By Dr Nikki Sullivan, South Australia Mobilisation + Empowerment for Sexual Health (SAMESH).

In 2021 the Australian Government Department of Health and Aged Care funded an HIV self-test (HIVST) pilot project as part of ‘Activities to Support the National Response to Blood Borne Viruses (BBVs) And Sexually Transmissible Infections (STI)’. The CONNECT pilot, which had an initial implemented period of twelve months, was run by Thorne Harbour Health (THH) in partnership with SHINE SA under the joint-partnership SAMESH program. Its aim was to test the efficacy of using vending machines to dispense free Atomo HIVST kits (the Atomo test is currently the only HIVST approved for use in Australia) in order to overcome barriers to testing and contribute to the attainment of United Nations 95-95-95 targets. The early success of CONNECT led to a twelve-month extension of the pilot which now has a completion date of June 2024.

The priority populations that this anonymous and easily accessible delivery model aims to engage are gay, bi+ and other men who have sex with men (GBMSM) from culturally and linguistically diverse (CALD) backgrounds, migrants and international students living in Adelaide. Research shows that these groups experience heightened barriers to testing for HIV. These include cost (in particular for those who are Medicare ineligible), low sexual health literacy, language/communication, concern about the impact of a positive result on visa status, stigma and discrimination, confidentiality concerns, negative past experiences in some health settings, and cultural norms related to sexuality and/or gender.  The pilot directly addresses these barriers by providing easy access to free HIVST kits via vending machines placed in discrete and safe locations that these populations frequent. In doing so it enhances personal control, privacy and convenience.

Given CONNECT’s focus on CALD populations, project development and implementation has been shaped in collaboration with a Cultural Advisory Group (CAG) that was established at the outset of the initiative. The placement of vending machines in locations that are accessible to diverse populations was agreed to be a key issue and partnership agreements were subsequently formalised with Pulteney 431, Adelaide’s only SOPV, the University of Adelaide, and the University of South Australia (UniSA), and five vending machines were installed in March/April 2022. Four of these are located in Adelaide’s central business district, and one at UniSA’s Mawson Lakes campus which is sixteen kilometres north of the city. A sixth machine was installed at Flinders University in early June 2023.

To access a free HIVST, users either scan a QR code (located on vending machines and promotional materials) or log on to the CONNECT webpage. The webpage, which is available in seven languages (Arabic, Chinese (simplified), Hindi, Indonesian, Malay, Spanish, and Vietnamese), provides (pre-test) information about the CONNECT pilot, HIV, self-testing, test results, confirmatory testing and linkage to care, and the window period.  Clinical and support service contact details are also provided for those requiring confirmatory testing and linkage to care, in addition to access to prevention services. To register to access a free HIVST, users are required to provide information regarding their age, country of birth, sexuality, and testing history, and a mobile phone number to which a four-digit code is sent. Once the code is entered into the webapp the user can access a kit by simply scanning the QR code on any of the CONNECT vending machines at any time. There is no restriction on the number of times users can access kits, and it is possible to acquire multiple kits per visit. The decision not to restrict usage was informed by research that suggests that secondary distribution of HIVSTs through existing social and sexual networks can be effective in reaching individuals who, for a range of reason, are unable or unwilling to access vending machines.

To date, 1560 people have registered to use CONNECT and 1825 HIVST kits have been dispensed. Sixty-three percent of users have never tested before, and of those who have accessed HIVSTs from campus-based machines, seventy-five per cent are first-time testers.

Fifty-one per cent of users are overseas born and come from eighty-three different countries. Thirty-six per cent of users were born in an Asian country. Of the eighteen Asian countries, China and Hong Kong account for one-third (12 per cent) of registered users, and India, the Philippines and Vietnam account for just over another third (14 per cent).

Sixty per cent of users identify as gay, bisexual, pansexual, or lesbian, forty per cent as heterosexual, and four per cent as asexual. Of the eleven per cent of users who have accessed kits on more than one occasion, seventy-five per cent identify as gay or bisexual. Of the repeat users who identify as heterosexual, eighty per cent are overseas born. This suggests that frequent testing using CONNECT is significantly higher amongst priority populations, that is, GBMSM and people from Southeast Asia, Latin America, and Sub-Saharan Africa.

Feedback sourced through a follow-up survey suggests that the majority of users have found both CONNECT and the Atomo HIVSTs easy to use and are highly likely to recommend them to others. The most common reasons given for using CONNECT were that it is easy, it is private, and it is free.

The CONNECT pilot clearly illustrates that the distribution of free HIVSTs via vending machines can increase testing amongst priority populations and play an important role in reaching 95-95-95 targets in Australia.

Published: June 2023