover. In 2023, 255,051 HIV tests were conducted, reflecting a 79.9% increase from 2022. Following the policy change in May 2023, when the national infectious disease crisis alert level was lowered from \u0026ldquo;Orange (Alert)\u0026rdquo; to \u0026ldquo;Yellow (Attention),\u0026rdquo; HIV testing volumes began to increase more noticeably. In particular, metropolitan regions\u0026mdash;where testing volumes had markedly declined during the pandemic\u0026mdash;showed partial recovery, with year-over-year increases of approximately 25% compared to the 2022 testing volumes.\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eSociodemographic characteristics of individuals tested for HIV at PHCs in 2023\u003c/h3\u003e\n\u003cp\u003eAmong the individuals tested in 2023, 69.3% were women and 30.7% were men. Foreign nationals accounted for 4.3% of all individuals tested. The majority of tests (83.2%) were conducted among individuals in their 20s to 40s. Regarding testing purposes, antenatal screening accounted for the largest proportion of tests (35.8%), followed by general health checkups (24.9%), routine STI screening (17.9%), voluntary anonymous testing (7.4%), correctional facility screening (3.8%), foreign resident screening (3.6%), and voluntary named testing (3.5%).\u003c/p\u003e\u003cp\u003eAge-stratified analysis showed that individuals in their 20s accounted for the highest proportion of voluntary anonymous testing (39.0%) (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Among individuals in their 30s, the relative distribution by testing purpose was as follows: antenatal testing (80.0%)\u0026thinsp;\u0026gt;\u0026thinsp;general health checkups (69.6%)\u0026thinsp;\u0026gt;\u0026thinsp;voluntary named testing (46.9%)\u0026thinsp;\u0026asymp;\u0026thinsp;foreign resident screening (44.9%). These findings suggest that antenatal care was the primary driver of HIV testing among women in their 30s. For routine STI screening, the proportions of individuals in their 40s (28.1%), 50s (28.5%), and 60s (16.7%) were higher than for other testing purposes (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001) (Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e1\u003c/span\u003ea).\u003c/p\u003e\u003cp\u003eA sex-specific analysis showed that men comprised the majority of individuals who underwent voluntary anonymous testing (82.7%), correctional facility screening (82.1%), and voluntary named testing (60.5%), whereas women predominated in antenatal screening (92.9%), routine STI screening (84.1%), and foreign resident screening (67.8%) (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001) (Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e1\u003c/span\u003eb).\u003c/p\u003e\u003cp\u003eHIV positivity was significantly higher in metropolitan areas than in small city and rural regions, highlighting regional disparities in HIV burden (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001).\u003c/p\u003e\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e\u003ch2\u003eHIV seroprevalence by nationality and testing purpose at PHCs in 2023\u003c/h2\u003e\u003cp\u003eIn 2023, the overall HIV seroprevalence among individuals tested at PHCs was 0.165%, indicating an increase compared to the 5-year average from 2018 to 2022 (0.129%). When disaggregated by sex, men had a significantly higher seroprevalence (0.430%, 95% CI: 0.386\u0026ndash;0.480) than women (0.026%, 95% CI: 0.020\u0026ndash;0.035) (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001).\u003c/p\u003e\u003cp\u003eBy nationality, the seroprevalence among foreign nationals was 0.676%, which was 4.8 times greater than that observed in Korean nationals (0.142%) (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Among men, the seroprevalence rate in foreign nationals was 1.237% (95% CI: 0.926\u0026ndash;1.646), compared to 0.386% (95% CI: 0.343\u0026ndash;0.435) in Korean nationals\u0026mdash;a 3.2-fold difference. Among women, the gap was more pronounced, with a seroprevalence of 0.367% (95% CI: 0.245\u0026ndash;0.545) in foreign nationals versus 0.012% (95% CI: 0.007\u0026ndash;0.019) in Korean nationals, representing a 30.6-fold higher rate (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001).\u003c/p\u003e\u003cp\u003eAge-specific analysis revealed the highest seroprevalence in individuals in their 20s (0.251%). Within this group, foreign nationals had a prevalence of 0.526%, which was more than twice the rate in Korean nationals (0.224%) (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001).\u003c/p\u003e\u003cp\u003eNotable variations in testing purpose were also observed. Voluntary anonymous testing yielded the highest seroprevalence (1.148%), followed by voluntary named testing (0.711%)\u0026mdash;approximately 7.0 and 4.3 times higher than the overall average (0.165%), respectively. Among voluntary anonymous testers, foreign nationals had a prevalence of 7.650%, compared to 1.084% among Korean nationals, indicating a 7.1-fold disparity (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Similarly, in voluntary named testing, seroprevalence among foreign nationals (3.182%) was 6.2 times higher than that among Korean nationals (0.516%) (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001) (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eHIV seroprevalence by nationality and testing purpose among attendees of public health centers, 2023\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"6\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colspan=\"2\" morerows=\"2\" nameend=\"c2\" namest=\"c1\" rowspan=\"3\"\u003e\u003cp\u003eStudy variables\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eTotal\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003eHIV Results\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003eHIV Seroprevalence\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eNumber (%)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eNegative\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003ePositive (n, %)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003eHPR\u003csup\u003e*\u003c/sup\u003e (95% CI) \u003csup\u003e\u0026dagger;\u003c/sup\u003e\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003e255051\u003c/b\u003e\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e254630\u003c/b\u003e\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e421\u003c/b\u003e\u003csup\u003e\u003cb\u003e**\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u003cb\u003e0.165%\u003c/b\u003e (0.150\u0026ndash;0.183)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eKorean nationals\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e243959 (95.