Use of vending machines to deliver oral rapid HIV self-tests to Veterans: Protocol for a pilot study

Abstract: BACKGROUND: California has the largest number of people living with HIV in the United States, and in 2022, there were 4882 new diagnoses. Veterans with histories of substance use, viral hepatitis, sexually transmitted infections, and homelessness carry substantial HIV burden. Testing is essential, yet approximately 12% of Californians with HIV were undiagnosed in 2020, and 50% of veterans in care had never been tested as of 2023. HIV self-tests (HIVSTs) can mitigate stigma, confidentiality, and access barriers, and vending machines (VMs) offer private, convenient distribution. However, the use of VM-dispensed HIVST has not been evaluated for veterans or within Veterans Affairs (VA) settings. OBJECTIVE: We describe a Reach, Evaluation, Adoption, Implementation, and Maintenance-guided pre-implementation protocol to evaluate VM-dispensed HIVSTs in Northern California VA clinics and supportive housing settings. METHODS: Fifteen VMs will stock oral-fluid HIVSTs (n=900). Program data (de-identified dispense logs), veteran electronic surveys (n=90), and qualitative interviews (n=15) will quantify reach (uptake), early effectiveness proxies (use, results, and next steps), adoption (machine/site dispensing), implementation (stockouts, restocking interval, and costs), and maintenance (dispensing trends). RESULTS: Ethics approval activities (study material development and Institutional Review Board submission) began 2 months prior to the receipt of award funding (January to February 2025). Following funding, the project is planned for over a total of 18 months (12 months original project period + 6 months no-cost extension; March 2025 to August 2026). Ethics approval was obtained in August 2025. Veteran feedback was incorporated into study materials, and HIVSTs were purchased and packaged in September to November 2025. HIVSTs were added to VMs, and data collection is projected to occur from December 2025 through June 2026. Results are anticipated to be available in August 2026. CONCLUSIONS: This study will generate practice-ready evidence on the feasibility, acceptability, and early behavioral impacts of VM-dispensed HIVSTs for veterans. By pairing a stigma-responsive delivery channel with pragmatic measures, findings can inform equitable scale-up across VA and community settings, guide comparative evaluations of distribution channels (VMs, mail-to-home, or clinic pick-up), and support privacy-preserving linkage strategies to confirmatory testing, HIV pre-exposure prophylaxis, and treatment. Results will address a critical evidence gap for veteran-focused HIV prevention and provide parameters for multi-site evaluations.