A Scoping Review using the COM-B Model to Examine the Barriers and Facilitators to Sexually Transmitted Infection Testing among African and Caribbean Heritage Communities in High-Income Countries

A Scoping Review using the COM-B Model to Examine the Barriers and Facilitators to Sexually Transmitted Infection Testing among African and Caribbean Heritage Communities in High-Income Countries | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Systematic Review A Scoping Review using the COM-B Model to Examine the Barriers and Facilitators to Sexually Transmitted Infection Testing among African and Caribbean Heritage Communities in High-Income Countries Temilola Adeniyi, Christie Cabral, Jeremy Horwood This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-5423720/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background: African and Caribbean communities in high-income countries face disproportionate sexually transmitted infection (STI) risks. In the US, the gonorrhoea rate among non-Hispanic Blacks is 7.7 times greater than that among non-Hispanic Whites, and the chlamydia rate is 5.6 times greater. In the UK, black caribbeans have the highest gonorrhoea and chlamydia rates among all ethnic minority groups. Identifying barriers to and facilitators of STI testing is crucial for developing effective interventions. This scoping review maps current evidence on multilevel factors influencing STI testing behaviours among these populations onto the COM-B (Capability, Opportunity, Motivation-Behaviour) model, which posits that capability (i.e., knowledge/skill), opportunity (i.e., social and environmental influence), and motivation (i.e., confidence/beliefs) are essential for engaging in a behaviour (i.e., STI testing). Methods: Two databases were searched for studies published between 2013 and 2024 on STI testing barriers and facilitators among African and Caribbean populations in high-income countries. Qualitative, quantitative, and mixed-methods studies were included. The titles/abstracts were screened, the data were charted, and the findings were synthesized via COM-B as an organizing framework. Results : Fifty-eight studies were included. The key capability barriers were low STI knowledge and language difficulties. Social opportunity barriers included stigma, discrimination, and lack of support. Clinic times and locations impeded physical opportunities. The motivation barriers were fear of positive results, cost, risk perception, confidentiality concerns, and competing priorities. The facilitators included awareness initiatives, treatment knowledge (capability), supportive networks, outreach (social opportunity), free testing, convenient options (physical opportunity), and risk perceptions, relationships, and incentives (motivation). Conclusion: This review highlights the complex interplay of COM-B factors influencing STI testing among African and Caribbean heritage communities, drawing attention to pervasive stigma and socioeconomic barriers. Multilevel interventions should enhance capability through education, opportunity via community coproduction and convenient testing, and motivation by addressing stigma and leveraging facilitators. Integrating an intersectionality lens and evaluating community-driven approaches are future directions for promoting sexual health equity. Infectious Diseases Preventive Medicine Sexually Transmitted Infections (STIs) STI Testing Barriers COM-B Model Health Disparities African and Caribbean Communities Public Health Interventions Health Equity High-Income Countries Behaviour Change Culturally Relevant Health Services Figures Figure 1 Figure 2 Figure 3 Background Sexually transmitted infections (STIs) are a major global public health concern, contributing significantly to the burden of disease worldwide. According to the World Health Organization, more than 1 million STIs are acquired every day, with far-reaching health consequences if left untreated ( 1 ). The impact of STIs is particularly pronounced among certain populations, including African and Caribbean Heritage (ACH) communities in high-income countries ( 1 ). Despite greater resources and access to healthcare in high-income countries, people in ACH communities disproportionately bear the burden of STIs such as HIV, chlamydia, and gonorrhoea in high-income countries compared with the general population ( 2 – 7 ). In the United States, the gonorrhoea rate among African Americans is 7.7 times greater than that among non-Hispanic whites, and the chlamydia rate is 5.6 times greater ( 8 ). Similarly, in the United Kingdom, black Caribbeans have the highest gonorrhoea and chlamydia rates among all ethnic minorities ( 9 ). Late STI/HIV diagnosis is common among Africans, enabling ongoing transmission ( 10 ). Undiagnosed STIs further increase the risk of HIV acquisition ( 11 ), perpetuating a vicious cycle of infection and transmission within these communities. Some studies provide insights into the barriers faced by ACH communities in accessing healthcare services in Europe, including language barriers, cultural differences, and a lack of awareness ( 5 , 12 ). These disparities underscore the urgent need to address the unique challenges faced by ACH communities in accessing sexual health services. Prior systematic reviews have examined healthcare access barriers among migrant populations in Europe, often with a focus on HIV testing and care ( 13 , 14 ). However, no reviews have focused specifically on STI testing barriers among people in ACH communities living in high-income countries. To enhance the understanding of the complex factors influencing STI testing, the COM-B behaviour change model provides a structured framework to identify key facilitators and barriers. The COM-B model posits that a behaviour (B), e.g., STI testing, is influenced by an individual having the capabilities (C) physically (skills) and psychologically (knowledge); opportunity (O) social (societal influence) and physical (environmental resources); and motivation (M) automatic (emotion) and reflective (beliefs, intentions)( 14 , 15 ). The COM-B model has been effectively utilized in various healthcare settings to understand behaviour change, including in the context of STI testing ( 13 , 14 ). By applying the COM-B (Capability, Opportunity, Motivation, and Behavior) model ( 14 ), this review will identify key capability, opportunity, and motivation barriers and facilitators influencing STI testing uptake in these populations. The findings from this review highlight the multilevel factors influencing STI uptake among ACH communities, revealing common themes and context-specific nuances. This scoping review aims to systematically search, map, and synthesize the existing evidence on barriers to and facilitators of STI testing experienced by ACH communities in high-income countries, using the COM-B model of behaviour change to inform the development of targeted interventions to improve STI testing uptake and reduce disparities. Methods Eligibility criteria: Studies were included in this scoping review if they investigated barriers or deterrents and/or facilitators to STI testing among ACH communities or black diasporic populations in high-income countries and met the eligibility criteria outlined in the supplementary file. Search strategy An initial scoping search was conducted to identify any existing reviews on barriers to and facilitators of STI testing among Africans and Caribbeans in high-income countries. One relevant systematic review focused on HIV testing among migrants in high-income countries ( 5 ). However, no review specifically addressing STI testing barriers and facilitators among African and Caribbean populations has been identified. To develop a comprehensive search strategy, a research librarian was consulted to identify relevant key terms and medical subject headings (MeSH) related to the study population (Africans and Caribbeans), phenomenon of interest (barriers and facilitators), outcome (STI testing) and context (high-income countries). The search strategy was limited by year (2013–2024) and language (English). Using the identified terms and criteria, a comprehensive search was conducted in two major databases (Embase and Medline), which were selected based on their broad coverage of relevant literature. The search strategy is presented in the additional file (see additional file 1). Upon completion, the searches from each database were documented and imported into a specific folder in the EndNote X7 software tool for managing bibliographies, citations, and references. Thereafter, all duplicates were removed. Relevant documents and reports from key websites were also added to the folder as they were pertinent to the introduction and discussion. The remaining records were exported to Rayyan for title and abstract screening and were shared with the research team. The first author, TA, reviewed all titles and abstracts for inclusion eligibility based on the defined inclusion and exclusion criteria (see Fig. 1 ). The first 200 records were independently double screened for inclusion by JJ and CC (100 each). TA, JJ and CC discussed cases where different decisions about inclusion had been made or where there was uncertainty about inclusion. This discussion continued until a consensus was reached about the inclusion criteria. Data Extraction: A data extraction form in Excel was used to extract relevant data from the included studies via TA, and the data were checked for accuracy by JH and CC. Inconsistencies were resolved through discussion. The extracted information included the following elements: author(s), paper title, year of publication, country, population size, study design, methods, theoretical framework (if applicable), barriers to STI testing, facilitators of STI testing, types of stigma (if reported), limitations, and recommendations for future research. See Table 1 for the summary of barriers and facilitators across the COM-B components. Data Synthesis: In synthesizing the findings, barriers and facilitators were mapped onto the COM-B (Capability, Opportunity, Motivation - Behaviour) framework ( 15 ) to understand the mechanisms influencing STI testing behaviour in these populations. See Fig. 2 and Fig. 3 . Results Study characteristics The 58 included studies represented research conducted predominantly in the United States (n = 40)( 16 – 55 ), the United Kingdom (n = 9)( 56 – 64 ), and Canada (n = 4)( 65 – 68 ), with some studies also from Australia (n = 2)( 69 , 70 ), France (n = 1)( 71 ), Ireland (n = 1)( 72 ) and China (n = 1)( 73 ). The studies focused on African and/or Caribbean populations, communities, and immigrants residing in these high-income countries. In terms of study design, there were 2 reviews, 31 qualitative studies utilizing methods such as focus groups and interviews, 21 quantitative studies including surveys and analyses of national datasets, and 4 mixed-methods studies combining qualitative and quantitative approaches. The qualitative studies allowed for in-depth exploration of barriers, facilitators, and experiences related to STI/HIV testing from the perspectives of the populations of interest. The sample sizes ranged from 14 to 91 participants. The quantitative studies had larger sample sizes ranging from 14 to 10,397 participants. Several studies have targeted key subpopulations, such as men who have sex with men( 17 , 31 , 40 , 45 , 50 – 52 , 61 ), youth/young adults( 21 , 33 , 38 , 40 , 45 , 48 , 49 , 51 , 58 , 64 , 74 ), HIV-serodiscordant couples( 16 ), and individuals with higher STI risk profiles( 47 , 49 , 53 ). A few studies have applied theoretical frameworks such as the PEN-3 model ( 27 ), comprehensive health-seeking and coping paradigm ( 24 ), Andersen's model of health care utilization ( 29 , 45 ), intersectionality theory ( 65 , 67 ), responsive evaluation framework ( 48 ), socioecological model ( 47 , 51 , 66 ), COM-B model ( 56 ), and ecodevelopmental theory ( 19 ). A table outlining the key characteristics of the included studies is presented in the supplementary file. (See additional file 2). Barriers and Facilitators to STI Testing: 1a. Capability barriers i. Low STI/HIV knowledge and awareness : Across multiple studies, a lack of knowledge and awareness about STI/HIV transmission, testing procedures, and available services was identified as a key barrier for ACH communities ( 19 , 34 , 35 , 43 , 58 , 60 , 62 , 64 – 66 ). Limited health literacy, campaigns, and advocacy have contributed to misconceptions about STI risk and susceptibility( 27 , 28 , 46 , 62 , 69 ). The specific knowledge gaps highlighted included being unaware of testing locations ( 59 , 72 ) and unfamiliar with self-testing methods ( 24 , 31 , 35 , 52 , 56 , 59 , 62 – 64 ). ii. Language Difficulties : Language difficulty was identified as a barrier to accessing information about testing, understanding test results, and communicating with healthcare providers ( 44 , 59 , 70 , 73 ). 1b. Capability Facilitators i. STI/HIV education and awareness : Increasing knowledge through community-based STI/HIV education and awareness initiatives and increased funding facilitated testing across studies ( 32 , 62 , 66 , 74 ). The incorporation of culturally relevant messaging and videos has helped enhance the resonance and impact of these awareness efforts ( 35 , 39 ). ii. Understanding STI treatment benefits : For those aware of current STI/HIV treatment effectiveness, studies have shown that this knowledge motivated testing by reducing the perceived consequences of a positive diagnosis ( 21 , 33 , 49 , 51 , 53 , 63 , 73 ). Evidence suggests that testing uptake can be enhanced through understanding STI/HIV transmission mechanisms, coupled with clear instructions for self-testing kits ( 24 , 63 , 73 , 74 ). 