97 machine users completed the survey and of these, 41 participants requested more information about the interviews. Emails were sent to 39 participants who provided valid email addresses and interviews were subsequently conducted with 15 vending machine users. The majority of the machine users interviewed were over 25 years old, of white ethnicity, GBMSM or men who have sex with women (MSW) and had been tested for HIV and STIs within the last year and used the machine at venue A (table 1).

Five of the 10 SHS staff invited to be interviewed participated in the study and included one SHS consultant, two nursing staff and two members of the administrative team. All three local authority sexual health commissioners and three of the four venues participated in the study with one staff member interviewed from each venue.

Three themes are presented from the interviews with illustrative quotes (box 1): expectations and experience of vending machines, service delivery and lessons identified.

Because obviously you’ve gotta wait quite some time now for, to go to the clinic and stuff now, so to do it [use a vending machine], it was very convenient um and the results were pretty much instant, 20 minutes or whatever it was, so it was, yeah, a lot, it was a lot easier and it was also a lot more private as well, I didn’t have to you know, like go down so I didn’t have to ring up or anything, so it was great that there was, yeah. (Service user, White, MSW, 26–35 years old, Venue A, Interview 3)

Yes, it was easy. It was convenient. So yes, I think that like I'm gonna switch into just using the machine, because it’s just also right close to the city centre, close to where I work. So it’s just, like, easier to just go there and pick it up. (Service user, White, GBMSM, 26–35 years old, Venue A, Interview 7)

I don’t like the way it’s positioned to be honest in the venue because when you type your information in, there’s like people behind you can see. I mean they probably don’t look but still I felt a bit nervous about selecting all those different things when I was you know, with my back to the rest of the room. (Service user, White, WSM, 36–45 years old, Venue A, Interview 8)

[Vending machine] adds an extra couple of little points to our promotion of being the heart of the community…. it’s the right place for it to be. But beyond that it doesn't make any kind of massive impact on us, positive, negative or otherwise really (…) we’re more than happy for it to stay here for as long as the project sees it’s relevant. Perhaps it’s me but I don't really understand why any venue that was approached would say no, to be honest. It was communicated clearly. (Venue D, Interview 17)

So we found like a bit of a process, but it was quite clunky because we didn't really know where our responsibilities were, where your [SHS] responsibilities were… So yes, I think knowing whose roles and responsibilities were (…) was getting ironed out at that time. And if you guys had that maybe in advance, then that would be helpful for new people.(…) I just gave them feedback in an email about that person who came in who was distressed and then they were like, oh well, you know, you can tell people to do the posting kit and I was like, it would have been helpful to have known. (Venue B, Interview 16)

But the limitation is, or has been, firstly our management of it as a team, because we didn’t have the staff infrastructure initially to pack the machines or to create the boxes—create the kits to go in the machines, so that was a limiting factor which probably meant that at the start of the service they were out of stock more frequently than they should have been. (SHS staff, Interview 21)

We just got told that it was happening. And then when they were gonna be set up, we were just told like, you know, (…) we’re gonna be expecting the kits to come in. So it wasn’t really, which was a shame (…) we felt like we should have had more involvement in it. Because it was something that we were taking on. We would take on the work and we were doing the work that was gonna come in. So we just felt that, you know, it would have been nice if we were more involved in getting involved in the vending machines when they were been set up really, have a bit more say into it. (SHS staff, Interview 20)

It makes us sound a bit useless. We have got patients who are using the testing kits phoning up the (SHS staff) and we don’t have answers for them. We don’t know when they are going to be restocked. We don’t know who is responsible for restocking them. No, we don’t know why it is not working. No, we don’t know how accurately these test kits are. It is just a difficult conversation to have when people phone up asking about them. (SHS staff, Interview 22)