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e243613\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e346 (82.2) \u003csup\u003e\u0026sect;\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.142% (0.128\u0026ndash;0.157)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eForeign nationals\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e11092 (4.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e11017\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e75 (17.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.676% (0.533\u0026ndash;0.854)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"11\" rowspan=\"12\"\u003e\u003cp\u003eOverall\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"5\" nameend=\"c6\" namest=\"c2\"\u003e\u003cp\u003eMissing values 193 (0.1%), Korean nationals 105, Foreign nationals 88\u003c/p\u003e\u003cp\u003eValid 254858 (99.9%), Korean nationals 243854, Foreign nationals 11004\u003c/p\u003e\u003cp\u003eχ2\u0026thinsp;=\u0026thinsp;1671.575; df \u003csup\u003e\u0026Dagger;\u003c/sup\u003e = 9; \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003eAll\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003e254858 (100)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e254439\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e419 (100)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u003cb\u003e0.164 (0.149\u0026ndash;0.181)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMedical consultation visitors\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e7771 (3.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e7737\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e34 (8.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.438 (0.308\u0026ndash;0.618)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eAntenatal testing\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e91347 (35.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e91344\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e3 (0.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.003 (0.001\u0026ndash;0.010)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eHealth checkups\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e63386 (24.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e63336\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e50 (11.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.079 (0.059\u0026ndash;0.105)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eVoluntary named testing\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e8998 (3.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e8934\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e64 (15.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.711 (0.553\u0026ndash;0.913)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eVoluntary anonymous testing\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e18732 (7.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e18517\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e215 (51.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1.148 (1.002\u0026ndash;1.313)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eForeign resident screening\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e9239 (3.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e9202\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e37 (8.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.400 (0.286\u0026ndash;0.558)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCorrectional facility admission screening\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e9727 (3.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e9720\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e7 (1.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.072 (0.032\u0026ndash;0.155)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eContact tracing of known HIV-positive individuals\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e6 (0.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1 (0.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e16.667 (0.876\u0026ndash;63.518)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eRoutine STI screening\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e45577 (17.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e45569\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e8 (1.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.018 (0.008\u0026ndash;0.036)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eOthers\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e75 (0.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e75\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0 (0.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"10\" rowspan=\"11\"\u003e\u003cp\u003eKorean nationals\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSubtotal\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e243854 (100)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e243510\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e344 (100) \u003csup\u003e\u0026sect;\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.141 (0.127\u0026ndash;0.157)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMedical consultation visitors\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e7634 (3.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e7601\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e33 (9.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.432 (0.303\u0026ndash;0.614)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eAntenatal testing\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e91347 (37.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e91344\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e3 (0.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.003 (0.001\u0026ndash;0.010)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eHealth checkups\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e63227 (25.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e63177\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e50 (14.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.079 (0.059\u0026ndash;0.105)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eVoluntary named testing\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e8338 (3.