2a. Opportunity Barriers Social Opportunity Barriers i. HIV/STI stigma : Stigma surrounding HIV/STIs has emerged as a pervasive social opportunity barrier across numerous studies ( 17 , 18 , 22 , 23 , 25 , 26 , 33 , 36 , 38 , 39 , 43 – 45 , 48 , 52 , 56 , 58 , 62 , 63 , 65 , 66 , 69 , 72 ). Different forms of stigma, including perceived stigma and felt stigma from communities( 27 , 36 , 64 , 65 , 73 ); experienced stigma and discrimination from healthcare providers( 46 , 51 , 53 , 62 , 66 , 70 , 72 ); intersectional stigma, where the impact of HIV/STI stigma intersects with other forms of stigma, including racism, xenophobia, homophobia, and stigma towards sex work; migration status; drug and substance use; and gender identities( 17 , 25 , 26 , 52 , 53 ); and institutionalized stigma within healthcare systems( 17 , 65 , 72 ), have been highlighted. Stigma led to fears of judgment, rejection, and fear of disclosing status. ii. Discrimination : In addition to HIV/STI stigma, studies have identified experiences of racial/ethnic discrimination ( 17 , 50 , 61 , 65 – 67 , 73 ), homophobia ( 17 , 50 ), cultural insensitivity ( 62 ), and discrimination related to immigration status ( 44 , 47 , 67 ) as key social barriers restricting opportunities for testing access. Mistrust in healthcare systems due to historical injustices towards minority groups has also manifested as a barrier ( 53 , 58 , 64 , 65 ). iii. Lack of Community Support : Multiple studies have highlighted how isolation, shame, and lack of supportive social networks undermine testing ( 19 – 21 , 33 , 35 , 39 , 46 , 52 , 53 , 56 , 62 , 72 ). This lack of community acceptance and affirmation hampered opportunities for testing. Poor links with community organisations were identified as deterrents ( 62 ). Negative stories such as HIV as a ‘death sentence’ told by community members deterred people from testing ( 19 , 46 , 70 ). iv. Cultural Norms and Expectations : Cultural norms and expectations influence testing behaviours, with some norms serving as barriers (e.g., prohibitions around discussing sexual health and assumptions of immoral behaviour) ( 38 , 58 , 62 , 64 , 69 ). Religious and moral beliefs also factored into shaping norms around testing in certain communities, associating HIV testing with perceived immoral behaviour ( 27 , 58 , 62 , 64 , 66 ). v. Gender differences : Gender differences emerged regarding barriers, with studies highlighting how African/Caribbean women faced additional barriers such as gender power dynamics, enacted stigma, and cultural expectations around femininity norms such as expectations of sexual purity ( 26 , 62 , 74 ). Poor healthcare-seeking behaviour in men influences their testing decisions, stemming from the perception that seeking healthcare is a sign of weakness ( 62 ). vi. Inadequate Provider Training and Support : Health providers had limited training on proper STI guidelines and counselling ( 62 ). This lack of comprehensive education and support for healthcare professionals can lead to missed opportunities for STI testing, inadequate pre- and post-testing counselling, and suboptimal patient experiences when accessing testing services. Physical Opportunity Barriers i. Poverty/cost issues : Financial barriers due to a lack of health insurance coverage, poverty, and costs associated with testing services impede physical opportunities for testing( 16 , 22 , 29 , 30 , 33 , 34 , 42 , 44 , 45 , 47 , 48 , 66 , 67 , 70 – 72 ). ii . Inadequate testing facilities and services : Geographic inaccessibility of testing facilities, lack of information on testing locations, and lack of transportation options restrict testing opportunities, especially in rural and low-income areas ( 16 , 24 , 26 , 45 , 48 , 51 , 65 , 72 , 73 ). Other access barriers include inconvenient clinic hours, excessive wait times, fragmentation of services, and lack of walk-in appointments ( 16 , 29 , 48 , 61 , 62 , 72 ). Concerns about a lack of privacy in testing locations and being seen in public appeared to be barriers ( 16 , 21 , 35 , 39 , 45 , 51 , 56 , 62 ). This prevented some from accessing testing services through regular healthcare channels. iii . High-risk subgroups : For subgroups such as men who have sex with men and serodiscordant couples, drug and substance users may have limited access to STI testing services in their physical environments, particularly if they are homeless or live in areas with high drug use prevalence ( 17 , 25 , 49 , 52 , 53 ). 2b. Opportunity Facilitators Social Opportunity Facilitators i. Supportive social networks : Having supportive friends, family members, being married or in a cohabiting relationship, peers and community ties that encouraged testing, and emerged as important social facilitators ( 19 , 20 , 22 , 23 , 25 , 29 , 32 , 33 , 41 , 45 , 51 , 62 , 66 ). Involving trusted peers and community leaders in testing promotion enhances opportunities ( 32 , 41 ). ii. Community outreach and partnerships : Successful interventions involve community organizations, faith-based groups, businesses, and culturally relevant venues to integrate testing and outreach( 33 , 35 , 38 , 62 , 66 ). iii. Absence of discrimination : Experiencing no recent discrimination creates a supportive social environment that enhances the opportunity for individuals to access STI testing services without fear or apprehension ( 16 , 31 , 38 ). When individuals feel safe and respected, they are more likely to seek out and utilize available healthcare services, including STI testing ( 16 , 38 , 62 ). iv. Situational Opportunity : Prompting that individuals seek STI testing as part of immigration requirements increases testing ( 42 ). Similarly, being offered testing by a healthcare provider during a medical visit provides a specific opportunity for individuals to access testing services conveniently ( 42 , 62 ). v. Cultural sensitivity training for providers : This enhances the ability of healthcare providers to understand and respond effectively to the cultural needs and preferences of ACH communities ( 46 , 62 , 72 ). This training equips providers with the knowledge, skills, and confidence to deliver STI testing services in a culturally competent manner. Physical Opportunity Facilitators i. Free/low-cost testing : Unsurprisingly, free or low-cost STI/HIV testing services facilitated uptake by minimizing financial barriers across studies ( 40 , 45 , 51 , 72 ). This included free community-based testing events and the distribution of self-test kits without cost to users. ii. Convenient testing locations/options : Bringing testing to convenient community locations such as businesses, clinics, events, and facilities improved physical access opportunities ( 21 , 29 , 30 , 35 , 39 , 50 , 62 , 72 ). Short waits for results encouraged testing ( 24 , 34 ). Adopting innovative approaches such as self-testing, routine opt-out testing, and self-sampling kits further enhances convenience ( 40 , 44 , 46 , 53 , 56 , 63 , 68 , 70 ). iii. Confidentiality assurances : Clear assurances of confidentiality and privacy protections increase comfort and facilitate testing ( 30 , 46 , 62 , 72 ). Providing separate, private testing spaces within healthcare and community settings also helps address confidentiality concerns as a facilitator ( 46 ). 3a. Motivation Barriers Automatic Motivation Barriers i. Fear/anxiety about testing or results : Multiple studies have indicated that fear represents a key motivation barrier, including fear of positive test results, fear of needles/blood draws, and generalized anxiety around being tested( 18 , 21 , 22 , 24 , 25 , 27 , 30 , 32 , 33 , 48 , 50 – 52 , 62 , 63 , 66 ). Anticipated stigma and worries about health/life implications contributed to these fears. Reflective Motivation Barriers i. Anticipated negative consequences : Participants frequently cited concerns about negative repercussions and life disruptions because of testing positive, which undermined their motivation to be tested ( 44 , 47 , 67 , 71 ). The anticipated consequences included HIV stigma, relationship conflicts/dissolution, impacts on immigration status, and the loss of employment/housing opportunities. Some participants indicated that they had prior negative experiences with testing (e.g., specific counsellors/healthcare providers) ( 30 , 31 ). ii. Low-Risk Perception : Even when aware of STIs, many individuals within these communities do not perceive themselves at risk, which reduces their motivation to be tested ( 18 , 21 , 23 , 26 , 27 , 29 , 42 , 48 , 51 , 60 , 62 , 65 , 69 , 73 ). Low-risk perceptions are linked to assumptions such as considering oneself low risk due to monogamous relationships ( 22 , 27 , 28 ), a lack of visible symptoms ( 52 ), or young age ( 22 ). iii. Confidentiality concerns : In addition to privacy opportunity barriers, confidentiality emerged as a distinct motivation barrier where distrust and doubts about ensuring confidentiality discouraged testing ( 16 , 27 , 29 , 48 , 51 , 62 , 70 , 71 ). This stemmed from fears of test results becoming public, distrust in the ability of the healthcare system to protect their personal information, and associations with HIV/STIs in smaller communities. iv. Competing priorities : For some individuals, low prioritization of sexual health relative to basic needs such as housing/employment and immediate life stressors reduces their motivation to seek testing ( 46 , 48 , 62 ). Drug and substance users may have competing priorities or a lack of self-efficacy in managing their health ( 53 ). This motivation barrier frequently intersects with the socioeconomic disadvantages faced by the population. 3b. Motivation Facilitators Reflective motivation Facilitators i . Perceived risk/suspected exposures : Across studies, individuals' motivation for testing increased when they perceived themselves to be at higher HIV/STI risk through experiences such as recent unprotected sexual encounters, symptoms of infection, previous STI diagnosis, pregnancy, having multiple partners, or suspected exposure events ( 18 , 21 , 25 , 49 , 51 , 57 ). ii. New relationships/partners : The formation of new sexual partnerships has emerged as a common motivator and catalyst for seeking testing ( 21 , 25 , 31 , 53 ). This enabled partners to establish mutual knowledge of STI status before the initiation of sexual activity. iii. Incentives for testing : Several studies have shown that providing small monetary incentives or gift cards facilitates motivation and follow-through with testing ( 33 , 38 , 39 ). iv. Positive attitudes toward testing : Some individuals are motivated to seek STI testing because of their positive attitudes and beliefs about the importance of regular testing for maintaining good health( 31 , 51 , 53 , 74 ). These intrinsic factors, such as the belief that testing is a responsible and necessary part of self-care, facilitate regular testing behaviour. Older adults demonstrate a greater level of awareness of sexual health issues and understand the need to test them ( 22 , 74 ). Discussion This scoping review synthesized evidence on the barriers to and facilitators of STI testing among ACH communities in high-income countries. By applying the COM-B model, we identified factors influencing testing behaviours across capability, opportunity, and motivation dimensions. Capability barriers were dominated by low STI/HIV knowledge and language difficulties, whereas social opportunity barriers included stigma, discrimination, and inadequate social support systems. Physical opportunity barriers emerged from inaccessible testing services, whereas motivation barriers were often related to fear of positive results, concerns around confidentiality, and low perceived risk of infection. Facilitators included community-driven STI education programs, supportive social networks, culturally relevant outreach initiatives, and free or low-cost testing services. These findings highlight the multifaceted challenges these populations face, necessitating interventions to improve testing uptake. This review also revealed several cross-cutting themes and intersecting influences. Notably, intersectional influences such as race, ethnicity, gender, and socioeconomic status intensified the barriers to STI testing, particularly for vulnerable subgroups such as women, men who have sex with men (MSM), and recent immigrants. Intersectionality theory provides a useful framework for understanding how multiple social identities and systems of oppression interact to shape health inequities ( 75 ). Our findings demonstrate the importance of applying an intersectional approach to STI testing research and interventions in ACH communities. Recognizing the intersections of race, ethnicity, gender, sexual orientation, and other social determinants is crucial for developing tailored strategies that address the unique needs and experiences of diverse subgroups. Cultural norms and expectations played a significant role in shaping testing behaviours among African and Caribbean communities. These findings align with previous research highlighting the impact of cultural taboos and silence around sexual health issues on HIV/STI testing in African communities ( 76 ). Findings on gender differences resonate with the broader literature on gender inequities in sexual health, which highlights how patriarchal norms, intimate partner violence, and limited sexual autonomy disproportionately affect women's access to HIV/STI services ( 77 – 79 ). Poor healthcare-seeking behaviour among African/Caribbean men also influences their testing decisions ( 62 ), mirroring the global trends of men's underutilization of health services ( 80 ). Addressing gender-related barriers requires interventions that challenge harmful masculinity norms, promote women's empowerment, and engage men in sexual health initiatives. Limitations of this review include the inclusion of only English-language studies, which may have excluded relevant research from non-English-speaking countries. Variability in study designs, populations, and contexts also presented challenges for direct comparisons and synthesis. However, the use of a comprehensive search strategy, and a systematic approach, categorizing the barriers and facilitators according