Acceptability of digital vending machines to access STI and HIV tests in two UK cities.

OBJECTIVES: Prompt HIV and STI diagnosis and treatment is a public health priority and relies on accessible testing. Technology-based approaches to distribute test kits have the potential to increase access to testing. We evaluated the acceptability and uptake of vending machines in publicly available settings in Brighton and Hove (BH) and Bristol, North Somerset and South Gloucestershire (BNSSG), to distribute HIV rapid self-test and STI self-sample kits. METHODS: Seven machines were installed in BH and four in BNSSG. User characteristics, proportion of kits returned and test results, taken from the machine database and clinic records, combined with online questionnaires completed by self-recruited users and analysed using Stata and SPSS. RESULTS: 2536 kits were dispensed over 12 months (April 2022 to March 2023). The STI self-sample kits were most popular (74% of vends). 78% of kits dispensed were among users aged 16-35 years and 56% identified as male. 68% and 59% of users had either not tested in the last 12 months or never tested for HIV and STIs, respectively. 51% of STI kits were returned via post, lower than the local online service (65%). 208 users completed questionnaires. Convenience, desire for instant access and increased confidentiality were the most common reasons for using machines. 92% of respondents thought the machines were user-friendly and 97% would recommend the service. Concerns about safety and privacy while using the machine were reported by 42% and 66% of respondents. CONCLUSIONS: This study demonstrates that vending machines are an acceptable and effective means of accessing infrequent or never testers in the general population and can act as a horizontal intervention to tackle HIV and STIs. Research is needed to understand optimal machine locations to assure privacy and safety along with the long-term impact on sexual health services.

Universal-offer HIV testing in primary care: A mixed-methods evaluation of a pilot study.

BACKGROUND: Offering HIV tests to all patients undergoing blood tests in primary care has been recommended by the National Institute for Health and Care Excellence (NICE) in the UK since 2016 but has not been fully adopted. We sought to evaluate the acceptability and feasibility of such a service in primary care. METHODS: A 3-weeks pilot of offering HIV tests to all patients undergoing blood tests was conducted in a general practice in the UK and evaluated using a mixed-methods approach. Whether patients were offered and accepted tests was recorded and any differences by patient's age and gender assessed. All patients and HCPs offering testing were approached for semi-structured interviews. RESULTS: Two-hundred-and-51 patients (mean [range] 57.5 years [18 to 97], 58% female) attended blood test appointments with 117 being offered a HIV test (46.6%). 78.6% (n = 92) accepted testing with 91 negative results. The proportion of patients offered testing was associated with the HCP offering the test. No associations between the age or gender of the patient and their odds of being offered or accepting a test were observed. Patient semi-structured interviews (n = 13) revealed a range of previous HIV testing experiences, patients felt the "offer" of a test to be routine and non-judgemental and felt that receiving negative results via SMS was appropriate. Several participants reported not fully considering the implications of a positive result when they accepted the test. Interviews with HCPs (n = 3) identified no significant service-level barriers. CONCLUSIONS: Offering HIV tests to patients undergoing blood tests in primary care is feasible and acceptable. The principal barrier to uptake was HCPs not offering testing.