Acceptability and Appropriateness of Harm Reduction Vending Machines Compared to Syringe Service Programs in Appalachian Kentucky

Many rural people who inject drugs do not use syringe service programs (SSPs). In addition, people who use drugs but do not inject may perceive SSPs are not intended for their use. Harm reduction vending machines (HRVMs) may be preferred by some individuals. This study examines attitudes and preference for HRVMs to consider possibilities for enhanced reach of harm reduction services. Structured surveys were conducted with 712 people who use drugs in two rural Appalachian counties in Kentucky. Participants rated acceptability/appropriateness of SSPs and HRVM; HRVM preference was the difference between the two scales. Linear regression models estimated SSP acceptability/appropriateness, HRVM acceptability/appropriateness, and HRVM preference across five groups that were differentiated by the SSP use, injection, and syringe sharing behaviors. Average ratings for acceptability/appropriateness of the SSP and HRVM were favorable (4.17 and 4.49, respectively, on a scale from 1 to 5), but HRVM acceptability was significantly higher (t=-14.21, p<.001). Compared to the reference group, people who inject but do not share syringes or use the SSP (b=.240, p<.01) and people who inject and share syringes without using the SSP (b=.402, p<.001) had greater preference for HRVM than people who inject and use the SSP. People who did not inject had greater preference for HRVM (b=.383, p<.001) than people who inject and use the SSP. HRVMs may engage people not currently using SSP services and those who use drugs without injecting, thus expanding the reach of harm reduction services, particularly in rural areas.