to the COM-B model, provides valuable insights into the factors influencing STI testing in ACH communities. Future research should prioritize implementation studies that evaluate the effectiveness of interventions addressing the identified barriers and facilitators. Interventions need to increase knowledge and awareness of STI and treatment; address misconceptions, fear and stigma; and increase awareness of susceptibility. They also need to promote the benefit of testing, early treatment and where and how to test. All promotional materials should be coproduced with communities to ensure that they are culturally acceptable, assessable and produced in multiple languages for key target audiences. Community-based participatory research (CBPR) ( 81 ), which actively engages ACH communities in all phases of the research process, is essential for ensuring the cultural relevance and sustainability of interventions. Intersectional analyses that examine how various social identities and systems of oppression interact to shape STI testing experiences and outcomes can inform tailored strategies for diverse subgroups within these communities. This could involve partnerships with trusted community organizations to codesign and codeliver services that meet specific cultural needs, e.g., community-based outreach and testing in convenient and accessible locations. This can also provide social role models with which to overcome social opportunity barriers and increase motivation to test. This should be done in partnership with sexual health services that need to examine the experiences of ACH communities accessing their services to ensure that they are culturally sensitive and competent in overcoming distrust in health services stemming from historical inequities. Studies should also focus on underserved subgroups, such as sex workers and migrants, to develop targeted testing strategies that address their unique barriers and leverage relevant facilitators. Community-based outreach and partnerships with trusted organizations serving these subgroups can enhance engagement and participation in research and interventions. Longitudinal research is needed to assess the long-term impacts of interventions on STI testing uptake, sexual health outcomes, and health equity. Such studies can provide insights into the sustainability and scalability of interventions and identify potential adaptations or modifications needed to maintain effectiveness in diverse contexts. Conclusion In conclusion, this scoping review provides a comprehensive synthesis of the barriers to and facilitators of STI testing among African and Caribbean communities in high-income countries. The application of the COM-B model offers a structured framework for understanding the complex determinants of testing behaviours. Our findings underscore the urgent need for culturally responsive interventions that address capability, opportunity, and motivation barriers while harnessing identified facilitators. Policymakers, healthcare providers, and public health practitioners must prioritize the sexual health needs of African and Caribbean populations and work collaboratively with communities to develop and implement equitable STI testing strategies. Abbreviations STIs Sexually Transmitted Infections ACH African and Caribbean Heritage COM B-Capability, Opportunity, Motivation-Behaviour MeSH Medical Subject Headings MSM Men who have sex with men CBPR Community-based participatory research Declarations Ethics approval and consent to participate: Not applicable Consent for publication: Not applicable Availability of data and materials: All data generated or analysed during this study are included in this published article and its supplementary information files contains the search strategy and an excel table outlining the characteristics of included studies. Competing interests: The authors declares that they have no competing interests. Funding: This research was funded by the National Institute for Health and Care Research (NIHR), NIHR303377, and supported by the National Institute for Health Research Health Protection Research Unit in Behavioural Science and Evaluation at the University of Bristol. The views expressed are those of the authors and not necessarily those of the NIHR or the Department of Health and Social Care. Authors' contributions: The first author TA performed the literature search. All authors made significant contributions to the analysis and discussion of the findings. The first draft of the manuscript was prepared by the Temilola Adeniyi, with Jeremy Horwood and Christie Cabral providing feedback on earlier versions. All authors reviewed and approved the final manuscript. Acknowledgements: The authors would like to thank NIHR for their financial support. Authors' information: Temilola Adeniyi: https://orcid.org/0009-0006-6752-1304 Christie Cabral: https://orcid.org/0000-0002-9884-0555 Jeremy Horwood: https://orcid.org/0000-0001-7092-4960 References Sinka K (2024) The global burden of sexually transmitted infections. 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Nov 19 [cited 2024 Oct 16]; https://oxfordre.com/anthropology/display/10.1093/acrefore/9780190854584.001.0001/acrefore-9780190854584-e-225 Tables Table 1 Summary of barriers and facilitators across the COM-B components COM-B Component Barrier Source Facilitator Source Capability Low STI/HIV knowledge and awareness ( 19 , 34 , 35 , 43 , 58 , 60 , 62 , 64 – 66 ) STI/HIV education and awareness ( 32 , 62 , 66 , 74 ) Language Difficulties ( 44 , 59 , 70 , 73 ) Understanding STI treatment benefits ( 21 , 33 , 49 , 51 , 53 , 63 , 73 ) Social Opportunity STI/HIV Stigma ( 17 , 18 , 22 , 23 , 25 , 26 , 33 , 36 , 38 , 39 , 43 – 45 , 48 , 52 , 56 , 58 , 62 , 63 , 65 , 66 , 69 , 72 ) Supportive social networks ( 19 , 20 , 22 , 23 , 25 , 29 , 32 , 33 , 41 , 45 , 51 , 62 , 66 ) Lack of Community Support ( 19 – 21 , 33 , 35 , 39 , 46 , 52 , 53 , 56 , 62 , 72 ) Community outreach and partnerships ( 33 , 35 , 38 , 62 , 66 ) Discrimination ( 17 , 50 , 61 , 65 – 67 , 73 ) Absence of discrimination ( 16 , 31 , 38 ) Cultural norms and expectations ( 38 , 58 , 62 , 64 , 69 ) Situational opportunity ( 42 , 62 ) Inadequate Provider Training and Support ( 62 ) Cultural sensitivity training for providers ( 46 , 62 , 72 ) Gender differences ( 26 , 62 , 74 ) Physical Opportunity Poverty/cost issues ( 16 , 22 , 29 , 30 , 33 , 34 , 42 , 44 , 45 , 47 , 48 , 66 , 67 , 70 – 72 ) Free/low-cost testing ( 40 , 45 , 51 , 72 ) Inadequate testing facilities and services ( 16 , 24 , 26 , 45 , 48 , 51 , 65 , 72 , 73 ) Convenient testing locations/options ( 23 , 31 , 32 , 37 , 41 , 52 , 64 , 74 ) ( 42 , 46 , 48 , 55 , 58 , 65 , 70 , 72 ) High-risk subgroups ( 17 , 25 , 49 , 52 , 53 ) Confidentiality assurances ( 30 , 46 , 62 , 72 ) Motivation Fear/anxiety about testing or results ( 18 , 21 , 22 , 24 , 25 , 27 , 30 , 32 , 33 , 48 , 50 – 52 , 62 , 63 , 66 ) Perceived risk/suspected exposures ( 18 , 21 , 25 , 49 , 51 , 57 ) Anticipated negative consequences ( 44 , 47 , 67 , 71 ) New relationship/partners ( 21 , 25 , 31 , 53 ) Confidentiality concerns ( 16 , 27 , 29 , 48 , 51 , 62 , 70 , 71 ) Incentives for testing ( 33 , 38 , 39 ) Low-risk perception ( 18 , 21 , 23 , 26 , 27 , 29 , 42 , 48 , 51 , 60 , 62 , 65 , 69 , 73 ) Positive attitudes toward testing ( 31 , 51 , 53 , 74 ) Competing priorities ( 46 , 48 , 62 ) Additional Declarations The authors declare no competing interests. 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Adeniyi","email":"data:image/png;base64,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","orcid":"https://orcid.org/0009-0006-6752-1304","institution":"University of Bristol","correspondingAuthor":true,"prefix":"","firstName":"Temilola","middleName":"","lastName":"Adeniyi","suffix":""},{"id":376146151,"identity":"028f4992-effc-4155-8928-f14d7d92856f","order_by":1,"name":"Christie Cabral","email":"","orcid":"","institution":"University of Bristol","correspondingAuthor":false,"prefix":"","firstName":"Christie","middleName":"","lastName":"Cabral","suffix":""},{"id":376146152,"identity":"e6f2d763-8f4e-48cd-bacc-05cf8afed4f3","order_by":2,"name":"Jeremy Horwood","email":"","orcid":"https://orcid.org/0000-0001-7092-4960","institution":"University of Bristol","correspondingAuthor":false,"prefix":"","firstName":"Jeremy","middleName":"","lastName":"Horwood","suffix":""}],"badges":[],"createdAt":"2024-11-09 23:43:26","currentVersionCode":1,"declarations":{"humanSubjects":false,"vertebrateSubjects":false,"conflictsOfInterestStatement":false,"humanSubjectEthicalGuidelines":false,"humanSubjectConsent":false,"humanSubjectClinicalTrial":false,"humanSubjectCaseReport":false,"vertebrateSubjectEthicalGuidelines":false},"doi":"10.21203/rs.3.rs-5423720/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-5423720/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":69042205,"identity":"c43723af-a64c-4738-9507-f339172bed33","added_by":"auto","created_at":"2024-11-15 01:56:46","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":143000,"visible":true,"origin":"","legend":"\u003cp\u003eFlowchart showing the inclusion and exclusion criteria of the papers included in this study\u003c/p\u003e","description":"","filename":"floatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-5423720/v1/52b6c5ea7f69fefe022b1849.png"},{"id":69042206,"identity":"b4200b7e-ffaf-4810-93e7-4a523acc93fe","added_by":"auto","created_at":"2024-11-15 01:56:46","extension":"jpeg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":105944,"visible":true,"origin":"","legend":"\u003cp\u003eBarriers to STI testing mapped onto the COM-B model.\u003c/p\u003e","description":"","filename":"floatimage2.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-5423720/v1/98b9d91c47b6a3aa1409c89e.jpeg"},{"id":69042209,"identity":"52d296df-4ca4-48e0-851d-d6c9ca5d8e6d","added_by":"auto","created_at":"2024-11-15 01:56:46","extension":"jpeg","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":102634,"visible":true,"origin":"","legend":"\u003cp\u003eFacilitators for STI testing mapped onto the COM-B model.\u003c/p\u003e","description":"","filename":"floatimage3.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-5423720/v1/f1d03ab1f7eefef94f47afbc.jpeg"},{"id":69042809,"identity":"0bb80827-4c09-41f3-b06e-303438f5ea94","added_by":"auto","created_at":"2024-11-15 02:12:51","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1407131,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5423720/v1/11233ceb-73ad-4846-b4af-0e3106c1d36d.pdf"},{"id":69042207,"identity":"841b20ec-2b79-49c9-adbd-3a683e334838","added_by":"auto","created_at":"2024-11-15 01:56:46","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":728867,"visible":true,"origin":"","legend":"\u003cp\u003eInclusion and Exckusion Criteria\u003c/p\u003e","description":"","filename":"AdditionalFile1.docx","url":"https://assets-eu.researchsquare.com/files/rs-5423720/v1/553b2a343b36851a4400d67a.docx"},{"id":69042255,"identity":"8904c47f-6013-4c75-b823-312f0f079508","added_by":"auto","created_at":"2024-11-15 02:04:46","extension":"xlsx","order_by":2,"title":"","display":"","copyAsset":false,"role":"supplement","size":36447,"visible":true,"origin":"","legend":"\u003cp\u003eStudy Characteristics\u003c/p\u003e","description":"","filename":"AdditionalFile2.xlsx","url":"https://assets-eu.researchsquare.com/files/rs-5423720/v1/619de31b5cf2d81134154bde.xlsx"}],"financialInterests":"The authors declare no competing interests.","formattedTitle":"\u003cp\u003eA Scoping Review using the COM-B Model to Examine the Barriers and Facilitators to Sexually Transmitted Infection Testing among African and Caribbean Heritage Communities in High-Income Countries\u003c/p\u003e","fulltext":[{"header":"Background","content":"\u003cp\u003eSexually transmitted infections (STIs) are a major global public health concern, contributing significantly to the burden of disease worldwide. According to the World Health Organization, more than 1\u0026nbsp;million STIs are acquired every day, with far-reaching health consequences if left untreated (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). The impact of STIs is particularly pronounced among certain populations, including African and Caribbean Heritage (ACH) communities in high-income countries (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eDespite greater resources and access to healthcare in high-income countries, people in ACH communities disproportionately bear the burden of STIs such as HIV, chlamydia, and gonorrhoea in high-income countries compared with the general population (\u003cspan additionalcitationids=\"CR3 CR4 CR5 CR6\" citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e). In the United States, the gonorrhoea rate among African Americans is 7.7 times greater than that among non-Hispanic whites, and the chlamydia rate is 5.6 times greater (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e). Similarly, in the United Kingdom, black Caribbeans have the highest gonorrhoea and chlamydia rates among all ethnic minorities (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eLate STI/HIV diagnosis is common among Africans, enabling ongoing transmission (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e). Undiagnosed STIs further increase the risk of HIV acquisition (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e), perpetuating a vicious cycle of infection and transmission within these communities. Some studies provide insights into the barriers faced by ACH communities in accessing healthcare services in Europe, including language barriers, cultural differences, and a lack of awareness (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e). These disparities underscore the urgent need to address the unique challenges faced by ACH communities in accessing sexual health services.