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e8295\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e43 (12.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.516 (0.378\u0026ndash;0.701)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eVoluntary anonymous testing\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e18549 (7.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e18348\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e201 (58.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1.084 (0.942\u0026ndash;1.246)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eForeign resident screening\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2 (0.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCorrectional facility admission screening\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e9560 (3.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e9553\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e7 (2.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.073 (0.032\u0026ndash;0.158)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eContact tracing of known HIV-positive individuals\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e6 (0.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1 (0.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e16.667 (0.876\u0026ndash;63.518)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eRoutine STI screening\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e45120 (18.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e45114\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e6 (1.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.013 (0.005\u0026ndash;0.031)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eOthers\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e71 (0.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e71\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"10\" rowspan=\"11\"\u003e\u003cp\u003eForeign nationals\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSubtotal\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e11004 (100)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e10929\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e75 (100)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.682 (0.540\u0026ndash;0.858)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMedical consultation visitors\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e137 (1.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e136\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1 (1.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.730 (0.038\u0026ndash;4.604)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eAntenatal testing\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eHealth checkups\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e159 (1.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e159\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0 (0.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eVoluntary named testing\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e660 (6.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e639\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e21 (28.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e3.182 (2.030\u0026ndash;4.905)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eVoluntary anonymous testing\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e183 (1.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e169\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e14 (18.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e7.650 (4.404\u0026ndash;12.757)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eForeign resident screening\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e9237 (83.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e9200\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e37 (49.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.401 (0.286\u0026ndash;0.558)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCorrectional facility admission screening\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e167 (1.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e167\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0 (0.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eContact tracing of known HIV-positive individuals\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eRoutine STI screening\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e457 (4.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e455\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e2 (2.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.438 (0.076\u0026ndash;1.749)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eOthers\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e4 (0.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0 (0.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003csup\u003e*\u003c/sup\u003eHPR: HIV positivity rate; \u003csup\u003e\u0026dagger;\u003c/sup\u003eCI: confidence interval; \u003csup\u003e\u0026Dagger;\u003c/sup\u003edf: degrees of freedom; HIV: human immunodeficiency virus; PHC: public health center; STI: sexually transmitted infection\u003c/p\u003e\u003cp\u003e\u003csup\u003e\u0026sect;\u003c/sup\u003eAmong 346 HIV-positive cases in Korean nationals, 2 were excluded owing to missing HIV testing purpose, leaving 344 cases for analysis.\u003c/p\u003e\u003cp\u003e\u003csup\u003e**\u003c/sup\u003e According to the national HIV surveillance data in Korea, a total of 1,005 individuals were newly diagnosed with HIV in 2023 [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. The reporting institutions included hospitals and clinics (n\u0026thinsp;=\u0026thinsp;637), PHC (n\u0026thinsp;=\u0026thinsp;284), and other facilities (n\u0026thinsp;=\u0026thinsp;84). In the present study, 421 individuals tested positive at PHCs; however, this number likely included 137 cases of duplicate testing, as the official number of cases reported by PHCs was 284, resulting in an estimated duplication rate of 1.48 (284/421). The majority of these duplicate cases were presumed to be among individuals undergoing voluntary anonymous testing.