Application of the COM-B model to facilitators and barriers to HIV and STI testing among people from Black African and Black Caribbean communities in the UK: a scoping review

Abstract

Objective: Individuals from Black African and Black Caribbean communities (black communities) in the UK bear a disproportionate burden of HIV and sexually transmitted infections (STIs), while exhibiting lower testing rates. The aim of the scoping review was to summarise interventions developed to increase HIV/STI testing among black communities in the UK and describe the facilitators and barriers that influence testing uptake in these populations, according to the Capability Opportunity Motivation Behaviour (COM-B) approach.

Methods: Six databases were systematically searched to identify quantitative, qualitative and mixed-method studies evaluating the effectiveness of HIV/STI testing interventions among black communities in the UK, published from 2000 onwards. The review was conducted in accordance with the Joanna Briggs Institute Framework of Evidence Synthesis and Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews guidelines. Data were analysed using thematic analysis, and the factors were mapped onto the COM-B model components.

Results: Twenty-two studies, of which 11 were available as abstracts only, were included. Twelve studies included testing provision and health promotion, six studies testing provision only and four health promotion only. Nineteen studies looked at HIV testing interventions only. Facilitators to testing included interventions that provided an understanding of STI and HIV risk, assured privacy for testers and normalised testing through integration into existing services and delivery in non-traditional settings by appropriately trained staff. Barriers to testing included interventions that were stigmatising through the choice of intervention settings and/or targeting of groups, low perceived risk and limited knowledge about infections among people from black communities, and limited engagement and partnership working with relevant community organisations and groups.

Conclusion: Multifaceted interventions that include health promotion and opportunities for testing, co-designed with and by local communities, are crucial in addressing the range of barriers and facilitators experienced by people from black communities.

Keywords: HIV; behavioral sciences; health promotion; health resources; sexual health.

Figure 1. Preferred Reporting Item for Systematic Reviews and Meta-Analyses (PRISMA) 2020 flow diagram. Adapted from the PRISMA 2020 template. Includes conference abstracts due to inclusion criteria.

Figure 2. Barriers to HIV and sexually transmitted infection (STI) testing at patient and service provider levels mapped to the subcomponents of Capability Opportunity Motivation Behaviour model.

Figure 3. Facilitators to HIV and sexually transmitted infection (STI) testing at patient and service provider levels mapped to the subcomponents of Capability Opportunity Motivation Behaviour model.