\u003c/p\u003e \u003cp\u003ePrior systematic reviews have examined healthcare access barriers among migrant populations in Europe, often with a focus on HIV testing and care (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e). However, no reviews have focused specifically on STI testing barriers among people in ACH communities living in high-income countries.\u003c/p\u003e \u003cp\u003eTo enhance the understanding of the complex factors influencing STI testing, the COM-B behaviour change model provides a structured framework to identify key facilitators and barriers. The COM-B model posits that a behaviour (B), e.g., STI testing, is influenced by an individual having the capabilities (C) physically (skills) and psychologically (knowledge); opportunity (O) social (societal influence) and physical (environmental resources); and motivation (M) automatic (emotion) and reflective (beliefs, intentions)(\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e). The COM-B model has been effectively utilized in various healthcare settings to understand behaviour change, including in the context of STI testing (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e). By applying the COM-B (Capability, Opportunity, Motivation, and Behavior) model (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e), this review will identify key capability, opportunity, and motivation barriers and facilitators influencing STI testing uptake in these populations. The findings from this review highlight the multilevel factors influencing STI uptake among ACH communities, revealing common themes and context-specific nuances.\u003c/p\u003e \u003cp\u003eThis scoping review aims to systematically search, map, and synthesize the existing evidence on barriers to and facilitators of STI testing experienced by ACH communities in high-income countries, using the COM-B model of behaviour change to inform the development of targeted interventions to improve STI testing uptake and reduce disparities.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eEligibility criteria:\u003c/h2\u003e \u003cp\u003eStudies were included in this scoping review if they investigated barriers or deterrents and/or facilitators to STI testing among ACH communities or black diasporic populations in high-income countries and met the eligibility criteria outlined in the supplementary file.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eSearch strategy\u003c/h3\u003e\n\u003cp\u003eAn initial scoping search was conducted to identify any existing reviews on barriers to and facilitators of STI testing among Africans and Caribbeans in high-income countries. One relevant systematic review focused on HIV testing among migrants in high-income countries (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e). However, no review specifically addressing STI testing barriers and facilitators among African and Caribbean populations has been identified.\u003c/p\u003e \u003cp\u003eTo develop a comprehensive search strategy, a research librarian was consulted to identify relevant key terms and medical subject headings (MeSH) related to the study population (Africans and Caribbeans), phenomenon of interest (barriers and facilitators), outcome (STI testing) and context (high-income countries). The search strategy was limited by year (2013\u0026ndash;2024) and language (English).\u003c/p\u003e \u003cp\u003eUsing the identified terms and criteria, a comprehensive search was conducted in two major databases (Embase and Medline), which were selected based on their broad coverage of relevant literature. The search strategy is presented in the additional file (see additional file 1). Upon completion, the searches from each database were documented and imported into a specific folder in the EndNote X7 software tool for managing bibliographies, citations, and references. Thereafter, all duplicates were removed. Relevant documents and reports from key websites were also added to the folder as they were pertinent to the introduction and discussion. The remaining records were exported to Rayyan for title and abstract screening and were shared with the research team.\u003c/p\u003e \u003cp\u003eThe first author, TA, reviewed all titles and abstracts for inclusion eligibility based on the defined inclusion and exclusion criteria (see Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). The first 200 records were independently double screened for inclusion by JJ and CC (100 each). TA, JJ and CC discussed cases where different decisions about inclusion had been made or where there was uncertainty about inclusion. This discussion continued until a consensus was reached about the inclusion criteria.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e\n\u003ch3\u003eData Extraction:\u003c/h3\u003e\n\u003cp\u003eA data extraction form in Excel was used to extract relevant data from the included studies via TA, and the data were checked for accuracy by JH and CC. Inconsistencies were resolved through discussion. The extracted information included the following elements: author(s), paper title, year of publication, country, population size, study design, methods, theoretical framework (if applicable), barriers to STI testing, facilitators of STI testing, types of stigma (if reported), limitations, and recommendations for future research. See Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e for the summary of barriers and facilitators across the COM-B components.\u003c/p\u003e\n\u003ch3\u003eData Synthesis:\u003c/h3\u003e\n\u003cp\u003eIn synthesizing the findings, barriers and facilitators were mapped onto the COM-B (Capability, Opportunity, Motivation - Behaviour) framework (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e) to understand the mechanisms influencing STI testing behaviour in these populations. See Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e and Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e.\u003c/p\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\n\u003ch2\u003eStudy characteristics\u003c/h2\u003e\n\u003cp\u003eThe 58 included studies represented research conducted predominantly in the United States (n\u0026thinsp;=\u0026thinsp;40)(\u003cspan class=\"CitationRef\"\u003e16\u003c/span\u003e\u0026ndash;\u003cspan class=\"CitationRef\"\u003e55\u003c/span\u003e), the United Kingdom (n\u0026thinsp;=\u0026thinsp;9)(\u003cspan class=\"CitationRef\"\u003e56\u003c/span\u003e\u0026ndash;\u003cspan class=\"CitationRef\"\u003e64\u003c/span\u003e), and Canada (n\u0026thinsp;=\u0026thinsp;4)(\u003cspan class=\"CitationRef\"\u003e65\u003c/span\u003e\u0026ndash;\u003cspan class=\"CitationRef\"\u003e68\u003c/span\u003e), with some studies also from Australia (n\u0026thinsp;=\u0026thinsp;2)(\u003cspan class=\"CitationRef\"\u003e69\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e70\u003c/span\u003e), France (n\u0026thinsp;=\u0026thinsp;1)(\u003cspan class=\"CitationRef\"\u003e71\u003c/span\u003e), Ireland (n\u0026thinsp;=\u0026thinsp;1)(\u003cspan class=\"CitationRef\"\u003e72\u003c/span\u003e) and China (n\u0026thinsp;=\u0026thinsp;1)(\u003cspan class=\"CitationRef\"\u003e73\u003c/span\u003e). The studies focused on African and/or Caribbean populations, communities, and immigrants residing in these high-income countries.\u003c/p\u003e\n\u003cp\u003eIn terms of study design, there were 2 reviews, 31 qualitative studies utilizing methods such as focus groups and interviews, 21 quantitative studies including surveys and analyses of national datasets, and 4 mixed-methods studies combining qualitative and quantitative approaches. The qualitative studies allowed for in-depth exploration of barriers, facilitators, and experiences related to STI/HIV testing from the perspectives of the populations of interest. The sample sizes ranged from 14 to 91 participants. The quantitative studies had larger sample sizes ranging from 14 to 10,397 participants. Several studies have targeted key subpopulations, such as men who have sex with men(\u003cspan class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e31\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e40\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e45\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e50\u003c/span\u003e\u0026ndash;\u003cspan class=\"CitationRef\"\u003e52\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e61\u003c/span\u003e), youth/young adults(\u003cspan class=\"CitationRef\"\u003e21\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e33\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e38\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e40\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e45\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e48\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e49\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e51\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e58\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e64\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e74\u003c/span\u003e), HIV-serodiscordant couples(\u003cspan class=\"CitationRef\"\u003e16\u003c/span\u003e), and individuals with higher STI risk profiles(\u003cspan class=\"CitationRef\"\u003e47\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e49\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e53\u003c/span\u003e). A few studies have applied theoretical frameworks such as the PEN-3 model (\u003cspan class=\"CitationRef\"\u003e27\u003c/span\u003e), comprehensive health-seeking and coping paradigm (\u003cspan class=\"CitationRef\"\u003e24\u003c/span\u003e), Andersen's model of health care utilization (\u003cspan class=\"CitationRef\"\u003e29\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e45\u003c/span\u003e), intersectionality theory (\u003cspan class=\"CitationRef\"\u003e65\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e67\u003c/span\u003e), responsive evaluation framework (\u003cspan class=\"CitationRef\"\u003e48\u003c/span\u003e), socioecological model (\u003cspan class=\"CitationRef\"\u003e47\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e51\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e66\u003c/span\u003e), COM-B model (\u003cspan class=\"CitationRef\"\u003e56\u003c/span\u003e), and ecodevelopmental theory (\u003cspan class=\"CitationRef\"\u003e19\u003c/span\u003e). A table outlining the key characteristics of the included studies is presented in the supplementary file. (See additional file 2).\u003c/p\u003e\n\u003c/div\u003e\n\u003ch3\u003eBarriers and Facilitators to STI Testing:\u003c/h3\u003e\n\u003cp\u003e\u003cstrong\u003e1a. Capability barriers\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ei. Low STI/HIV knowledge and awareness\u003c/strong\u003e: Across multiple studies, a lack of knowledge and awareness about STI/HIV transmission, testing procedures, and available services was identified as a key barrier for ACH communities (\u003cspan class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e34\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e35\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e43\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e58\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e60\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e62\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e64\u003c/span\u003e\u0026ndash;\u003cspan class=\"CitationRef\"\u003e66\u003c/span\u003e). Limited health literacy, campaigns, and advocacy have contributed to misconceptions about STI risk and susceptibility(\u003cspan class=\"CitationRef\"\u003e27\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e28\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e46\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e62\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e69\u003c/span\u003e). The specific knowledge gaps highlighted included being unaware of testing locations (\u003cspan class=\"CitationRef\"\u003e59\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e72\u003c/span\u003e) and unfamiliar with self-testing methods (\u003cspan class=\"CitationRef\"\u003e24\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e31\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e35\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e52\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e56\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e59\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e62\u003c/span\u003e\u0026ndash;\u003cspan class=\"CitationRef\"\u003e64\u003c/span\u003e).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eii. Language Difficulties\u003c/strong\u003e: Language difficulty was identified as a barrier to accessing information about testing, understanding test results, and communicating with healthcare providers (\u003cspan class=\"CitationRef\"\u003e44\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e59\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e70\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e73\u003c/span\u003e).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e1b. Capability Facilitators\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ei. STI/HIV education and awareness\u003c/strong\u003e: Increasing knowledge through community-based STI/HIV education and awareness initiatives and increased funding facilitated testing across studies (\u003cspan class=\"CitationRef\"\u003e32\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e62\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e66\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e74\u003c/span\u003e). The incorporation of culturally relevant messaging and videos has helped enhance the resonance and impact of these awareness efforts (\u003cspan class=\"CitationRef\"\u003e35\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e39\u003c/span\u003e).