Introduction

Since becoming widely known in the early 1980s, HIV (Human Immunodeficiency Virus) has been one of the most feared and known viruses in the world.¹ The reason for this fear is that HIV can cause AIDS (Acquired Immunodeficiency Syndrome), in the 1980s there was no treatment and getting HIV was practically a death sentence, also the stigma (the Oxford Dictionary defines it as: “negative feelings that people have about particular circumstances or characteristics that somebody may have.”)² contributed to turn HIV/AIDS into the worst nightmare for many people.

HIV is a virus that gets into the body and destroys the person’s immune defences. At the same time, AIDS is the combination of symptoms that a person will have when, due to the lack of immune defences, gets many different diseases. When a person has multiple sexual partners and tends to have sex without a condom, those are high-risk sex encounters, so it is recommended to have testing for sex-transmitted infections (STI), including HIV. When detected early, HIV is treated to prevent patients from w going into the AIDS stage.³

I am sure that most of us have seen a vending machine, these machines are designed to expend a product after a payment has been made. The technology on these machines has evolved throughout the years. Initially, this was merely mechanical, but the development of smart vending software and the Internet of Things have changed this apparatus drastically. Nowadays, the name used is Digital Vending Machine, the software used allows the owner to know how is the stock, to have reports and obtain operational status in real-time.

These machines are used for dispensing medicines that can be sold over the counter in some places; no prescription is needed. This allows people to have access to those medicines 24/7.

In this article, we want to inform the public about how digital vending technology is being used in the HIV self-testing world. Also, we want to let them know the benefits and responsibilities of using it. 

Background information

Traditional methods of HIV testing

As with most medical examinations, HIV testing traditionally tends to be done in the laboratory; antibody test, antigen/antibody test, and Nucleic acid test (NAT). These exams will involve healthcare providers, this can be a barrier to receiving the services because many people as written before, fear the stigma, some have in mind that people will believe they are promiscuous, and the biggest fear is if the result is positive.³ 

In my personal experience, some patients have expressed to me that it would destroy their lives. Other barriers are accessibility and privacy concerns; there are places where most people know each other, and it is feared that someone could identify them.

Evolution of HIV self-testing

HIV self-testing can be used, and it’s easy to find university campuses, primary care clinics or public places with points where the HIV self-testing kits are provided for free or at low cost. These testing kits tend to be accurate, but it is recommended to perform a follow-up test if there is a positive result. These days, an HIV self-testing kit is as accurate as an ELISA test performed in a lab.⁴

The FDA (U.S. Food & Drug Administration) has approved just one brand for HIV Self-Testing, and it is OraQuick. Studies have shown that the sensitivity for this test is 97%, which means that if 12 persons are infected with HIV and the test is performed, 1 is going to receive a negative result. Other information shown by studies is that the test’s specificity is 99.98%, which means that if 5000 people uninfected with HIV are tested, just 1 will get a false positive result. Based on this information we can say the test is trustworthy.   

Digital vending technology in healthcare

Concept and functionality

A digital vending machine is a device which uses software, and mechanical & automated mechanisms for dispensing specific products once a payment has been made. These machines can use technology, such as touchscreens, mobile app integration, secure dispensing, and receive payment with coins, notes, cards and NFC technology (Near-field communication). Also, software and internet connection are other technologies these devices use.

Benefits of Digital Vending Machines

• Accessibility and convenience
• Anonymity and privacy
• Availability in non-traditional settings (e.g., public spaces, community centres)

Benefits of HIV self-testing through digital vending technology

Increased accessibility and reach

Having HIV self-testing through digital vending technology provides an easier way to provide services to high-risk populations and those underserved. It allows them to overcome barriers related to stigma and discrimination, people who could be restricted from going to a healthcare site for fear of being discriminated, stigmatised or identified by someone they might know would feel freer to have an HIV test. An example of this is the Martin Fisher Foundation project of placing machines for dispensing HIV self-testing kits in vending machines near places where men who have sex with men concur.⁵

Empowerment and autonomy

• This will enable individuals to take control of their health and decide when and where to have an HIV test
• It enhances confidentiality and reduces the fear of judgment the user might feel⁶

Public health impact

Having a bigger number of tests easily available to people can help with early detection and the linkage they will have to care. My experience providing healthcare to people living with HIV has taught me that on repeated occasions before some people know they are HIV positive; they have had intercourse with some other people, which makes the web bigger and bigger, making the goal of stopping transmission more difficult to reach.

