Table 2

Individual, interpersonal, organisational, contextual levels of barriers, facilitators and recommendations to implementation

Socioecological model	Themes	Barriers	Facilitators	Recommendations
Contextual	Sociocultural norms	Misleading by traditional beliefs Gender inequality		Incorporate gender-sensitive interventions to promote couples testing—examples include targeting men through community members, male peers and male-friendly ANCs
Contextual	Policy factors	Programme target are baby-centred and mandatory Lack of screening and management guidelines Limited programme coverage (eg, lack of involvement of private health facilities)	High political will	To deliver person-centred care to enhance women’s right across HIV/syphilis RDT services for pregnant women.
Organisational	Resources	Understaffing Absence of clinic supplies, including RDTs Inadequate financial support (eg, salary)	Job security Adequate financial support	Provision of a full two-way feedback loop and creation of a culture of openness among stakeholders Strengthen monitoring and supervision Sufficient transport infrastructure Clear procurement systems Accurate budgets Adequate training on stock and supply management
Organisational	Training	Inadequate comprehensive training in HIV/syphilis RDTs	Having access to routine training	Providing informative training sessions which are interactive, flexible, comprehensive and incorporate previous experience of other colleagues
Intrapersonal	Influence of health provider’s attitude	Lack of respect toward pregnant women (eg, neglected, threatened)	Good interaction and communication between healthcare workers and pregnant women
Intrapersonal	Support	Lack of support from partner, family and friends	Receiving support from partner, family, peers, healthcare workers, and communities Peer support from other healthcare workers Effective supervision and mentoring from practice managers
Interpersonal	Information	Lack of knowledge about infections and testing Lack of information about HIV/syphilis epidemiology and testing policy	High awareness about infections and testing	Initiating testing services and introducing knowledge of diseases prior to pregnancy Providing information and testing for women before pregnancy
	Fear, beliefs motivation, and experience	Fear and shame regarding having a positive result; Low risk perception of infections; Low level of trust on RDTs Lack of confidence of performing test	Belief that RDTs could deliver a better service and provide- effective testing Recognise the benefit of RDTS as easy to use, accurate, convenient and time saving tool	Comprehensive training in HIV/syphilis RDTs Competence of implementing RDTs increases with use
	Characteristics of pregnant women	Financial hardship (eg, refugees, unemployed) Young age mothers who faced with social discrimination of pregnancy at their age		Psychosocial support and peer support to encourage pregnant women to attned ANCs and access HIV/syphilis testing

ANCs, antenatal clinics; RDTs, rapid diagnostic tests.