Project HOPE - Exploring the Role of Harm Reduction Vending Machines in Reducing the Risk of HIV Infection and Transmission - No known studies have examined a health vending machine program’s (Project HOPE) efficacy, mechanisms, and impact on the social environment through a longitudinal mixed methods approach. The long-term goal is to determine if Project HOPE provides a sustainable approach to accessing HIV self-testing and health promotion supplies and information among people who use drugs (PWUDs) facing complex health challenges. The objectives of this proposal are three-fold: 1) determine the effects of participation on Project HOPE on HIV screening behaviors, 2) assess whether Project HOPE improves access to HIV self-testing kits and health-related supplies, and 3) examine how health vending machine characteristics (e.g. location, operating hours) influence utilization patterns. The central hypothesis is that people identified as high-risk for overdose and HIV infection will utilize more health promotion supplies, including HIV self-testing and naloxone kits, than low-risk program participants, resulting in increased HIV screening, reduced risk behaviors, improvements to the naloxone cascade, and diffusion of innovation within peer networks. The rationale is that amid the fourth wave of the opioid epidemic, PWUDs are experiencing an acceleration of drug-related morbidity and mortality outcomes, including HIV infection, yet encounter a multitude of barriers to accessing health promotion and HIV self-testing resources. The proposed work aims to inform the expansion of evidence-based, accessible, low-threshold, and low-barrier health vending machine programs, which include HIV self-testing kits. The central hypothesis will be tested by pursuing three specific aims: 1) to examine the characteristics of people who utilize Project HOPE; 2) to describe the impact of the program on drug and sexual risk behaviors, HIV screening behaviors, naloxone cascade outcomes, and diffusion of innovation; and 3) to examine the longitudinal utilization patterns in relation to Project HOPE health vending machine features. We will pursue these aims by conducting a mixed methods study, including 300 brief cross-sectional surveys with people registered to use Project HOPE, quarterly interviews with 75 participants recruited into the high-risk cohort, and periodic qualitative interviews with a subset of 12 high-risk cohort participants. The proposed research is significant, because it is the first study to include a network of health vending machines with varying characteristics and to employ a longitudinal mixed methods approach to study the efficacy of the health vending machine model in improving engagement with the “seek, test, treat, and retain” model of care; health promotion supplies; and the naloxone cascade.
