HIV Test Vending Machine Wins Award

Nicky Broyd

May 21, 2018

The world's first vending machine providing HIV tests was among the winning projects at the BMJ Awards 2018.

Innovation

Brighton and Sussex University Hospitals NHS Trust won Innovation Team of the Year for the world's first vending machine providing HIV tests. The judges said it "reduces stigma, has great interaction design, and has the potential to be used much more widely - a whole new approach to testing."

In 2016 it was estimated that 89,400 people in England were living with HIV infection, 10,400 of whom were unaware they had the virus. The aim of the vending machine was to access those parts of the population that were normally hard to reach and didn't use conventional services. 

Installed at a gay sauna in Brighton which sees around 400 men a week, the touch-screen digital vending machine was designed to ensure more people got themselves tested by dispensing free, HIV testing kits, quickly and discreetly.

The test requires just one drop of blood and takes 15 minutes.

Dr Gillian Dean, HIV Consultant at Brighton & Sussex University Hospitals NHS trust & a trustee of the Martin Fisher Foundation which is working towards zero HIV infection, told Medscape News UK that it was the owner of the sauna who got them thinking: "He was chatting and said, 'Oh, you know, I've noticed that lots of people are taking risk, we need to do more testing. The THT [Terrence Higgins Trust] workers are coming in twice a week, which is great, but a lot of men give them a wide berth, don't engage with them… but I can see that they're taking lots of risk and they're very unlikely to come to conventional services because they're not typically gay men so to speak', and so it's that that got us thinking." 
 

Information

That was in 2015 when self-testing kits for HIV had just come on the market in the UK. Initially a box of free kits was simply put in the sauna reception. This resulted in some kits reappearing on eBay, but more importantly no information was gathered on who was using them. Dr Dean says: "So the beauty of the machine is that it's an interaction going on and whilst it's a fine balance, isn't it, between having an interaction and still putting those people off who gave the THT workers a wide berth and didn't want to interact with anything, at least then we get a bit of information." 

Users of the vending machine are asked to put in their mobile phone number, which is not stored. They then receive a unique code to their phone to key into the vending machine. Once this is given the client is asked for some basic epidemiological information including age, whether they are resident in Brighton and Hove, and when their last HIV test was. After this the test kit is dispensed along with a leaflet giving clear instructions on what to do in the event of a reactive or non-reactive test result.

Dr Dean says with the machine: "You know they've taken the kits, you know how old they are. We know whether they live in Brighton and Hove and we know when their last test was …. So we can see the proportion who've never tested, or haven't tested for a long time, or probably even more importantly, people who are testing regularly because that's more and more what we want to do these days in high risk populations, test them, really often, every 3 months if possible, and pick them up while they're super infectious with primary HIV infection." 
 

Success Rate

From June 2017 to March 2018 265 test kits were taken from the machine. Before that, fewer than five tests per month were completed by the outreach workers. 

Just under a quarter of people who used the vending machine said they had either never tested, or not tested in the past 12 months, and 95% said they would recommend the vending machine type testing to others.

It's not compulsory but people taking the HIV test kits from the vending machine are invited to fill out a post-test questionnaire. Dr Dean says: "We've had about 20% of people fill in the questionnaire and then we asked a lot more information about sexual practices and what they think about the machine and what their test result was. So, of the about 50 people who filled that in there was one person who said they were positive, and three preferred not to say, and then the rest said they were negative." 
 

Feedback

People interviewed about the vending machine said:

"It's great, it promotes awareness … it makes people start to think, 'Hey, am I being safe today, am I taking risks that I don't need to take?' I just think it's a fantastic idea."

Another said: "This is absolutely amazing, please continue this as it helps me to just grab a box and go home and do it in my own comfort without panicking and having to tell my entire sexual history."

"So much easier and accessible, less embarrassment. Great tool to use!!"

Future

The second generation of more robust, powerful and tamper-proof vending machines has already been built. Suggestions from testers for where they should go in the Brighton area include other gay venues, colleges, GP surgeries, and public toilets.

The newer machines have a contactless payment facility although Dr Dean hopes the tests in the sauna, which has such a high-risk population, can always be provided for free. 

The developers say the machine can be tailored for specific campaigns, can be altered to operate in different languages and plans are underway to have a sexually transmitted infections (STI) screening channel in addition to HIV. 

However, Dr Dean says that may prove more difficult as so many different kits might be needed: "Are you a heterosexual man, woman, gay man, trans man or woman, you know, actually stocking kits for all those people could get a bit complex." She says they are also looking into whether a vending machine delivering PrEP (pre-exposure prophylaxis - medicines to reduce the chance of contracting HIV) might be a possibility. 

The prototype vending machine was funded by Public Health England as part of the HIV Innovations grant 2016/7 and was a collaboration between the Martin Fisher Foundation, BioSure (the test manufacturer), designers, clinicians, researchers, patients, and the sauna owner.

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