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eii. Understanding STI treatment benefits\u003c/strong\u003e: For those aware of current STI/HIV treatment effectiveness, studies have shown that this knowledge motivated testing by reducing the perceived consequences of a positive diagnosis (\u003cspan class=\"CitationRef\"\u003e21\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e33\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e49\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e51\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e53\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e63\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e73\u003c/span\u003e). Evidence suggests that testing uptake can be enhanced through understanding STI/HIV transmission mechanisms, coupled with clear instructions for self-testing kits (\u003cspan class=\"CitationRef\"\u003e24\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e63\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e73\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e74\u003c/span\u003e).\u003c/p\u003e\n\u003ch3\u003e2a. Opportunity Barriers\u003c/h3\u003e\n\u003cul\u003e\n\u003cli\u003e\n\u003cp\u003e\u003cstrong\u003eSocial Opportunity Barriers\u003c/strong\u003e\u003c/p\u003e\n\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003e\u003cstrong\u003ei. HIV/STI stigma\u003c/strong\u003e: Stigma surrounding HIV/STIs has emerged as a pervasive social opportunity barrier across numerous studies (\u003cspan class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e22\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e23\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e25\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e26\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e33\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e36\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e38\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e39\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e43\u003c/span\u003e\u0026ndash;\u003cspan class=\"CitationRef\"\u003e45\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e48\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e52\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e56\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e58\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e62\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e63\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e65\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e66\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e69\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e72\u003c/span\u003e). Different forms of stigma, including perceived stigma and felt stigma from communities(\u003cspan class=\"CitationRef\"\u003e27\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e36\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e64\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e65\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e73\u003c/span\u003e); experienced stigma and discrimination from healthcare providers(\u003cspan class=\"CitationRef\"\u003e46\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e51\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e53\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e62\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e66\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e70\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e72\u003c/span\u003e); intersectional stigma, where the impact of HIV/STI stigma intersects with other forms of stigma, including racism, xenophobia, homophobia, and stigma towards sex work; migration status; drug and substance use; and gender identities(\u003cspan class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e25\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e26\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e52\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e53\u003c/span\u003e); and institutionalized stigma within healthcare systems(\u003cspan class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e65\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e72\u003c/span\u003e), have been highlighted. Stigma led to fears of judgment, rejection, and fear of disclosing status.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eii. Discrimination\u003c/strong\u003e: In addition to HIV/STI stigma, studies have identified experiences of racial/ethnic discrimination (\u003cspan class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e50\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e61\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e65\u003c/span\u003e\u0026ndash;\u003cspan class=\"CitationRef\"\u003e67\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e73\u003c/span\u003e), homophobia (\u003cspan class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e50\u003c/span\u003e), cultural insensitivity (\u003cspan class=\"CitationRef\"\u003e62\u003c/span\u003e), and discrimination related to immigration status (\u003cspan class=\"CitationRef\"\u003e44\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e47\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e67\u003c/span\u003e) as key social barriers restricting opportunities for testing access. Mistrust in healthcare systems due to historical injustices towards minority groups has also manifested as a barrier (\u003cspan class=\"CitationRef\"\u003e53\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e58\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e64\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e65\u003c/span\u003e).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eiii. Lack of Community Support\u003c/strong\u003e: Multiple studies have highlighted how isolation, shame, and lack of supportive social networks undermine testing (\u003cspan class=\"CitationRef\"\u003e19\u003c/span\u003e\u0026ndash;\u003cspan class=\"CitationRef\"\u003e21\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e33\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e35\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e39\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e46\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e52\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e53\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e56\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e62\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e72\u003c/span\u003e). This lack of community acceptance and affirmation hampered opportunities for testing. Poor links with community organisations were identified as deterrents (\u003cspan class=\"CitationRef\"\u003e62\u003c/span\u003e). Negative stories such as HIV as a \u0026lsquo;death sentence\u0026rsquo; told by community members deterred people from testing (\u003cspan class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e46\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e70\u003c/span\u003e).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eiv. Cultural Norms and Expectations\u003c/strong\u003e: Cultural norms and expectations influence testing behaviours, with some norms serving as barriers (e.g., prohibitions around discussing sexual health and assumptions of immoral behaviour) (\u003cspan class=\"CitationRef\"\u003e38\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e58\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e62\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e64\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e69\u003c/span\u003e). Religious and moral beliefs also factored into shaping norms around testing in certain communities, associating HIV testing with perceived immoral behaviour (\u003cspan class=\"CitationRef\"\u003e27\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e58\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e62\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e64\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e66\u003c/span\u003e).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ev. Gender differences\u003c/strong\u003e: Gender differences emerged regarding barriers, with studies highlighting how African/Caribbean women faced additional barriers such as gender power dynamics, enacted stigma, and cultural expectations around femininity norms such as expectations of sexual purity (\u003cspan class=\"CitationRef\"\u003e26\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e62\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e74\u003c/span\u003e). Poor healthcare-seeking behaviour in men influences their testing decisions, stemming from the perception that seeking healthcare is a sign of weakness (\u003cspan class=\"CitationRef\"\u003e62\u003c/span\u003e).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003evi. Inadequate Provider Training and Support\u003c/strong\u003e: Health providers had limited training on proper STI guidelines and counselling (\u003cspan class=\"CitationRef\"\u003e62\u003c/span\u003e). This lack of comprehensive education and support for healthcare professionals can lead to missed opportunities for STI testing, inadequate pre- and post-testing counselling, and suboptimal patient experiences when accessing testing services.\u003c/p\u003e\n\u003cul\u003e\n\u003cli\u003e\n\u003cp\u003e\u003cstrong\u003ePhysical Opportunity Barriers\u003c/strong\u003e\u003c/p\u003e\n\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003e\u003cstrong\u003ei. Poverty/cost issues\u003c/strong\u003e: Financial barriers due to a lack of health insurance coverage, poverty, and costs associated with testing services impede physical opportunities for testing(\u003cspan class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e22\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e29\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e30\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e33\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e34\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e42\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e44\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e45\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e47\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e48\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e66\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e67\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e70\u003c/span\u003e\u0026ndash;\u003cspan class=\"CitationRef\"\u003e72\u003c/span\u003e).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eii\u003c/strong\u003e. \u003cstrong\u003eInadequate testing facilities and services\u003c/strong\u003e: Geographic inaccessibility of testing facilities, lack of information on testing locations, and lack of transportation options restrict testing opportunities, especially in rural and low-income areas (\u003cspan class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e24\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e26\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e45\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e48\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e51\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e65\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e72\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e73\u003c/span\u003e). Other access barriers include inconvenient clinic hours, excessive wait times, fragmentation of services, and lack of walk-in appointments (\u003cspan class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e29\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e48\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e61\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e62\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e72\u003c/span\u003e). Concerns about a lack of privacy in testing locations and being seen in public appeared to be barriers (\u003cspan class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e21\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e35\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e39\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e45\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e51\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e56\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e62\u003c/span\u003e). This prevented some from accessing testing services through regular healthcare channels.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eiii\u003c/strong\u003e. \u003cstrong\u003eHigh-risk subgroups\u003c/strong\u003e: For subgroups such as men who have sex with men and serodiscordant couples, drug and substance users may have limited access to STI testing services in their physical environments, particularly if they are homeless or live in areas with high drug use prevalence (\u003cspan class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e25\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e49\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e52\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e53\u003c/span\u003e).\u003c/p\u003e\n\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e\n\u003ch2\u003e2b. Opportunity Facilitators\u003c/h2\u003e\n\u003cul\u003e\n\u003cli\u003e\n\u003cp\u003e\u003cstrong\u003eSocial Opportunity Facilitators\u003c/strong\u003e\u003c/p\u003e\n\u003c/li\u003e\n\u003c/ul\u003e\n\u003cstrong\u003ei. Supportive social networks\u003c/strong\u003e: Having supportive friends, family members, being married or in a cohabiting relationship, peers and community ties that encouraged testing, and emerged as important social facilitators (\u003cspan class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e22\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e23\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e25\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e29\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e32\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e33\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e41\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e45\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e51\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e62\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e66\u003c/span\u003e). Involving trusted peers and community leaders in testing promotion enhances opportunities (\u003cspan class=\"CitationRef\"\u003e32\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e41\u003c/span\u003e).