Table 2.

Major barriers to accepting HIV counseling and testing, categorized by their underlying behavioral determinants

Sample excerpts
MOTIVATION
A. Fear of HIV diagnosis	Male, 32, declined: [Testing for HIV] makes them get so worried because when they get to know that they are infected they will keep in constant fear… That makes people refuse to test for HIV. Female, 20, declined: She asked whether we would like to be tested and all those people refused…I also refused because I had fear. We all refused but later I went to [the clinic] and I was tested. Male, 16, accepted: I first got terrified a bit because I had spent a long time without testing and asked myself “In case I am infected, what will I do?” I had two hearts; one was saying that I have HIV and the other was saying that I am safe.
CAPABILITY
B. Feeling unprepared	Female, 28, declined: There were too many questions and that is why for some of the questions I kept on telling her “Let’s leave that…” You know…when she asked “When do you plan to test for HIV?” I told her “Give me some time…” I: Did she talk about HIV? Female, 28, declined: She talked about it but I wasn’t prepared by then and I asked her to give me some time. I: What made it so hard for you to have it done? Female, 28, declined: I was not prepared; I still had a shock. Female, 20, declined: I didn’t want to stay worried about it even though the CHW comforted us. I felt like I didn’t want to keep worried about being HIV-positive.
OPPORTUNITY
C. Not offered	Male, 51, declined: I wouldn’t have had any problem if she had come with the testing kits. Female, 36, declined: [HIV testing] is not bad…if they had come with all the testing kits they would have been able to do it but they never had the testing kits and that is why they requested me to go to the clinic.

Abbreviations: HCT, HIV Counseling and Testing

Legend: The COM-B model organizes determinants of behavior into three major domains. Capability, which refers to the capacity to perform a behavior, consists of physical and psychological sub-domains. Opportunity, which refers to the environmental context of a behavior, consists of physical and social sub-domains. Motivation, which refers to the internal influences that drive individuals to act on opportunities and capabilities, consists of automatic and reflective sub-domains. Motivation is automatic if it derives from emotion, desire, impulses, habits, or reflexes. For more details, see Supplemental Digital Content S2 (“COM-B model and BCW framework.”)