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Opportunities and barriers to STI testing in community health centres in China: a nationwide survey
  1. Jason J Ong1,
  2. Minghui Peng2,
  3. Shanzhu Zhu2,
  4. Ying-Ru J Lo3,
  5. Christopher K Fairley1,
  6. Michael R Kidd4,
  7. Martin Roland5,
  8. Sunfang Jiang2,
  9. William C W Wong6
  1. 1 Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
  2. 2 General Practice Department, Zhongshan Hospital Fudan University, Shanghai, China
  3. 3 Division of Communicable Diseases, World Health Organization, Regional Office for the Western Pacific, Manila, The Philippines
  4. 4 Department of Family & Community Medicine, University of Toronto, Toronto, Canada
  5. 5 Cambridge Centre for Health Services Research, University of Cambridge, Cambridge, UK
  6. 6 Department of Family Medicine and Primary Care, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
  1. Correspondence to Sunfang Jiang, General Practice Department, Zhongshan Hospital Fudan University, Xuhui, Shanghai, China; sfjiang999{at} and Dr William C W Wong, The Department of Family Medicine and Primary Care, The University of Hong Kong, Ap Lei Chau Clinic, Ap Lei Chau, Hong Kong, China; wongwcw{at}


Background China has strengthened its primary care workforce and implemented a wide network of community health centres (CHCs). However, STI testing and management are not currently included in the ‘Essential Package of Primary Health Care in China’. Legislation change to encourage STI service delivery would be important, but it is also critical to determine if there are also provider-related opportunities and barriers for implementing effective STI programmes through CHCs if future legislation were to change.

Methods A national representative survey was conducted between September and December 2015 in a stratified random sample of 180 CHCs based in 20 cities in China. Primary care practitioners (PCPs) provided information on current experiences of STI testing as well as the barriers and facilitators for STI testing in CHCs. Multivariate logistic regression was conducted to determine factors associated with PCPs performing STI testing.

Results 3580 out of 4146 (86%) invited PCPs from 158 CHCs completed the survey. The majority (85%, 95% CI 84% to 87%) of doctors stated that STI testing was an important part of healthcare. However, less than a third (29%, 95% CI 27% to 31%) would perform an STI test if the patients asked. Barriers for performing STI testing included lack of training, concerns about reimbursement, concerns about damage to clinics’ reputations and the stigma against key populations. Respondents who reported that they would perform an STI test were likely to be younger, received a bachelor degree or higher, received specific training in STIs, believed that STI test was an important part of healthcare or had resources to perform STI testing.

Conclusions There is potential for improving STI management in China through upskilling the primary care workforce in CHCs. Specific training in STIs is needed, and other structural, logistical and attitudinal barriers are needed to be addressed.

  • Infection control
  • primary care
  • community services
  • health services research
  • service delivery
  • China

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  • JJO and MP contributed equally.

  • Contributors WCWW and JJO designed the study. SJ and MP coordinated the collection of data. JJO did the analysis of the data. All authors contributed to writing the article, revising the manuscript and have given the final approval of this version to be published.

  • Funding JJO (number 1104781) is supported by the Australian National Health and Medical Research Council (NHMRC) Early Career Fellowship.

  • Competing interests None declared.

  • Ethics approval Hong Kong University; World Health Organization.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement All data relevant to the study have been presented in the tables and supplementary tables. If additional clarification is needed, please write to the corresponding author.

  • Correction notice This article has been corrected since it was published Online First. The spelling of the author name “Sunfong Jiang” has been corrected to “Sunfang Jiang”.