\u003cbr /\u003e\n\u003cp\u003e\u003cstrong\u003eii. Community outreach and partnerships\u003c/strong\u003e: Successful interventions involve community organizations, faith-based groups, businesses, and culturally relevant venues to integrate testing and outreach(\u003cspan class=\"CitationRef\"\u003e33\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e35\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e38\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e62\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e66\u003c/span\u003e).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eiii. Absence of discrimination\u003c/strong\u003e: Experiencing no recent discrimination creates a supportive social environment that enhances the opportunity for individuals to access STI testing services without fear or apprehension (\u003cspan class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e31\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e38\u003c/span\u003e). When individuals feel safe and respected, they are more likely to seek out and utilize available healthcare services, including STI testing (\u003cspan class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e38\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e62\u003c/span\u003e).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eiv. Situational Opportunity\u003c/strong\u003e: Prompting that individuals seek STI testing as part of immigration requirements increases testing (\u003cspan class=\"CitationRef\"\u003e42\u003c/span\u003e). Similarly, being offered testing by a healthcare provider during a medical visit provides a specific opportunity for individuals to access testing services conveniently (\u003cspan class=\"CitationRef\"\u003e42\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e62\u003c/span\u003e).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ev. Cultural sensitivity training for providers\u003c/strong\u003e: This enhances the ability of healthcare providers to understand and respond effectively to the cultural needs and preferences of ACH communities (\u003cspan class=\"CitationRef\"\u003e46\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e62\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e72\u003c/span\u003e). This training equips providers with the knowledge, skills, and confidence to deliver STI testing services in a culturally competent manner.\u003c/p\u003e\n\u003cul\u003e\n\u003cli\u003e\n\u003cp\u003e\u003cstrong\u003ePhysical Opportunity Facilitators\u003c/strong\u003e\u003c/p\u003e\n\u003c/li\u003e\n\u003c/ul\u003e\n\u003cstrong\u003ei. Free/low-cost testing\u003c/strong\u003e: Unsurprisingly, free or low-cost STI/HIV testing services facilitated uptake by minimizing financial barriers across studies (\u003cspan class=\"CitationRef\"\u003e40\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e45\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e51\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e72\u003c/span\u003e). This included free community-based testing events and the distribution of self-test kits without cost to users.\u003cbr /\u003e\n\u003cp\u003e\u003cstrong\u003eii. Convenient testing locations/options\u003c/strong\u003e: Bringing testing to convenient community locations such as businesses, clinics, events, and facilities improved physical access opportunities (\u003cspan class=\"CitationRef\"\u003e21\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e29\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e30\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e35\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e39\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e50\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e62\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e72\u003c/span\u003e). Short waits for results encouraged testing (\u003cspan class=\"CitationRef\"\u003e24\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e34\u003c/span\u003e). Adopting innovative approaches such as self-testing, routine opt-out testing, and self-sampling kits further enhances convenience (\u003cspan class=\"CitationRef\"\u003e40\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e44\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e46\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e53\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e56\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e63\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e68\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e70\u003c/span\u003e).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eiii. Confidentiality assurances\u003c/strong\u003e: Clear assurances of confidentiality and privacy protections increase comfort and facilitate testing (\u003cspan class=\"CitationRef\"\u003e30\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e46\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e62\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e72\u003c/span\u003e). Providing separate, private testing spaces within healthcare and community settings also helps address confidentiality concerns as a facilitator (\u003cspan class=\"CitationRef\"\u003e46\u003c/span\u003e).\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec12\" class=\"Section2\"\u003e\n\u003ch2\u003e3a. Motivation Barriers\u003c/h2\u003e\n\u003cul\u003e\n\u003cli\u003e\n\u003cp\u003e\u003cstrong\u003eAutomatic Motivation Barriers\u003c/strong\u003e\u003c/p\u003e\n\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003e\u003cstrong\u003ei. Fear/anxiety about testing or results\u003c/strong\u003e: Multiple studies have indicated that fear represents a key motivation barrier, including fear of positive test results, fear of needles/blood draws, and generalized anxiety around being tested(\u003cspan class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e21\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e22\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e24\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e25\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e27\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e30\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e32\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e33\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e48\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e50\u003c/span\u003e\u0026ndash;\u003cspan class=\"CitationRef\"\u003e52\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e62\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e63\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e66\u003c/span\u003e). Anticipated stigma and worries about health/life implications contributed to these fears.\u003c/p\u003e\n\u003cul\u003e\n\u003cli\u003e\n\u003cp\u003e\u003cstrong\u003eReflective Motivation Barriers\u003c/strong\u003e\u003c/p\u003e\n\u003c/li\u003e\n\u003c/ul\u003e\n\u003cstrong\u003ei. Anticipated negative consequences\u003c/strong\u003e: Participants frequently cited concerns about negative repercussions and life disruptions because of testing positive, which undermined their motivation to be tested (\u003cspan class=\"CitationRef\"\u003e44\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e47\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e67\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e71\u003c/span\u003e). The anticipated consequences included HIV stigma, relationship conflicts/dissolution, impacts on immigration status, and the loss of employment/housing opportunities. Some participants indicated that they had prior negative experiences with testing (e.g., specific counsellors/healthcare providers) (\u003cspan class=\"CitationRef\"\u003e30\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e31\u003c/span\u003e).\u003cbr /\u003e\n\u003cp\u003e\u003cstrong\u003eii. Low-Risk Perception\u003c/strong\u003e: Even when aware of STIs, many individuals within these communities do not perceive themselves at risk, which reduces their motivation to be tested (\u003cspan class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e21\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e23\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e26\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e27\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e29\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e42\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e48\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e51\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e60\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e62\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e65\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e69\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e73\u003c/span\u003e). Low-risk perceptions are linked to assumptions such as considering oneself low risk due to monogamous relationships (\u003cspan class=\"CitationRef\"\u003e22\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e27\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e28\u003c/span\u003e), a lack of visible symptoms (\u003cspan class=\"CitationRef\"\u003e52\u003c/span\u003e), or young age (\u003cspan class=\"CitationRef\"\u003e22\u003c/span\u003e).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eiii. Confidentiality concerns\u003c/strong\u003e: In addition to privacy opportunity barriers, confidentiality emerged as a distinct motivation barrier where distrust and doubts about ensuring confidentiality discouraged testing (\u003cspan class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e27\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e29\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e48\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e51\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e62\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e70\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e71\u003c/span\u003e). This stemmed from fears of test results becoming public, distrust in the ability of the healthcare system to protect their personal information, and associations with HIV/STIs in smaller communities.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eiv. Competing priorities\u003c/strong\u003e: For some individuals, low prioritization of sexual health relative to basic needs such as housing/employment and immediate life stressors reduces their motivation to seek testing (\u003cspan class=\"CitationRef\"\u003e46\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e48\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e62\u003c/span\u003e). Drug and substance users may have competing priorities or a lack of self-efficacy in managing their health (\u003cspan class=\"CitationRef\"\u003e53\u003c/span\u003e). This motivation barrier frequently intersects with the socioeconomic disadvantages faced by the population.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec13\" class=\"Section2\"\u003e\n\u003ch2\u003e3b. Motivation Facilitators\u003c/h2\u003e\n\u003cul\u003e\n\u003cli\u003e\n\u003cp\u003e\u003cstrong\u003eReflective motivation Facilitators\u003c/strong\u003e\u003c/p\u003e\n\u003c/li\u003e\n\u003c/ul\u003e\n\u003cstrong\u003ei\u003c/strong\u003e. \u003cstrong\u003ePerceived risk/suspected exposures\u003c/strong\u003e: Across studies, individuals' motivation for testing increased when they perceived themselves to be at higher HIV/STI risk through experiences such as recent unprotected sexual encounters, symptoms of infection, previous STI diagnosis, pregnancy, having multiple partners, or suspected exposure events (\u003cspan class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e21\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e25\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e49\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e51\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e57\u003c/span\u003e).\u003cbr /\u003e\n\u003cp\u003e\u003cstrong\u003eii. New relationships/partners\u003c/strong\u003e: The formation of new sexual partnerships has emerged as a common motivator and catalyst for seeking testing (\u003cspan class=\"CitationRef\"\u003e21\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e25\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e31\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e53\u003c/span\u003e). This enabled partners to establish mutual knowledge of STI status before the initiation of sexual activity.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eiii. Incentives for testing\u003c/strong\u003e: Several studies have shown that providing small monetary incentives or gift cards facilitates motivation and follow-through with testing (\u003cspan class=\"CitationRef\"\u003e33\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e38\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e39\u003c/span\u003e).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eiv. Positive attitudes toward testing\u003c/strong\u003e: Some individuals are motivated to seek STI testing because of their positive attitudes and beliefs about the importance of regular testing for maintaining good health(\u003cspan class=\"CitationRef\"\u003e31\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e51\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e53\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e74\u003c/span\u003e). These intrinsic factors, such as the belief that testing is a responsible and necessary part of self-care, facilitate regular testing behaviour. Older adults demonstrate a greater level of awareness of sexual health issues and understand the need to test them (\u003cspan class=\"CitationRef\"\u003e22\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e74\u003c/span\u003e).