\u003c/p\u003e\u003cp\u003e\u003cb\u003eMultivariable logistic regression of factors associated with HIV positivity among individuals tested at PHCs in 2023\u003c/b\u003e\u003c/p\u003e\u003cp\u003eTo identify the factors independently associated with HIV positivity, a multivariable logistic regression analysis was conducted using 2023 HIV screening data from PHCs. Records with incomplete sociodemographic information were excluded from the analysis. Therefore, 240,552 test records (94.3% of 255,051 tests) and 268 HIV-positive cases (63.7% of 421 confirmed cases) were included in the final analysis. The age distribution of individuals tested was as follows: those in their 30s accounted for the highest proportion (57.3%), followed by individuals in their 40s (13.9%), 20s (12.0%), 50s (7.7%), 60s and older (6.6%), and \u0026lt;\u0026thinsp;20s (2.5%).\u003c/p\u003e\u003cp\u003eAdjusted ORs (aORs) and 95% CIs were calculated for each covariate. Men had significantly higher odds of testing HIV-positive than women (aOR: 9.48; 95% CI: 6.52\u0026ndash;13.80; \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Similarly, foreign nationals had increased odds of HIV positivity compared to Korean nationals (aOR: 6.22; 95% CI: 4.27\u0026ndash;9.07; \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Moreover, individuals residing in metropolitan areas had significantly higher odds of testing HIV-positive than those residing in small- to mid-sized cities (aOR: 2.50; 95% CI: 1.93\u0026ndash;3.24; \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001). The purpose of HIV testing also showed a significant association with HIV positivity. Individuals who underwent voluntary testing (including both anonymous and named testing) had markedly higher odds of being HIV-positive than those tested under routine or mandatory screening programs driven by institutional or public health requirements (aOR: 7.67; 95% CI: 5.76\u0026ndash;10.04; \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001) (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eHIV positivity-associated factors among PHC attendees tested in 2023 based on univariable and multivariable analyses\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"9\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colspan=\"2\" morerows=\"1\" nameend=\"c2\" namest=\"c1\" rowspan=\"2\"\u003e\u003cp\u003eStudy variables\u003c/p\u003e\u003cp\u003eCategory\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eTotal\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003eHIV Results\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e\u003cp\u003ecOR\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e\u003cp\u003eaOR\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eNumber (%)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eNegative\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003ePositive (%)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003ecOR (95% CI)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u003cp\u003e\u003cem\u003ep\u003c/em\u003e\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c8\"\u003e\u003cp\u003eaOR (95% CI) \u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c9\"\u003e\u003cp\u003e\u003cem\u003ep\u003c/em\u003e\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eOverall\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e240552 (100)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e240284\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e268 (100)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eSex\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e67827 (28.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e67593\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e234 (87.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e17.58 (12.27,25.20)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e9.48 (6.52,13.80)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eFemale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e172725 (71.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e172691\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e34 (12.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eAge (years)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e0.009\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;20\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e5906 (2.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e5903\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e3 (1.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.80 (0.22,2.91)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e0.736\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.43 (0.12,1.61)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e0.212\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e20s (20\u0026ndash;29)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e28983 (12.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e28910\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e73 (27.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e3.98 (2.05,7.71)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e1.65 (0.84,3.22)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e0.143\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e30s (30\u0026ndash;39)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e137912 (57.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e137799\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e113 (42.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1.29 (0.68,2.47)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e0.437\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e1.28 (0.66,2.46)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e0.466\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e40s (40\u0026ndash;49)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e33401 (13.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e33352\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e49 (18.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e2.32 (1.17,4.57)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e0.016\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e1.91 (0.96,3.81)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e0.064\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e50s (50\u0026ndash;59)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e18577 (7.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e18557\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e20 (7.