Public finds vending machines dispensing HIV and STI self-test kits acceptable

Vending machines dispensing test kits for HIV and sexually transmitted infections (STIs) are acceptable to the public and staff at venues where they are located, suggests a study published in BMJ Open.

In 2022 the sexual health services led by University Hospitals Bristol and Weston NHS Foundation Trust introduced four vending machines for HIV and STI testing in Bristol, North Somerset and South Gloucestershire. Researchers from the National Institute for Health and Care Research Applied Research Collaboration West (NIHR ARC West) and the Health Protection Research Unit in Behavioural Science and Evaluation (HPRU) at the University of Bristol interviewed machine users, venue staff, sexual health service staff and commissioners to understand their views and experiences.

People using the service valued the machines for their convenience, instant access and ease of use, but the need to balance privacy and not being overlooked while using the machine in accessible, convenient, high footfall areas was raised by many. Maintenance and low stock issues also affected the user experience at times.

There were some challenges associated with running the service at the start. These included its quick introduction, a high number of users, limited resources and engagement with sexual health service staff. However, once these were resolved the service was easy to manage.

The vending machines offered two types of test kits which could be done at home. One was for chlamydia, gonorrhoea, HIV and syphilis. The other was an HIV mouth swab testing kit. A person using the first test kit sent their sample to a lab for free and got their results by text message in 1-3 weeks. Someone using the HIV testing kit swabs the inside of their cheek with a mouth swab to get a result in just 20 minutes.

Researchers also worked with target user groups and stakeholders to co-produce the service. They did this to ensure its design met the needs of those less likely to test through sexual health clinics, including black African and black Caribbean heritage communities, young people and men who have sex with men.

Making more testing available and easier to access is particularly important for groups who find it difficult to access sexual health clinics. Targeted and repeated promotion of the machines in settings accessed by priority groups is needed to ensure that people currently not accessing any sexual health service know about the machines and are encouraged to use them.

Dr Maya Gobin, lead author of the study, said:

“Using the person-based approach allowed us to meaningfully involve people from each priority group in the design of the service and promotional material.

“Evaluating the service in the early stages of its implementation also helped to quickly identify suggestions for improvements.

“More research is needed to understand further service experience and acceptability among people from African and black Caribbean heritage communities, young people and those who have not previously tested.”

Dr Jo Kesten, Research Fellow, NIHR ARC West and NIHR HPRU in Behavioural Science and Evaluation, who led the study, said:

“New services like these vending machines are important additions to sexual health services with the potential to reach target groups. A mixed methods evaluation of the machines in Bristol, North Somerset, South Gloucestershire (BNSSG) and Brighton and Hove found that uptake was high and over half of the people using the machines self-reported infrequent or never testing for HIV or STIs.

“This interview study provides a more detailed understanding of how the service was experienced by people using it and delivering it, with important lessons for other areas considering introducing similar services. Continued efforts are needed to ensure that promotional messages reach target groups to support access to the service among those who do not currently access sexual health services.”

The research was funded by University Hospitals Bristol and Weston NHS Foundation Trust and supported by National Institute for Health Research (NIHR) Applied Research Collaboration (ARC) West at University Hospitals Bristol and Weston NHS Foundation Trust and NIHR Health Protection Research Unit (HPRU) in Behavioural Science and Evaluation at University of Bristol, in partnership with UK Health Security Agency (UKHSA).