Enhancing HIV Self-Testing Uptake through Syringe Vending Machines: A Case Study in Tbilisi, Georgia

Background: In Georgia, with an estimated 8,500 HIV cases, 17% remain unaware of their status, notably impacting high-risk groups. Late diagnoses pose a substantial challenge. Innovative measures are required to expand HIV testing for high-risk groups and improve accessibility within the community. 
Description: Since 2019, we have operated ten Syringe Vending Machines (SVM) in Tbilisi to distribute HIV prevention consumables to people who inject drugs (PWID). HIV self-test (HIVST) kits have been available through SVMs since January 2021. Real-time transaction logs have recorded the date/time, SVM location, beneficiary’s unique 15-digit code assigned by service centers, and the type of product vended. We intended to collect the testing outcome via SVM touch screen survey (pop up messages on screen every time the client who took HIVST comes to SVM), QR codes linked to online surveys, various messaging platforms. The questions asked were: (1) “Did you perform testing using the HIVST taken from SVM”” and (2) “If yes, how many red strips appeared on the test?”.Lessons learned: Between January 2021 and June 2024, total of 1,831 (173 women)
received 206,973 HIV prevention kits from SVMs. Over this period, 1,092 HIVST kits were obtained by the 453 unique clients. Questions about testing outcome were unswered on the SVM touch screen 450 times by the unique 270 clients. Some 215 clients reported 306 episodes of HIV testing. Some 29 individuals reported a positive result of the test. Despite offering other safe and confidential feedback options, none of the beneficiaries responded via other channels. We were unable to examine the post-test behaviors and linkage to care of those who were positive.Conclusions/Next steps: The integration of HIV self-tests into SVM is feasible, acceptable, innovative approach and represents a promising tool in the fight against HIV transmission among PWID and other key risk groups. SVMs have the potential to play an important role in expanding HIV testing and reducing the transmission. Further research is needed to evaluate the long-term impact on HIV testing rates, strategies for linkage to care, and the overall public health benefits of this approach.