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1.70 (0.79,3.63)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e0.171\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e1.92 (0.89,4.12)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e0.094\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u0026ge;\u0026thinsp;60\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e15773 (6.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e15763\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e10 (3.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eNationality\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eKorean nationals\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e229855 (95.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e229649\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e206 (76.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eForeign nationals\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e10697 (4.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e10635\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e62 (23.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e6.50 (4.89,8.64)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e6.22 (4.27,9.07)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eRegion (Residency)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMetropolitan\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e96724 (40.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e96564\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e160 (59.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e2.20 (1.73,2.81)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e2.50 (1.93, 3.24)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSmall city/rural area\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e143828 (59.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e143720\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e108 (40.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eHIV testing groups by purpose\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePublic health service-based testing\u003csup\u003e\u0026dagger;\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e162242 (67.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e162159\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e83 (31.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eVoluntary testing\u003csup\u003e\u0026Dagger;\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e13981 (5.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e13848\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e133 (49.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e18.76 (14.26,24.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e7.67 (5.67,10.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eProvider-initiated testing\u003csup\u003e\u0026sect;\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e18782 (7.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e18738\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e44 (16.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e4.59 (3.18,6.61)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e1.17 (0.73,1.89)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e0.518\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eRoutine STI screening \u003csup\u003eǁ\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e45547 (18.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e45539\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e8 (3.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.34 (0.17,0.71)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e0.004\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.56 (0.26,1.17)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e0.122\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003csup\u003e*\u003c/sup\u003eCI: Confidence interval; aOR: adjusted odds ratio; cOR: crude odds ratio; HIV: human immunodeficiency virus; PHC: public health center; STI: sexually transmitted infection.\u003c/p\u003e\u003cp\u003e\u003csup\u003e\u0026dagger;\u003c/sup\u003ePublic health service-based testing: Antenatal testing, health checkups, and medical consultation visitors\u003c/p\u003e\u003cp\u003e\u003csup\u003e\u0026Dagger;\u003c/sup\u003eVoluntary testing: Voluntary named testing and voluntary anonymous testing\u003c/p\u003e\u003cp\u003e\u003csup\u003e\u0026sect;\u003c/sup\u003eProvider-initiated testing: Foreign resident screening, correctional facility admission screening, and contact tracing of known HIV-positive individuals\u003c/p\u003e\u003cp\u003e\u003csup\u003eǁ\u003c/sup\u003e Routine STI screening: Individuals in occupations wherein it is legally required to undergo periodic HIV testing (1\u0026ndash;2 times per year)\u003c/p\u003e\u003cp\u003e\u003cb\u003eThirteen-year trends in HIV testing demographics, testing purposes, and positivity rates at PHCs in Korea (2011\u0026ndash;2023)\u003c/b\u003e\u003c/p\u003e\u003cp\u003eHIV screening data from PHCs in Korea were analyzed to evaluate demographic trends and testing purposes over the 13-year period between 2011 and 2023. Over this period, individuals in their 30s consistently accounted for the highest proportion of HIV tests (mean: 42.4%), followed by those in their 20s (21.5%) and 40s (13.9%), with individuals aged 20\u0026ndash;40 years comprising 77.8% of all test recipients. The Mann\u0026ndash;Kendall trend test revealed a significant decreasing trend in testing among individuals aged\u0026thinsp;\u0026le;\u0026thinsp;19 years (Kendall\u0026rsquo;s tau = \u0026minus;\u0026thinsp;0.615, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.0041) and those in their 20s (Kendall\u0026rsquo;s tau = \u0026minus;\u0026thinsp;0.718, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.0079), whereas testing among individuals in their 30s showed a significant increasing trend (Kendall\u0026rsquo;s tau\u0026thinsp;=\u0026thinsp;0.821, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001), likely attributable to the rising number of antenatal screenings. No consistent trend was observed among individuals aged\u0026thinsp;\u0026ge;\u0026thinsp;40 years (Fig.\u0026nbsp;\u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e2\u003c/span\u003ea).\u003c/p\u003e\u003cp\u003eThroughout the study period, women consistently accounted for a greater proportion of tests than men, maintaining a stable ratio of approximately 7:3 (women 70.8%, men 29.2%), with no significant monotonic trend observed in the annual sex distribution (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.428).