Table 2 Quotes associated with the four domains from the interviews with lay providers and end users of HIV testing at AHF-Checkpoint

1. Accessibility of HIV testing

 1

So, we do not give priority to someone. Of course, we encourage MSM to test, because of their high risk. But we test everyone, we test heterosexuals, women with a very, very, very low risk. So, we do not say no to anyone. We test every person and that is what I like about AHF [Checkpoint] [Lay provider 4, MSM, 26 years]

 2

At the sexual health clinic you really have to fill out a very long form before you even can get an appointment. And if you get an appointment, it takes really three or four weeks [Lay provider 6, MSM, 38 years]

 3

They [SHC] are working from eight to four, and I can never reach them again. Why is not there a sexual health clinic open on Saturday for HIV testing or STI testing? … They are very strict when you come from a different zip code area … clients were annoyed [Lay provider 3, HIV infected, 52 years]

 4

Well, first of all it was near, I live close so that was good. Second, it's for free, so that’s a very plus. Third, it’s anonymous … I did not have to sign up … It was more like, you go there, you wait and then you get tested. … those were the three key aspects I would say [End user 3, MSM, 31 years]

 5

.. you will hear the result quickly. And two, you do not have to pay a deductible. It is free. And three, if you just test… then the stress just immediately decreases [End user 4, MSM, 22 years]

 6

To be true, it was not super easy to find, because it was kind of sketchy, you need to go into a closet store and then go upstairs. But once you are there.. at the same time, it is also kind of convenient, because, it is not that everybody can see that you are entering a testing facility for HIV … Although, we should not be ashamed of that [End user 3, MSM, 31 years]

 7

And that was within four or five text messages, we had arranged an appointment. I really liked it! [End user 1, MSM, 26 years]

 8

Because everyone is living in AZC [centre for asylum seekers] and we [refugees] do not have all the knowledge about the health care in The Netherlands. So, they wait in line… and half of them are MSM or transgender who are having sex with men. So, they wait ever since to test [for HIV]. So that's why my first testing experience with AHF was pretty good. I tested a lot, 60 tests! [Lay provider 4, MSM, former refugee, 26 years]

 9

So, it’s a different kind of people, they are mostly heterosexual and another community. So, they are not interested. You see the differences when you test at a gay festival or a queer festival. … You see another reaction ‘No I’m clean, no I’m clean’. So, they have this thing that they are clean [Lay provider 4, MSM, 26 years]

2. Quality of test procedures

 10

When they do not live in Amsterdam or are not insured, they are afraid, or they have no documents and are afraid that they will come into contact with the immigration police … People are.. they feel safe with us … if they are inside Checkpoint it is already a victory.” [Lay provider 2, MSM, 32 years]

 11

From my experience working with African populations abroad, I do understand the cultural barriers … The way they like to do things.. like the process that involves with gaining their trust and making sure you do things the right way before you even think about talking about testing with them [Lay provider 1, female, 40 years]

 12

.. a strong feature is just listening. Listen more. We want to help so badly and then we go straight to the help mode. But by just listening to the customer and listen to his story, “What happened?”, then you know exactly what kind of approach needs to be done [Lay provider 6, MSM, 38 years]

 13

[Addressing a panicked client] So, I start to relax them, I change the subject. I talk about the weather, I talk about pets. Anything else, just to make them ready for the test, because at Checkpoint it is not that busy. We have time to communicate with the client. This is a good thing! You can give him or her all the info they want [Lay provider 4, MSM, 26 years]

 14

It is not a subject that I discuss with friends or family. It is not that it has a stigma, but it is not that you are talking about it quickly. So, no, I would not know how they would react if I started talking about HIV testing. I have no idea [End user 5, MSM, 26 years]

 15

They always explain me first how the test works. … how you should read the result. Then they show me the results. So basically, I am part of the test! … and I can see the test working. So that, uh, gives more confidence [End user 3, MSM, 31 years]

 16

When I’m at Checkpoint … They (lay providers) should say “Okay now, you do not have HIV. By the way, we also recommend that you have a regular test on other STI's if you want. It is recommended. And these are places were you also could go in case you are interested”. But at least, OPEN THE DOOR! (to test for other STI’s) [End user 3, MSM, 31 years]

3. Bridging (transitional care)

 17

So, if I’m taking the shift on Saturday and someone comes with a reactive result. So, I need to take his info and tell him that on Monday someone will call you. And I do not like this thing, to be honest. Because we cannot refer on Saturday. Everything is closed. When someone has a reactive result, I do not think he can wait until Monday for support. It’s two days! [Lay provider 4, MSM, 26 years]

 18

If we just, kind of stop focusing. ‘I am my organisation AHF, you are PHS’. So, everyone does their own thing. We all have the same purpose, the same goal. So why not just work together and achieve what they all want? Together we are obviously stronger! [Lay provider 6, MSM, 38 years]

 19

So in Amsterdam, if someone comes to the Checkpoint and tested positive, we can send them to one place if they do not have insurance or if they're a refugee, or if they do have insurance we send them somewhere else … the lines are a little more clear. But when you're somewhere else (off-site testing), it's less familiar. You're not familiar with the event and the clientele. And then after the event and after the test where you can refer those people to? … I want a.. a liaison! [Lay provider 9, MSM, 26 years]

4. Future strategies for service delivery

 20

I’m assuming they [AHF-Checkpoint] already do that, but I think they might advertise even more with the fact that they exist and that you have the possibility to test. Maybe via social media too, (because) I know exactly how to look it up online and stuff, but it could be easier or more user-friendly [End user 2, MSM, 38 years]

 21

So that you no longer have to physically go to a place for a training, but that you develop a number of training courses yourself and that you can view them once in a while (E-learning)... Or make your own document, reference book, as an organization. I think it’s just important that you just make sure you have your own information available [Lay provider 7, MSM, 27 years]

 22

I have no idea of what are the symptoms for chlamydia or what are the symptoms for syphilis or any of the other STI's. I know, sort of.. when I was taught at school. But that is (a) long time ago [End user 3, MSM, 31 years]

  23

If you're going to do everything [STI testing], you’re not going to be successful. You have to be specific … One thing only and people who look for you, for one thing only … So it's better to be good in HIV testing, than bad in testing for all [STI] [Lay provider 4, MSM, 26 years]

 24

AHF, based on my experience, really only wants to test positive people. So they go looking for the people in the MSM-community. While I'm looking for the one or two people in the straight community who are also positive. But AHF says no! We have to cut costs, so we need positives, so we go more to the MSM-community… That's where we find most [HIV positive people] [Lay provider 3, MSM, 52 years]