Novel strategies are needed to increase HIV testing in high-risk groups including men who have sex with men (MSM), and to meet goals to reduce undiagnosed HIV. HIV self-testing is an attractive strategy enabling user autonomy in the timing, location and disclosure of testing as well as convenience. Self-testing also provides opportunities for providers to reach populations not engaged with conventional testing. We developed and evaluated a vending machine approach to target HIV self-testing to high-risk MSM in a UK community setting.
A cross-sectional survey in a sex-on-premises venue (sauna) assessed feasibility and informed development of a vending machine interface. Co-design workshops between designers and LGBT community volunteers explored attitudes towards self-testing and a vending machine interface to deliver HIV self-test kits in community settings (bars/clubs, pharmacies, university campuses and train stations). A bespoke vending machine distributing BioSure© self-test kits was installed in a sauna in this high-HIV-prevalence city (Brighton). A cross-sectional mixed methods evaluation was conducted with 30 users. Demographics were collected via the machine’s user-friendly touch-pad screen. An online questionnaire and structured interviews gathered information on user-experience of the machine, and experience, acceptability and attitudes towards HIV self-tests accessed via a machine.
The survey and co-design workshops found that 32% of 281 sauna users had never tested for HIV, despite high infection risks. Acceptability of self-testing before installation of the vending machine was 93%. A total of 95 testing kits were accessed between 8th July and 25th Sept 2017: mean age 35 (Range 18-65); 7.4% (n=7) had never tested for HIV before; 15.8% (n=15) had tested within the last 2-5 years. Uptake of tests was higher via the vending machine compared to HIV testing conducted by community outreach workers in the same venue and study period (95 vs 12). Qualitative interview and online questionnaires demonstrated high acceptability and support for this intervention, which was considered accessible and appropriately targeted.
Community co-design supported the development of an acceptable vending machine interface for the distribution of HIV self-testing kits. This delivered low-cost HIV self-tests to men with low levels of prior testing; and represents an acceptable targeted distribution method that could be applied in other settings.