\u003c/p\u003e\u003cp\u003eRegarding testing purpose, antenatal screening accounted for the largest proportion of tests (mean: 27.6%), followed by general health checkups (25.9%), routine STI screening (21.0%), voluntary named testing (9.0%), voluntary anonymous testing (6.0%), correctional facility screenings (5.4%), and medical consultations (5.1%). Antenatal screening demonstrated a significant upward trend (Kendall\u0026rsquo;s tau\u0026thinsp;=\u0026thinsp;0.897, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001), reflecting the expansion of public health services for women of reproductive age. In 2023, 73,061 women in their 30s underwent antenatal testing (28.6% of all HIV tests that year). Conversely, testing related to medical consultations, correctional facilities, voluntary named testing, and contact tracing of HIV-positive individuals exhibited significant declines over time (all Kendall\u0026rsquo;s tau \u0026lt; \u0026minus;\u0026thinsp;0.5). No significant trend was observed for voluntary anonymous testing, health checkups, or routine STI screening (Fig.\u0026nbsp;\u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e2\u003c/span\u003eb).\u003c/p\u003e\u003cp\u003eDuring the most recent 5-year period (2019\u0026ndash;2023), voluntary HIV testing\u0026mdash;including both anonymous and named tests\u0026mdash;accounted for an average of only 12.26% of all tests conducted at PHCs but contributed disproportionately to the total number of confirmed HIV-positive cases, comprising 76.58% overall (56.62% from anonymous testing and 19.96% from named testing) (Fig.\u0026nbsp;\u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e2\u003c/span\u003ec). Since 2019, the HIV positivity rate among individuals undergoing voluntary anonymous testing has consistently increased, underscoring the importance of this subgroup in ongoing HIV surveillance and prevention strategies.\u003c/p\u003e\u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis nationwide study analyzed HIV testing trends and seroprevalence among persons accessing HIV testing services at 260 PHCs in Korea over a 13-year period (2011\u0026ndash;2023), with detailed analysis for the year 2023. The findings underscore the ongoing public health value of community-based testing strategies, especially those offering free services to vulnerable groups, including foreign nationals and individuals undergoing routine screenings for STIs. By providing both anonymous and named testing options, the PHC-based testing system plays a vital role in facilitating access to HIV screening for individuals who may otherwise remain undiagnosed [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eTrend analysis revealed a substantial decrease in testing volume during the COVID-19 pandemic (2020\u0026ndash;2022), particularly in metropolitan regions, such as Seoul and Gyeonggi Province, where diagnostic services were temporarily suspended or scaled down. This decline was especially pronounced among younger individuals and those undergoing voluntary testing, contributing to a temporary drop in reported HIV cases [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. However, following the easing of pandemic-related restrictions, testing volume rebounded significantly in 2023\u0026mdash;rising by approximately 80% compared to 2022\u0026mdash;demonstrating the resilience of the public health infrastructure in Korea.\u003c/p\u003e\u003cp\u003eAntenatal testing accounted for the largest proportion of all HIV tests throughout the study period and displayed a steady increase, reflecting the expanding role of PHCs in maternal health services for women of reproductive age. Because antenatal HIV screening is now integrated into routine care, sustained support for these programs is essential for early diagnosis and the prevention of vertical transmission [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. By contrast, testing among individuals aged\u0026thinsp;\u0026lt;\u0026thinsp;30 years has declined, a worrisome trend given rising HIV notifications in younger populations worldwide and in Korea. Younger adults remain a priority for HIV prevention owing to evolving risk behaviors and lower health-seeking tendencies, which can delay diagnosis [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. Therefore, youth-focused outreach\u0026mdash;leveraging digital platforms and stigma-free voluntary testing\u0026mdash;warrants urgent expansion. Evidence from other settings supports broader routine testing. In the United States, local public health sexually transmitted disease clinics that offered HIV testing as a standard option reported substantial gains in case detection [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. Similarly, a population-based cohort study in Taiwan showed that routinely offered, opt-out HIV testing\u0026mdash;compared with risk-based, non-routine testing\u0026mdash;was associated with markedly lower odds of late diagnosis (aOR, 0.20) and HIV-related mortality (aOR, 0.63) [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. These findings have prompted calls to explore opt-out HIV testing in Korean healthcare settings to improve early detection and reduce preventable mortality.\u003c/p\u003e\u003cp\u003eIn 2023, HIV seroprevalence was higher among men, individuals in their 20s, and foreign nationals. These findings are consistent with previous study findings indicating that certain demographic groups face elevated HIV risks. Foreign nationals, in particular, showed a 4.8-fold higher seropositivity rate than Korean nationals. Structural and systemic factors, such as limited healthcare access and sociocultural or legal barriers, may contribute to delayed testing and greater vulnerability among migrants. Expanding culturally appropriate and linguistically accessible testing options for this population is essential. Multivariable logistic regression analysis identified male sex, foreign nationality, residence in metropolitan areas, and voluntary testing as independent predictors of HIV positivity. These findings align with previous research and underscore the importance of targeted interventions for high-risk groups, including migrants, MSM, individuals under the age of 40 years, residents of metropolitan areas, and those actively seeking testing outside routine medical settings [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eCollectively, the findings emphasize the importance of sustaining and expanding PHC-based HIV testing services accessible to key populations. Public health authorities should continue to support both routine and voluntary testing programs and enhance outreach to under-tested or marginalized groups. Strengthening the role of PHCs\u0026mdash;particularly in reaching vulnerable populations\u0026mdash;will be critical for achieving the UNAIDS 95-95-95 goals and reducing late HIV diagnosis in Korea.