JMIR Publications

ABSTRACT

Background:

California has the largest number of people living with human immunodeficiency virus (HIV) in the United States, and in 2022 there were 4,882 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 (HIVST) can mitigate stigma, confidentiality, and access barriers, and vending machines (VMs) offer private, convenient distribution. However, VM-dispensed HIVST has not been evaluated for Veterans or within VA settings.

Methods:

We describe a RE-AIM–guided pre-implementation protocol to evaluate VM-dispensed HIVST in Northern California Veterans Affairs (VA) clinics and supportive housing settings. Fifteen VMs will stock oral-fluid HIVST (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, next steps), adoption (machine/site dispensing), implementation (stockouts, restocking interval, costs), and maintenance (dispensing trends). Discussion: This study will generate practice-ready evidence on feasibility, acceptability, and early behavioral impacts of VM-dispensed HIVST 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, clinic pick-up), and support privacy-preserving linkage strategies to confirmatory testing, HIV pre-exposure prophylaxis (PrEP), and treatment. Results will address a critical evidence gap for Veteran-focused HIV prevention and provide parameters for multi-site evaluations.