Marschke Rachel M, Young April M, Knudsen Hannah K, Cheatom Chelsi N, Cooper Hannah L F
, 1518 Clifton Road NE, Atlanta, GA, 30322, USA.
Harm Reduct J. 2025 May 28;22(1):88. doi: 10.1186/s12954-025-01222-y.
Rural Appalachia has been significantly affected by drug-related harms (Hepatitis C, HIV, overdose deaths) over the past two decades, but harm reduction responses still lag behind other regions. Harm reduction vending machines (HRVMs) are an effective intervention for preventing overdose and the spread of infection, though they are newer to the US and have rarely scaled out to rural areas. Here, we report on guidance from people who use drugs (PWUD) and health department staff on how to adapt HRVMs to suit local needs in rural Appalachian Kentucky.
Focus groups were conducted with local health department and syringe service program (SSP) staff, PWUD who use the SSP, and PWUD who do not use the SSP. The interview guide covered key HRVM features including identification for access, contents, location, and appearance. Focus groups were recorded and transcribed, and data thematically analyzed.
The results yielded 3 major themes: participants sought an HRVM that was discreet and nonjudgmental, accessible and equitable, and holistic. These themes informed their decisions when ranking features of the machine's location, content, appearance, etc. Focus groups favored discreet machines that were out of plain sight; placing the machine somewhere walkable to ensure it is accessible; and including items that address needs beyond harm reduction to give participants more holistic help.
HRVM scale out in this rural area should be guided by discreet and non-judgmental approaches that create an accessible and equitable machine that responds holistically to community needs. Future efforts to scale out HRVMs into rural areas could use this guidance as a starting point for exploring local priorities, to help ensure successful implementation in under-served rural areas.
在过去二十年中，阿巴拉契亚农村地区受到了与毒品相关危害（丙型肝炎、艾滋病毒、过量用药死亡）的严重影响，但减少危害的应对措施仍落后于其他地区。减少危害自动售货机（HRVMs）是预防过量用药和感染传播的有效干预措施，尽管它们在美国尚属新生事物，且很少推广到农村地区。在此，我们报告吸毒者（PWUD）和卫生部门工作人员关于如何使HRVMs适应肯塔基州阿巴拉契亚农村地区当地需求的指导意见。
对当地卫生部门和注射器服务项目（SSP）工作人员、使用SSP的PWUD以及不使用SSP的PWUD进行了焦点小组访谈。访谈指南涵盖了HRVM的关键特征，包括获取方式、内容、位置和外观。焦点小组访谈进行了录音和转录，并对数据进行了主题分析。
结果产生了3个主要主题：参与者寻求一台谨慎且无歧视的、易于使用且公平的、全面的HRVM。这些主题在对机器的位置、内容、外观等特征进行排名时为他们的决策提供了依据。焦点小组倾向于选择不易被看到的谨慎型机器；将机器放置在步行可达的地方以确保其易于使用；并包括满足减少危害之外需求的物品，以便为参与者提供更全面的帮助。
在这个农村地区推广HRVM应该以谨慎和无歧视的方法为指导，打造一台易于使用且公平的、能全面满足社区需求的机器。未来将HRVM推广到农村地区的努力可以将这一指导意见作为探索当地优先事项的起点，以帮助确保在服务不足的农村地区成功实施。