\u003c/p\u003e\u003cp\u003eCertain limitations should be taken into account when interpreting the findings of this study. First, although efforts were made to exclude duplicate tests using specimen identification codes, repeated tests performed anonymously may not have been fully identified. This limitation may have resulted in an overestimation of the number of confirmed HIV cases attributed to anonymous testing. Second, records with incomplete sociodemographic information were excluded from the multivariable analysis, resulting in the inclusion of 240,552 out of 255,051 tests (94.3%) and 268 out of 421 confirmed HIV-positive cases (63.7%). A total of 279 voluntary tests were conducted in 2023, but only 133 cases were included in the regression analysis owing to missing epidemiological data in anonymous test records. This underrepresentation may have led to an underestimation of the HIV risk associated with voluntary testing. Individuals in their 20s and 30s accounted for 39.0% and 33.7% of those who underwent voluntary anonymous testing, respectively, and comprised nearly 70% of HIV-positive cases within this group. Their disproportionate exclusion may have resulted in underestimated aORs for these age group. Finally, while HIV testing trends were analyzed over a 13-year period, detailed stratified analyses by demographic variables were limited to data from 2023. These limitations underscore the need to improve the completeness and accuracy of surveillance data, particularly for key subgroups, such as individuals who opted for anonymous testing.\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eThis study highlights the pivotal role of PHCs in the Korean national HIV prevention strategy, particularly in delivering accessible and equitable testing services to vulnerable and high-risk populations. The findings emphasize the continued necessity of sustaining both voluntary and routine HIV testing programs, while also addressing gaps in data completeness to support robust surveillance and monitoring. Targeted public health interventions aimed at expanding outreach to key populations\u0026mdash;such as foreign nationals, men, individuals in their 20s, and those undergoing voluntary testing\u0026mdash;will be critical for enhancing early HIV detection and curbing further transmission. These insights provide critical evidence to inform national HIV management policies, optimize resource allocation, and strengthen the overall testing infrastructure to ensure timely diagnosis and linkage to care.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003ePHCs\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003ePublic health centers\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eaOR\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eadjusted odds ratio\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eHIV\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003ehuman immunodeficiency virus\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eAIDS\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eacquired immunodeficiency syndrome\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003ePLHIV\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003epeople living with HIV\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eSTIs\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003esexually transmitted infections\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eMSM\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003emen who have sex with men\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003ePHIS\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003epublic health information system\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eKDCA\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eKorea Disease Control and Prevention Agency\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eHASNet\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eHIV/AIDS Supporting Network System\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eOR\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eodds ratio\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eCI\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003econfidence interval\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eIRB\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eInstitutional Review Board\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate:\u003c/strong\u003e\u003cp\u003e This study was conducted in accordance with the ethical principles of the Declaration of Helsinki and its later amendments. Ethical approval was obtained from the Institutional Review Board (IRB) of the KDCA (Approval No. KDCA-2025-02-05-PE-01). The HIV testing data analyzed in this study were obtained from PHCs in an anonymized format using specimen codes, without any personally identifiable information. Consequently, the IRB waived the requirement for written informed consent.\u003c/p\u003e\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eConsent for publication:\u003c/strong\u003e\u003cp\u003eNot applicable\u003c/p\u003e\u003c/p\u003e\u003cp\u003e\u003ch2\u003eCompeting interests:\u003c/h2\u003e\u003cp\u003eThe authors declare that they have no competing interests\u003c/p\u003e\u003c/p\u003e\u003ch2\u003eFunding:\u003c/h2\u003e\u003cp\u003eThis research was supported by the Korea Disease Control and Prevention Agency (grant No. 6331-301-210)\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eAuthors\u0026rsquo; contributions: J.-S.W. and M.-G.H. designed and conceived the study, and M.-G.H. supervised all aspects of its implementation. J.-S.W. wrote the first draft of the manuscript and created the visualizations. E.J.K. and G.K. collected data from public health centers. N.R.J. and T.-Y.H. analyzed the data. S.K. and H.M.K. coordinated funding for the project. All authors have read and approved the final version of the manuscript.