\u003c/p\u003e\n\u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003e This scoping review synthesized evidence on the barriers to and facilitators of STI testing among ACH communities in high-income countries. By applying the COM-B model, we identified factors influencing testing behaviours across capability, opportunity, and motivation dimensions. Capability barriers were dominated by low STI/HIV knowledge and language difficulties, whereas social opportunity barriers included stigma, discrimination, and inadequate social support systems. Physical opportunity barriers emerged from inaccessible testing services, whereas motivation barriers were often related to fear of positive results, concerns around confidentiality, and low perceived risk of infection. Facilitators included community-driven STI education programs, supportive social networks, culturally relevant outreach initiatives, and free or low-cost testing services. These findings highlight the multifaceted challenges these populations face, necessitating interventions to improve testing uptake.\u003c/p\u003e \u003cp\u003eThis review also revealed several cross-cutting themes and intersecting influences. Notably, intersectional influences such as race, ethnicity, gender, and socioeconomic status intensified the barriers to STI testing, particularly for vulnerable subgroups such as women, men who have sex with men (MSM), and recent immigrants. Intersectionality theory provides a useful framework for understanding how multiple social identities and systems of oppression interact to shape health inequities (\u003cspan citationid=\"CR75\" class=\"CitationRef\"\u003e75\u003c/span\u003e). Our findings demonstrate the importance of applying an intersectional approach to STI testing research and interventions in ACH communities. Recognizing the intersections of race, ethnicity, gender, sexual orientation, and other social determinants is crucial for developing tailored strategies that address the unique needs and experiences of diverse subgroups.\u003c/p\u003e \u003cp\u003eCultural norms and expectations played a significant role in shaping testing behaviours among African and Caribbean communities. These findings align with previous research highlighting the impact of cultural taboos and silence around sexual health issues on HIV/STI testing in African communities (\u003cspan citationid=\"CR76\" class=\"CitationRef\"\u003e76\u003c/span\u003e). Findings on gender differences resonate with the broader literature on gender inequities in sexual health, which highlights how patriarchal norms, intimate partner violence, and limited sexual autonomy disproportionately affect women's access to HIV/STI services (\u003cspan additionalcitationids=\"CR78\" citationid=\"CR77\" class=\"CitationRef\"\u003e77\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR79\" class=\"CitationRef\"\u003e79\u003c/span\u003e). Poor healthcare-seeking behaviour among African/Caribbean men also influences their testing decisions (\u003cspan citationid=\"CR62\" class=\"CitationRef\"\u003e62\u003c/span\u003e), mirroring the global trends of men's underutilization of health services (\u003cspan citationid=\"CR80\" class=\"CitationRef\"\u003e80\u003c/span\u003e). Addressing gender-related barriers requires interventions that challenge harmful masculinity norms, promote women's empowerment, and engage men in sexual health initiatives.\u003c/p\u003e \u003cp\u003eLimitations of this review include the inclusion of only English-language studies, which may have excluded relevant research from non-English-speaking countries. Variability in study designs, populations, and contexts also presented challenges for direct comparisons and synthesis. However, the use of a comprehensive search strategy, and a systematic approach, categorizing the barriers and facilitators according to the COM-B model, provides valuable insights into the factors influencing STI testing in ACH communities.\u003c/p\u003e \u003cp\u003eFuture research should prioritize implementation studies that evaluate the effectiveness of interventions addressing the identified barriers and facilitators. Interventions need to increase knowledge and awareness of STI and treatment; address misconceptions, fear and stigma; and increase awareness of susceptibility. They also need to promote the benefit of testing, early treatment and where and how to test. All promotional materials should be coproduced with communities to ensure that they are culturally acceptable, assessable and produced in multiple languages for key target audiences. Community-based participatory research (CBPR) (\u003cspan citationid=\"CR81\" class=\"CitationRef\"\u003e81\u003c/span\u003e), which actively engages ACH communities in all phases of the research process, is essential for ensuring the cultural relevance and sustainability of interventions. Intersectional analyses that examine how various social identities and systems of oppression interact to shape STI testing experiences and outcomes can inform tailored strategies for diverse subgroups within these communities. This could involve partnerships with trusted community organizations to codesign and codeliver services that meet specific cultural needs, e.g., community-based outreach and testing in convenient and accessible locations. This can also provide social role models with which to overcome social opportunity barriers and increase motivation to test. This should be done in partnership with sexual health services that need to examine the experiences of ACH communities accessing their services to ensure that they are culturally sensitive and competent in overcoming distrust in health services stemming from historical inequities.\u003c/p\u003e \u003cp\u003eStudies should also focus on underserved subgroups, such as sex workers and migrants, to develop targeted testing strategies that address their unique barriers and leverage relevant facilitators. Community-based outreach and partnerships with trusted organizations serving these subgroups can enhance engagement and participation in research and interventions. Longitudinal research is needed to assess the long-term impacts of interventions on STI testing uptake, sexual health outcomes, and health equity. Such studies can provide insights into the sustainability and scalability of interventions and identify potential adaptations or modifications needed to maintain effectiveness in diverse contexts.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eIn conclusion, this scoping review provides a comprehensive synthesis of the barriers to and facilitators of STI testing among African and Caribbean communities in high-income countries. The application of the COM-B model offers a structured framework for understanding the complex determinants of testing behaviours. Our findings underscore the urgent need for culturally responsive interventions that address capability, opportunity, and motivation barriers while harnessing identified facilitators. Policymakers, healthcare providers, and public health practitioners must prioritize the sexual health needs of African and Caribbean populations and work collaboratively with communities to develop and implement equitable STI testing strategies.\u003c/p\u003e "},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\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\"\u003eACH\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eAfrican and Caribbean Heritage\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eCOM\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eB-Capability, Opportunity, Motivation-Behaviour\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eMeSH\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eMedical Subject Headings\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\"\u003eCBPR\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eCommunity-based participatory research\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate:\u0026nbsp;\u003c/strong\u003eNot applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication:\u0026nbsp;\u003c/strong\u003eNot applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials:\u0026nbsp;\u003c/strong\u003eAll data generated or analysed during this study are included in this published article and its supplementary information files contains the search strategy and an excel table outlining the characteristics of included studies.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests:\u0026nbsp;\u003c/strong\u003eThe authors declares that they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding:\u0026nbsp;\u003c/strong\u003eThis research was funded by the National Institute for Health and Care Research (NIHR), NIHR303377,\u0026nbsp;and supported by\u0026nbsp;the\u0026nbsp;National Institute for Health Research Health Protection Research Unit in Behavioural Science and Evaluation at\u0026nbsp;the\u0026nbsp;University of Bristol. The views expressed are those of the authors and not necessarily those of the NIHR or the Department of Health and Social Care.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026apos; contributions:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe first author TA performed the literature search. All authors made significant contributions to the analysis and discussion of the findings. The first draft of the manuscript was prepared by the Temilola Adeniyi, with Jeremy Horwood and Christie Cabral providing feedback on earlier versions. All authors reviewed and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors would like to thank NIHR for their financial support.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026apos; information:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTemilola Adeniyi: https://orcid.org/0009-0006-6752-1304\u003c/p\u003e\n\u003cp\u003eChristie Cabral: https://orcid.org/0000-0002-9884-0555\u003c/p\u003e\n\u003cp\u003eJeremy Horwood: https://orcid.org/0000-0001-7092-4960\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eSinka K (2024) The global burden of sexually transmitted infections. 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citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e, \u003cspan additionalcitationids=\"CR44\" citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e, \u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e48\u003c/span\u003e, \u003cspan citationid=\"CR52\" class=\"CitationRef\"\u003e52\u003c/span\u003e, \u003cspan citationid=\"CR56\" class=\"CitationRef\"\u003e56\u003c/span\u003e, \u003cspan citationid=\"CR58\" class=\"CitationRef\"\u003e58\u003c/span\u003e, \u003cspan citationid=\"CR62\" class=\"CitationRef\"\u003e62\u003c/span\u003e, \u003cspan citationid=\"CR63\" class=\"CitationRef\"\u003e63\u003c/span\u003e, \u003cspan citationid=\"CR65\" class=\"CitationRef\"\u003e65\u003c/span\u003e, \u003cspan citationid=\"CR66\" class=\"CitationRef\"\u003e66\u003c/span\u003e, \u003cspan citationid=\"CR69\" class=\"CitationRef\"\u003e69\u003c/span\u003e, \u003cspan citationid=\"CR72\" class=\"CitationRef\"\u003e72\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eSupportive social networks\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e(\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e, \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e, \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e, \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e, \u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e, \u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e, \u003cspan citationid=\"CR51\" class=\"CitationRef\"\u003e51\u003c/span\u003e, \u003cspan citationid=\"CR62\" class=\"CitationRef\"\u003e62\u003c/span\u003e, \u003cspan citationid=\"CR66\" class=\"CitationRef\"\u003e66\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLack of Community Support\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(\u003cspan additionalcitationids=\"CR20\" citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e, \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e, \u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e, \u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e, \u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e, \u003cspan citationid=\"CR52\" class=\"CitationRef\"\u003e52\u003c/span\u003e, \u003cspan citationid=\"CR53\" class=\"CitationRef\"\u003e53\u003c/span\u003e, \u003cspan citationid=\"CR56\" class=\"CitationRef\"\u003e56\u003c/span\u003e, \u003cspan citationid=\"CR62\" class=\"CitationRef\"\u003e62\u003c/span\u003e, \u003cspan citationid=\"CR72\" class=\"CitationRef\"\u003e72\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eCommunity outreach and partnerships\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e(\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e, \u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e, \u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e, \u003cspan citationid=\"CR62\" class=\"CitationRef\"\u003e62\u003c/span\u003e, \u003cspan citationid=\"CR66\" class=\"CitationRef\"\u003e66\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDiscrimination\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR50\" class=\"CitationRef\"\u003e50\u003c/span\u003e, \u003cspan citationid=\"CR61\" class=\"CitationRef\"\u003e61\u003c/span\u003e, \u003cspan additionalcitationids=\"CR66\" citationid=\"CR65\" class=\"CitationRef\"\u003e65\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR67\" class=\"CitationRef\"\u003e67\u003c/span\u003e, \u003cspan citationid=\"CR73\" class=\"CitationRef\"\u003e73\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eAbsence of discrimination\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e(\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e, \u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCultural norms and expectations\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e, \u003cspan citationid=\"CR58\" class=\"CitationRef\"\u003e58\u003c/span\u003e, \u003cspan citationid=\"CR62\" class=\"CitationRef\"\u003e62\u003c/span\u003e, \u003cspan citationid=\"CR64\" class=\"CitationRef\"\u003e64\u003c/span\u003e, \u003cspan