But in both venues the screen is, it’s quite a huge screen that’s sort of facing out into the lobby of the venue and so it’s sort of asking you questions like, how old are you, who do you normally have sex with, all these things (…) and I just thought, surely these could be placed in a more discreet way so that they’re—the screen is, like find a little corner in a venue where you can sort of put the machine round the corner or something so that like it’s very unlikely that there’s gonna be just people standing around seeing what you’re typing in. (Service user, White, GBMSM, 36–45 years old, Venue A, Interview 10)

They need to have a very clear way of making sure that they can cope with the capacity for kits or any surges that might happen and that the venue is able to stock them up, you know, as required. You know, try and keep it as slick as possible so that we don’t have people being, you know, at that teachable moment or at that moment where they might get a test and then can’t. (Commissioner B, Interview 25)

I think all it would need is someone to be given designated hours to commit to the vending machine (….) at the beginning of the project I had to stop the machines because we didn’t yet have the infrastructure, or the connections with the venues. So then in that situation if there could be a vending machine administrator for example, who wouldn’t need that many hours a week, but would need to have time build into their job to address the vending machine issues promptly; for example, to be able to get there on the day it dysfunctions, call the vending machine team and get the problem troubleshooted quickly. (SHS staff, Interview 21)

[Installation] could have been streamlined where (SHS staff) would have been there for the delivery and (…) could have helped (…) position it and talk us through or even, not just (SHS staff) but just somebody just to be there and be like, cool, so let me train you have to stock up the machine. Here is some stock, we’ll be sending you another box of stock next week or in the next two weeks just to know when stock is then coming in. (Venue B, Interview 16)

I think actually probably what would be a good idea (…) is maybe having like a bit of like a script or something for users(…) But maybe if there was somebody who’s a bit more nervous, who was like, don’t really know what to advise. And you know maybe from this and from information that you've had from people being like asking particular types of questions, you could have that little script there and be like if somebody asks. (Venue B, Interview 16)

I think having a meeting with the teams who manage the results and actually take calls from patients would have been good because then we would have had the opportunity to ask questions about the actual vending machines themselves and how they work, what tests are offered, what the window periods on the Oraquick [HIV self test] are, what the accuracy of those kits are, how they work, because that way if we get users phoning us, and we do get users phoning up asking about them, we can then advise those users. (SHS staff, Interview 22)

GBMSM, gay, bisexual and other men who have sex with men; MSW, men who have sex with women; SHS, sexual health service; WSM, women who have sex with men only

For most machine users interviewed, there was a history of recent and repeat STI and HIV testing and the decision to use the machines was influenced by convenience, accessibility and privacy offered by the service which circumvented challenges such as long waiting times to get a clinic appointment and for postal kits to arrive encountered in accessing in-person or postal testing. Interviewed users stated that the machines would now be their main route for accessing testing, including if symptomatic and/or following high-risk behaviour. For some users, the ready access to testing offered them the option to collect kits for future use when required. Users’ choice of test was informed by their perceptions of risk and history of testing with most users stating a preference for a full STI screen; however, for some users, choice was limited by the availability of kits within the machine.

Interviewed machine users valued the prompt access to testing, at a time and place that worked for them with minimal disruption to their daily routine and without the need for specific planning and time beyond locating the machine. They also felt that the ability to obtain tests from machines without the need to interact with anyone or disclose their sexual health risk could avoid the shame and embarrassment other people may experience when accessing SHS or receiving postal tests.

The experience of most users was positive; the promotional material shown during the interview was easy to understand and informative, the machines were quick and straightforward to use and users valued the requirement for minimal personal information to obtain a kit.16 Negative experiences related to issues of maintenance and stock with some users expressing frustration and disappointment when they encountered machines that were out of stock or not working. Users approved of the public locations of the machines acknowledging the convenience offered and appropriateness of the selected venues. Balancing privacy and not being overlooked while using the machine in accessible, convenient, high footfall areas was discussed by several participants. For some, the vending machine was situated in a sufficiently private setting, while for others a more private location was preferred.