Predicting HIV self-testing intentions among Chinese college students: a dual-model analysis integrating health belief constructs and machine learning prioritization

Abstract

Introduction: As college students emerge as a key HIV-vulnerable population in China, HIV self-testing (HIVST) presents a critical strategy for enhancing detection rates and enabling timely intervention. While observational studies have identified multifactorial influences on HIVST willingness, few investigations integrate behavioral theory with machine learning approaches among college students. This study aims to fill this gap by exploring the determinants of HIVST willingness among college students using the Health Belief Model (HBM) and random forest analytics.

Methods: This cross-sectional study employed stratified cluster sampling to recruit 1,015 undergraduates from Xiangnan College (July-August 2022), The Health Belief Model (HBM) was synthesized with random forest analytics to elucidate determinants of HIVST willingness. Data were collected through questionnaires, and logistic regression and random forest modeling were used for analysis.

Results: Among participants, 69.3% (n = 703) expressed willingness to adopt HIVST within the next 6 months. 15.0% reported sexual activity (n = 152), with 12.0% (n = 122) of sexually active participants demonstrating concurrent engagement in unprotected intercourse and HIV testing willingness. HBM-based logistic regression revealed that self-efficacy (OR = 1.64, 95% CI: 1.21-2.21) and cues to action (OR = 1.34, 1.04-1.75) were significant facilitators, contrasting with the inhibitory effects of perceived barriers (OR = 0.69, 0.55-0.86). Random forest modeling prioritized these psychological constructs (mean decrease Gini >2.5), identifying male students and arts majors as critical subpopulations requiring targeted intervention.

Discussion: Our dual-method analysis establishes that campus HIV control necessitates: 1) Gender-specific prevention programs addressing male students' elevated risk exposure; 2) HBM-informed education strengthening self-efficacy and environmental cues; 3) Structural interventions reducing testing barriers through discreet service delivery. This theoretical-empirical integration advances predictive understanding of HIVST behaviors, providing actionable insights for developing precision public health strategies in academic settings.

Keywords: HIV self-testing; college student; health belief model; high-risk behaviors; random forest modeling.

Figure 1

Random forest modeling of HIV self-testing intention. Action, Cues to action; Efficacy, Self-efficacy; Relationship, Relationship status; Susceptibility, Perceived susceptibility, Severity, Perceived severity; Partners, Number of sexual partners; unprotected, Ever had unprotected sex; Expenses, Living expenses; Knowledge, Received relevant knowledge on AIDS prevention and treatment; Orientation, Sexual orientation; Barriers, Perceived barriers; Benefits, Perceived benefits; Household, Household registration; Specialized, Specialized field.