Challenges and considerations

Potential Barriers to Adoption

Technological literacy and issues for accessing these machines could be potential barriers to adopting them. One more thing to consider is cultural and societal acceptance.

Ensuring Accuracy and Reliability

A whole mechanism to regulate the standards for vending machines, self-testing kits and quality control should be deployed. It has to take into account different environments, temperatures of venues, and the right conservation of kits so accurate results can be expected.

Supporting and educating the users is another important challenge. One more thing I have learnt from my journey as a physician for people living with HIV is that education and information users receive before and after results, will determine how they react and relate to care. Many people can get into a state of denial, others think life is over, and it is extremely important to make sure they know all the options they have, to make sure they know that they can still live a normal life and fulfill their dreams.

FAQs

What is HIV and why is it important to get tested?

HIV (Human Immunodeficiency Virus) is a virus that attacks the immune system, potentially leading to AIDS (Acquired Immunodeficiency Syndrome). Early detection through testing is crucial to prevent the progression of AIDS and to reduce the risk of transmission to others. Regular testing is recommended, especially for individuals with high-risk sexual behaviour.

What are the traditional methods of HIV testing and their limitations?

Traditional HIV testing methods include laboratory-based tests such as antibody tests, antigen/antibody tests, and Nucleic Acid Tests (NAT). These methods often require healthcare provider involvement, which can be a barrier due to stigma, fear of a positive result, accessibility issues, and privacy concerns, especially in small communities where people may know each other.

How has HIV self-testing evolved and what is its accuracy?

HIV self-testing has become more accessible, with kits available at universities, clinics, and public places, often for free or at low cost. The OraQuick self-test, approved by the FDA, has a sensitivity of 97% and a specificity of 99.98%, making it highly accurate. However, a follow-up test is recommended if the result is positive.

What is digital vending technology and how is it used in healthcare?

Digital vending machines are advanced devices using software and automated mechanisms to dispense products after payment. They accept various payment methods and offer real-time stock monitoring. In healthcare, they are used to dispense over-the-counter medicines and HIV self-testing kits, providing 24/7 access in various locations.

What are the benefits of using digital vending machines for HIV self-testing?

Digital vending machines offer:

• Accessibility and Convenience: Easy access to testing kits anytime
• Anonymity and Privacy: Users can discreetly obtain and use the kits
• Availability in Non-Traditional Settings: Placement in public spaces and community centres increases reach, especially among high-risk and underserved populations

What challenges might arise with the adoption of digital vending machines for HIV self-testing?

Challenges include technological literacy and access issues, cultural and societal acceptance, and ensuring the accuracy and reliability of the vending machines and self-testing kits. Education and support for users are essential to help them understand their results and access appropriate care, especially in the case of a positive test result.

Summary

HIV has been a major global health concern since the 1980s, largely due to its potential to develop into AIDS and the associated stigma. Traditional HIV testing methods, typically conducted in labs, often present barriers, such as fear of stigma, accessibility issues, and privacy concerns. The existence of HIV self-testing kits, for instance, the OraQuick, which has been approved by the U.S. Food & Drugs Administration, provides an alternative that allows accurate results and enables people to test themselves with discretion.

Digital vending machines represent a significant advancement in healthcare technology. These machines, equipped with smart software and internet connectivity, offer a convenient and anonymous way to access HIV self-testing kits. They can be placed in various locations, including public spaces and community centres, making HIV testing more accessible to high-risk and underserved populations. This approach helps overcome barriers related to stigma and discrimination, empowering individuals to take control of their health and ensuring confidentiality.

The increased availability of HIV self-testing through digital vending machines has the potential to significantly impact public health by facilitating early detection and linkage to care, ultimately aiding in the reduction of HIV transmission rates.

We encourage readers to utilise digital vending machines for HIV self-testing, taking advantage of the privacy, and convenience, they offer. It is crucial to promote awareness and education about HIV self-testing, ensuring that individuals understand the benefits and responsibilities associated with it. By doing so, we can work together to enhance public health outcomes and support those living with HIV.