Engaging with people experiencing homelessness Sarah Montague and

Engaging with people experiencing homelessness Sarah Montague and Rob Allan

King’s and HCT mobile outreach model King’s clinical team King’s pharmacy team The Hep C Trust peer navigator The Hep C Bus Genotypes 1&4 ‘Clinical Trial’ Access to Treat in the Community ATTIC Genotypes 2, 3, 5 & 6 NHS standard of care treatment

P 110005 Patient 110005 was approached around Waterloo Station. They consented to participate in the trial on 09/09/2019. They asked if we could supply medication weekly, which the team agreed to. Actual TW 8 29 -Oct-19 No missed doses. One weeks supply given. Actual TW 12 07 -Jan-20 Patient seen. Bloods taken. HCV MDM 12 -Sep-19 Consent 24 -Sep-19 TW 0 10 -Sep-19 Actual TW 4 29 -Oct-19 Last dose 27 -Oct-20. A friend (another homeless man) is reminding him to take meds. Actual SVR 4 04 -Feb-20 Patient not yet due SVR 4 appointment 07 -Jan-20 HCV RNA NOT DETECTED Projected TW 4 08 -Oct-19 Blood sample 09 -Aug-19 HCV RNA 1. 41 E 7 Blood sample Projected TW 8 08 -Nov-19 Actual SVR 12 31 -Mar-20 Patient not yet due SVR 12 appointment Projected TW 12 (EOT) 03 -Dec-19 Projected SVR 4 Projected SVR 12 31 -Dec-19 2019 Aug Sep Oct Nov Dec Jan Zepatier Looked for patient 17 -Sep-19 Looked for patient 04 -Nov-19 Found patient. TW 1 medication dispensed to patient. 25 -Sep-19 Found patient. TW 2 weeks medication dispensed to patient. Looked for patient 02 -Oct-19 TW 3 meds given to patient. 3 tablets left. Feb Mar Looked for patient 25 -Feb-20 15 -Oct-19 ‘Clucking’ Not taken any meds declined to take since when last seen. this weeks Patient wanted to be supply of meds. prompted daily. Looked for patient 09 -Oct-19 TW 4 meds not given to patient. 5 doses missed. Patient agrees to restart meds that evening. 05 -Nov-19 Patient found. Encouraged to attend CGL. 11 -Nov-19 ‘Clucking’ declined to take this weeks supply of meds. 04 -Dec-19 Patient not found. Unable to hand over TW 9 meds. 09 -Dec-19 12 -Nov-19 Patient found. Given advice about registering with GP. 18 -Nov-19 Now at TW 7. Denies missing doses. Given another weeks supply. Patient found. At TW 10. Denies missing doses. 16 -Dec-19 Patient not found. 17 -Dec-19 Patient not found. 2020 18 -Dec-19 Patient found. Reports no missed doses and may leave London. 07 - Jan-19 Patient found. Reports to have completed treatment.

Acceptability of model amongst patients Theoretical Framework of Acceptability (TFA) Affective attitude Burden Ethicality Intervention Coherence How an individual feels about the intervention The perceived amount of effort that is required to participate in the intervention The extent to which the intervention has good fit with an individual’s value system The extent to which the participant understands the intervention and how it works Opportunity Costs Perceived effectiveness Self-efficacy The extent to which benefits, profits or values must be given up to engage in the intervention The extent to which the intervention is perceived as likely to achieve its purpose The participant’s confidence that they can perform the behaviour(s) required to participate in the intervention Sekhon et al (2017)

Item scores for the patient TFA surveys Theoretical Framework of Acceptability - TFA (Sekhon et al, 2017) Overall service Q 1) How acceptable did you find the hepatitis c mobile outreach service? Q 2) Did you like or dislike the hepatitis c mobile outreach service? Q 3) How much effort did it take to engage with the hepatitis c mobile outreach service? Q 4) How fair (to all homeless people) is the hepatitis c mobile outreach service? Q 5) The hepatitis c mobile outreach service is likely to improve the chances of homeless people being cured from hepatitis c: Q 6) It is clear to me how the Hepatitis C Mobile Outreach Clinic would help homeless people manage their hepatitis c infection: Q 7) How confident did you feel engaging with the hepatitis c mobile outreach service? Q 8) Engaging with the Hepatitis C Mobile Outreach Clinic interfered with my other priorities: Mean SD Median 4. 8 4. 5 4. 2 4. 8 4. 4 0. 43 5 0. 61 5 1. 28 5 0. 49 5 0. 85 5 4. 6 4. 5 4. 1 0. 56 5 0. 74 5 1. 06 4 4. 4 3. 5 4. 2 0. 73 4 1. 20 4 1. 27 5 4. 4 4. 2 4. 4 0. 66 5 0. 65 5 0. 94 4 0. 87 4 0. 92 5 4. 7 4. 5 4. 3 4. 6 4. 4 4. 5 4. 6 0. 58 5 0. 56 5 1. 18 5 0. 81 5 0. 65 4 0. 51 4 0. 49 5 Finger prick Q 1) How acceptable is the finger prick test that is offered as part of the hepatitis c mobile outreach service? Q 2) Did you like or dislike the finger prick testing? Q 3) How much effort did it take to receive the finger prick testing? Q 4) How fair (to all homeless people) is having access to finger prick testing as part of the hepatitis c mobile outreach service? Q 5) Finger prick testing is likely to improve patient engagement with the hepatitis c mobile outreach service: Q 6) It is clear to me how finger prick testing would help homeless people manage their hepatitis c infection: Q 7) How confident did you feel about completing the finger prick testing? Q 8) Finger prick testing interfered with my other priorities: Peer navigator Q 1) How acceptable do you find the role of having a peer navigator on the hepatitis c mobile outreach service? Q 2) Do you like or dislike having a peer navigator as part of the hepatitis c mobile outreach service? Q 3) How much effort does it take to engage with the peer navigator? Q 4) How fair (to all homeless people) is having access to a peer navigator as part of the hepatitis c mobile outreach service? Q 5) The peer navigator is likely to improve patient engagement with the hepatitis c mobile outreach service? Q 6) It is clear to me how the peer navigator will help homeless people manage their hepatitis c infection: Q 7) How confident did you feel about interacting with the peer navigator?

Peer perspective Conflicting priorities Perception of self and healthcare professionals

Peer perspective Snap shot of a day on the Hep C Bus

Thank you for listening Sarah Montague Rob Allan Biomedical Research Associate Peer Navigator sarah. montague@nhs. net rob. allan@hepctrust. org. uk