Theme: Models of Care Year: 2025
Background:
Harm reduction vending machines (HRVMs) have operated globally for decades yet have only recently expanded in the rural U.S. Complicating the implementation of HRVM-based syringe services in many areas are jurisdictions’ requirements for 1:1 exchange wherein the HRVM must count returned syringes and direct dispensing accordingly.
Description of model of care/intervention/program:
With guidance from a design team comprised of agency partners and people with lived experience with substance use, a “health kiosk” was custom designed for a rural Appalachian Kentucky community. The kiosk involves two outdoor machines installed side-by-side, with one engineered to facilitate syringe exchange and the other to dispense supplies for harm reduction and basic needs. Both are discretely marked to reduce potential for community resistance. To address concerns about missed opportunities for service linkage, the supply kiosk also integrates a call-back function in which clients can select services from the menu and receive a call from a peer recovery coach for service linkage.
Effectiveness:
The supply machine was implemented on January 23, 2025 and the adjacent syringe exchange machine is installed and pending implementation (mid-March 2025). As of March 2, 2025, 61 individuals accessed the supply machine, among whom 18% (n=9) visited multiple times. Among those who successfully accessed the machine with a valid client code (n=42), the most popular selections were wound care kits, snacks, and water, followed by alcohol swabs, sharps containers, hygiene kits, naloxone, fentanyl and xylazine test strips, and condoms. More than one-third (36%, n=15) have requested a call-back service, including for syringe exchange (n=7), buprenorphine/methadone (n=3), and assistance with food, domestic violence, housing, legal matters, education, and finding support groups (n=1 each).
Conclusion and next steps:
Kiosk effectiveness in reducing risks for overdose, HCV, and HIV and implementation outcomes are being evaluated through an ongoing, hybrid effectiveness trial and mathematical modeling.
Disclosure of Interest Statement:
AF-B is a co-founder of Voices of Hope, the contracted recovery community organization providing the recovery coaching services. The device to facilitate syringe disposal and dispensing that will be installed in conjunction with the kiosk is intellectual property of the University of Kentucky, with AMY designated as the inventor. CC is a paid consultant on the implementation of harm reduction vending machines, including on the described project.
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