\u003c/p\u003e\u003ch2\u003eAcknowledgement\u003c/h2\u003e\u003cp\u003eWe would like to express our sincere gratitude to the Division of HIV/AIDS Prevention and Control of the KDCA for managing the HIV/AIDS Supporting Network System (HASNet).\u003c/p\u003e\u003ch2\u003eData Availability\u003c/h2\u003e\u003cp\u003eThe datasets generated or analysed during the current study are available from the corresponding author upon reasonable request.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eLu Y, Li H, Dong R, Zhang M, Dong X, Yang C, Wang X, Ye J. BMC Public Health. 2025;25(1):1928. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1186/s12889-025-23121-4\u003c/span\u003e\u003cspan address=\"10.1186/s12889-025-23121-4\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. 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Routine HIV testing and outcomes: a population-based cohort study in Taiwan. Am J Prev Med. 2022;62:234\u0026ndash;42. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.amepre.2021.07.010\u003c/span\u003e\u003cspan address=\"10.1016/j.amepre.2021.07.010\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-public-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"pubh","sideBox":"Learn more about [BMC Public Health](http://bmcpublichealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/pubh/default.aspx","title":"BMC Public Health","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"HIV testing, Seroprevalence, Key populations, Voluntary testing, HIV surveillance","lastPublishedDoi":"10.21203/rs.3.rs-7426511/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7426511/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e\u003cp\u003ePublic health centers (PHCs) in South Korea provide free and anonymous 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 to inform targeted prevention and diagnostic strategies.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e\u003cp\u003eWe 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 was used to identify independent predictors of HIV positivity, and temporal changes were evaluated using the Mann\u0026ndash;Kendall trend test.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003eOver the 13-year study period, approximately 4.7\u0026nbsp;million HIV screening tests were completed at PHCs. Annual testing volume declined by nearly 75% during the COVID-19 pandemic but rebounded to 255,051 tests by 2023. Although fewer than 5% of national HIV tests were performed in PHCs, they identified 28.3% of newly diagnosed HIV infections in 2023. In that year, the overall HIV seroprevalence at PHCs was 0.165%, with elevated positivity among foreign nationals (0.677%), men (0.430%), individuals in their 20s (0.251%), and those undergoing anonymous (1.148%) or named (0.711%) client-initiated testing. Multivariable logistic regression revealed that male sex (adjusted odds ratio [aOR]\u0026thinsp;=\u0026thinsp;9.48), foreign nationality (aOR\u0026thinsp;=\u0026thinsp;6.22), voluntary testing (aOR\u0026thinsp;=\u0026thinsp;7.67), and residence in metropolitan areas (aOR\u0026thinsp;=\u0026thinsp;2.50) were significant independent predictors of HIV positivity (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001 for all). Trend analysis demonstrated significant increases in testing among individuals aged 30\u0026ndash;39 years (Kendall\u0026rsquo;s tau\u0026thinsp;=\u0026thinsp;0.821, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001) and in antenatal care screening (Kendall\u0026rsquo;s tau\u0026thinsp;=\u0026thinsp;0.897, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001), reflecting expanded maternal health services and changing demographic patterns in test uptake.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e\u003cp\u003eDespite accounting for a small proportion of national HIV testing, PHCs consistently contributed a disproportionately large proportion of new diagnoses\u0026mdash;especially among high-risk groups, such as men, foreign nationals, young adults, urban residents, and individuals, who actively seek confidential 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.\u003c/p\u003e","manuscriptTitle":"Trends in HIV testing and seroprevalence among key populations at public health centers in South Korea, 2011–2023: A nationwide analysis","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-09-10 18:57:51","doi":"10.21203/rs.3.rs-7426511/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-09-29T08:24:45+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-09-26T01:45:15+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-09-17T20:10:47+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"27476305837035353651523472518555241808","date":"2025-09-10T17:09:30+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-09-05T10:08:00+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"91232966088464591207432324615515136724","date":"2025-09-03T18:40:52+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"193384634403413616659125589531322007732","date":"2025-09-03T17:49:39+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-09-03T17:40:40+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-08-22T08:48:51+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-08-22T03:20:51+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-08-22T03:20:09+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Public Health","date":"2025-08-21T12:56:58+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-public-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"pubh","sideBox":"Learn more about [BMC Public Health](http://bmcpublichealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/pubh/default.aspx","title":"BMC Public Health","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"858bcd2b-8f56-4783-9614-fcf1dcb2f645","owner":[],"postedDate":"September 10th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2025-12-01T16:12:46+00:00","versionOfRecord":{"articleIdentity":"rs-7426511","link":"https://doi.org/10.1186/s12889-025-25641-5","journal":{"identity":"bmc-public-health","isVorOnly":false,"title":"BMC Public Health"},"publishedOn":"2025-11-27 15:58:48","publishedOnDateReadable":"November 27th, 2025"},"versionCreatedAt":"2025-09-10 18:57:51","video":"","vorDoi":"10.1186/s12889-025-25641-5","vorDoiUrl":"https://doi.org/10.1186/s12889-025-25641-5","workflowStages":[]},"version":"v1","identity":"rs-7426511","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7426511","identity":"rs-7426511","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}