Table 1.

Barriers and strengths to PITC acceptability by Informational-Motivational-Behavioral Skill (IMB) model of prevention behavior

	Information	Motivation	Behavioural Skills	Structural/Community-level/Other
Barriers to PITC	Misinformation about HIV testing HIV testing uses a lot of blood The HIV test cannot be accurate due to the small size of the testing kit itself Lack of knowledge HIV treatment Lack of knowledge on the availability of free ARVs Lack of knowledge regarding the ability to live a healthy, long life on HIV treatment Inaccurate assumptions about one’s HIV status People assume they are positive based on the HIV positive status, illness, or death of a partner, as well as their own sexual history.	Fear of positive test results Perceived vulnerability related to one’s own mortality Perceived negative outcomes of disclosing one’s status to a partner Separation or conflict Being accused of infidelity and blamed for HIV (women) Gender differences in accessing care Women test and come to the clinic more than men Normative barriers to discussing matters regarding one’s sexual behaviour Unacceptable to discuss in public or outside of one’s relationship Especially regarding socially deviant sexual behaviour, such as infidelity. Fear of feeling judgment from the counsellor	Poor coping skills related to test results “Some people are afraid of testing because they can commit suicide in case their HIV results are positive” (32 year old female). Communication deficits Discussions with counsellors “We know that such issues are private [discussing sexual behaviour with the counsellor] we can’t just talk about them in public” (52 year old male). Discussions with partners (especially women) Difficulty expressed in discussing the topic of testing, convincing their partner to test, disclosing their status, and discussing sex with one’s partner	Concerns about confidentiality “Some counsellors don’t keep patients secrets” (21 year old female). HIV-related stigma People fear being labelled HIV positive by others if seen at the clinic. “People are afraid of coming for HIV testing because if they are found HIV positive, they won’t be able to come for HIV drugs because drugs are given in public” (39 year old male). Barriers related to resource-limited healthcare facilities (staff) Limited facility resources and space Lack of human resource Limited time for counselling Need for more counselling training
Strengths about PITC	Understanding of the benefits of PITC “Some of them [patients] are interested in testing to know their HIV status and make a decision on how to start medication” (32 year old female). Understanding the benefits of disclosure “To me it is very good to disclose your HIV results to your partner because this can influence your partner also to go for an HIV test” (21 year old female). Understanding the benefits of couples testing	Positive attitudes towards testing Before a new relationship When getting married As a requirement for hospital care Staff comfortable counselling patients one-on-one Trust in counsellors leads to comfort in counselling Participants who believed counsellors to be knowledgeable and able to help them were willing to have open discussions	Ability to disclose HIV negative results to one’s partner Women’s ability to devise strategies to encourage partner testing “I think that what we can do is to bring children to hospital for HIV test…and show HIV card to the husband [so] that he is also called to the hospital to have his blood tested” (21 year old married female).	Willing to test in more confidential settings Trust in counsellors that are mature, friendly, and keep confidentiality