citationid=\"CR69\" class=\"CitationRef\"\u003e69\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eSituational opportunity\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e(\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e, \u003cspan citationid=\"CR62\" class=\"CitationRef\"\u003e62\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eInadequate Provider Training and Support\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(\u003cspan citationid=\"CR62\" class=\"CitationRef\"\u003e62\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eCultural sensitivity training for providers\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e(\u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e, \u003cspan citationid=\"CR62\" class=\"CitationRef\"\u003e62\u003c/span\u003e, \u003cspan citationid=\"CR72\" class=\"CitationRef\"\u003e72\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGender differences\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e, \u003cspan citationid=\"CR62\" class=\"CitationRef\"\u003e62\u003c/span\u003e, \u003cspan citationid=\"CR74\" class=\"CitationRef\"\u003e74\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePhysical Opportunity\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePoverty/cost issues\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e, \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e, \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e, \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e, \u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e, \u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e, \u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e, \u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e, \u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e, \u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e48\u003c/span\u003e, \u003cspan citationid=\"CR66\" class=\"CitationRef\"\u003e66\u003c/span\u003e, \u003cspan citationid=\"CR67\" class=\"CitationRef\"\u003e67\u003c/span\u003e, \u003cspan additionalcitationids=\"CR71\" citationid=\"CR70\" class=\"CitationRef\"\u003e70\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR72\" class=\"CitationRef\"\u003e72\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eFree/low-cost testing\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e(\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e, \u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e, \u003cspan citationid=\"CR51\" class=\"CitationRef\"\u003e51\u003c/span\u003e, \u003cspan citationid=\"CR72\" class=\"CitationRef\"\u003e72\u003c/span\u003e)\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\u003eInadequate testing facilities and services\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e, \u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e, \u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e48\u003c/span\u003e, \u003cspan citationid=\"CR51\" class=\"CitationRef\"\u003e51\u003c/span\u003e, \u003cspan citationid=\"CR65\" class=\"CitationRef\"\u003e65\u003c/span\u003e, \u003cspan citationid=\"CR72\" class=\"CitationRef\"\u003e72\u003c/span\u003e, \u003cspan citationid=\"CR73\" class=\"CitationRef\"\u003e73\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eConvenient testing locations/options\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e(\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e, \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e, \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e, \u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e, \u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e, \u003cspan citationid=\"CR52\" class=\"CitationRef\"\u003e52\u003c/span\u003e, \u003cspan citationid=\"CR64\" class=\"CitationRef\"\u003e64\u003c/span\u003e, \u003cspan citationid=\"CR74\" class=\"CitationRef\"\u003e74\u003c/span\u003e) (\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e, \u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e, \u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e48\u003c/span\u003e, \u003cspan citationid=\"CR55\" class=\"CitationRef\"\u003e55\u003c/span\u003e, \u003cspan citationid=\"CR58\" class=\"CitationRef\"\u003e58\u003c/span\u003e, \u003cspan citationid=\"CR65\" class=\"CitationRef\"\u003e65\u003c/span\u003e, \u003cspan citationid=\"CR70\" class=\"CitationRef\"\u003e70\u003c/span\u003e, \u003cspan citationid=\"CR72\" class=\"CitationRef\"\u003e72\u003c/span\u003e)\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\u003eHigh-risk subgroups\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e, \u003cspan citationid=\"CR49\" class=\"CitationRef\"\u003e49\u003c/span\u003e, \u003cspan citationid=\"CR52\" class=\"CitationRef\"\u003e52\u003c/span\u003e, \u003cspan citationid=\"CR53\" class=\"CitationRef\"\u003e53\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eConfidentiality assurances\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e(\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e, \u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e, \u003cspan citationid=\"CR62\" class=\"CitationRef\"\u003e62\u003c/span\u003e, \u003cspan citationid=\"CR72\" class=\"CitationRef\"\u003e72\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMotivation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFear/anxiety about testing or results\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e, \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e, \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e, \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e, \u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e48\u003c/span\u003e, \u003cspan additionalcitationids=\"CR51\" citationid=\"CR50\" class=\"CitationRef\"\u003e50\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR52\" class=\"CitationRef\"\u003e52\u003c/span\u003e, \u003cspan citationid=\"CR62\" class=\"CitationRef\"\u003e62\u003c/span\u003e, \u003cspan citationid=\"CR63\" class=\"CitationRef\"\u003e63\u003c/span\u003e, \u003cspan citationid=\"CR66\" class=\"CitationRef\"\u003e66\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePerceived risk/suspected exposures\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e(\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e, \u003cspan citationid=\"CR49\" class=\"CitationRef\"\u003e49\u003c/span\u003e, \u003cspan citationid=\"CR51\" class=\"CitationRef\"\u003e51\u003c/span\u003e, \u003cspan citationid=\"CR57\" class=\"CitationRef\"\u003e57\u003c/span\u003e)\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\u003eAnticipated negative consequences\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(\u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e, \u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e, \u003cspan citationid=\"CR67\" class=\"CitationRef\"\u003e67\u003c/span\u003e, \u003cspan citationid=\"CR71\" class=\"CitationRef\"\u003e71\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eNew relationship/partners\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e(\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e, \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e, \u003cspan citationid=\"CR53\" class=\"CitationRef\"\u003e53\u003c/span\u003e)\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\u003eConfidentiality concerns\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e, \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e, \u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e48\u003c/span\u003e, \u003cspan citationid=\"CR51\" class=\"CitationRef\"\u003e51\u003c/span\u003e, \u003cspan citationid=\"CR62\" class=\"CitationRef\"\u003e62\u003c/span\u003e, \u003cspan citationid=\"CR70\" class=\"CitationRef\"\u003e70\u003c/span\u003e, \u003cspan citationid=\"CR71\" class=\"CitationRef\"\u003e71\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eIncentives for testing\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e(\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e, \u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e, \u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e)\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\u003eLow-risk perception\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e, \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e, \u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e, \u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e48\u003c/span\u003e, \u003cspan citationid=\"CR51\" class=\"CitationRef\"\u003e51\u003c/span\u003e, \u003cspan citationid=\"CR60\" class=\"CitationRef\"\u003e60\u003c/span\u003e, \u003cspan citationid=\"CR62\" class=\"CitationRef\"\u003e62\u003c/span\u003e, \u003cspan citationid=\"CR65\" class=\"CitationRef\"\u003e65\u003c/span\u003e, \u003cspan citationid=\"CR69\" class=\"CitationRef\"\u003e69\u003c/span\u003e, \u003cspan citationid=\"CR73\" class=\"CitationRef\"\u003e73\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePositive attitudes toward testing\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e(\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e, \u003cspan citationid=\"CR51\" class=\"CitationRef\"\u003e51\u003c/span\u003e, \u003cspan citationid=\"CR53\" class=\"CitationRef\"\u003e53\u003c/span\u003e, \u003cspan citationid=\"CR74\" class=\"CitationRef\"\u003e74\u003c/span\u003e)\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\u003eCompeting priorities\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(\u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e, \u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e48\u003c/span\u003e, \u003cspan citationid=\"CR62\" class=\"CitationRef\"\u003e62\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[{"identity":"102e03b7-4ff7-4add-9044-655615321bd1","identifier":"10.13039/501100000272","name":"National Institute for Health Research","awardNumber":"NIHR303377","order_by":0}],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"University of Bristol","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Sexually Transmitted Infections (STIs), STI Testing Barriers, COM-B Model, Health Disparities, African and Caribbean Communities, Public Health Interventions, Health Equity, High-Income Countries, Behaviour Change, Culturally Relevant Health Services","lastPublishedDoi":"10.21203/rs.3.rs-5423720/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-5423720/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground:\u003c/strong\u003e African and Caribbean communities in high-income countries face disproportionate sexually transmitted infection (STI) risks. In the US, the gonorrhoea rate among non-Hispanic Blacks is 7.7 times greater than that among non-Hispanic Whites, and the chlamydia rate is 5.6 times greater. In the UK, black caribbeans have the highest gonorrhoea and chlamydia rates among all ethnic minority groups. Identifying barriers to and facilitators of STI testing is crucial for developing effective interventions. This scoping review maps current evidence on multilevel factors influencing STI testing behaviours among these populations onto the COM-B (Capability, Opportunity, Motivation-Behaviour) model, which posits that capability (i.e., knowledge/skill), opportunity (i.e., social and environmental influence), and motivation (i.e., confidence/beliefs) are essential for engaging in a behaviour (i.e., STI testing).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods:\u003c/strong\u003e Two databases were searched for studies published between 2013 and 2024 on STI testing barriers and facilitators among African and Caribbean populations in high-income countries. Qualitative, quantitative, and mixed-methods studies were included. The titles/abstracts were screened, the data were charted, and the findings were synthesized via COM-B as an organizing framework.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e: Fifty-eight studies were included. The key capability barriers were low STI knowledge and language difficulties. Social opportunity barriers included stigma, discrimination, and lack of support. Clinic times and locations impeded physical opportunities. The motivation barriers were fear of positive results, cost, risk perception, confidentiality concerns, and competing priorities.\u003c/p\u003e\n\u003cp\u003eThe facilitators included awareness initiatives, treatment knowledge (capability), supportive networks, outreach (social opportunity), free testing, convenient options (physical opportunity), and risk perceptions, relationships, and incentives (motivation).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion:\u003c/strong\u003e This review highlights the complex interplay of COM-B factors influencing STI testing among African and Caribbean heritage communities, drawing attention to pervasive stigma and socioeconomic barriers. Multilevel interventions should enhance capability through education, opportunity via community coproduction and convenient testing, and motivation by addressing stigma and leveraging facilitators. Integrating an intersectionality lens and evaluating community-driven approaches are future directions for promoting sexual health equity.\u003c/p\u003e","manuscriptTitle":"A Scoping Review using the COM-B Model to Examine the Barriers and Facilitators to Sexually Transmitted Infection Testing among African and Caribbean Heritage Communities in High-Income Countries","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-11-15 01:56:41","doi":"10.21203/rs.3.rs-5423720/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"58f0ec52-8df1-4186-8c7f-e801499be435","owner":[],"postedDate":"November 15th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":40106988,"name":"Infectious Diseases"},{"id":40106989,"name":"Preventive Medicine"}],"tags":[],"updatedAt":"2024-11-15T01:56:41+00:00","versionOfRecord":[],"versionCreatedAt":"2024-11-15 01:56:41","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-5423720","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-5423720","identity":"rs-5423720","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}