High patient acceptability for a hepatitis C mobile outreach service targeting 'vulnerable‘ homeless communities - an important component for elimination?

Background and Aims: Given the HCV elimination agenda, finding and treating 'seldom heard‘ communities such as the homeless is critical. Such populations do not interface well with traditional models of care. In 2018, King‘s College Hospital, in collaboration with The Hepatitis C Trust, commissioned a mobile clinic to screen and treat homeless people in Lambeth, Lewisham and Southwark for HCV. The 'HCV Mobile Outreach Service‘ includes point-of-care finger prick HCV screening (InTec anti-HCV antibody) and confirmatory testing (Cepheid finger GeneXpert prick HCV RNA), non-invasive liver assessment by Fibroscan (Echosens), a multidisciplinary medical team (including peer) and needle and syringe programme provision. The aim of this study was to measure the patients‘ acceptability of the service model (overall service, finger prick testing and peer). Method: Patient acceptability was assessed using a theoretical framework of acceptability (TFA) survey (Sekhon et al, 2017) which considers cognitive and emotional responses to an intervention. It is formed of seven distinct constructs (affective attitude, burden, ethicality, perceived effectiveness, intervention coherence, self- efficacy and opportunity cost). Each construct is measured by a 5- point Likert scale. Question 1 (Q1) indicates overall performance and either a score (out of 35) for Q2-8 or a composite be calculated. At Q6, patients were asked to elaborate further about their views allowing qualitative insight. A paper survey was administered to patients using a purposive sampling strategy. Consent was received verbally. Results: Demographics - 35 patients (60% Male, 40% Female), Intravenous drug use (34% current, 26% past use, 40% never), HCV status (11% past infection, 40% current infection, 45% never infected). The results suggest patient acceptability for all components were high. Few chose to elaborate further, (response rates: overall service (37%), finger prick testing (37%) and Peer Navigator (20%)). Most comments were positive describing the benefit of not having to attend appointments at the hospital and a preference for engaging with a Peer. Although patients found the finger prick testing less acceptable than other components of the service, feedback suggests it is more acceptable than venepuncture. Distribution of the patients‘ TFA score and composite mean. Conclusion: The HCV Mobile Outreach Service is considered a highly acceptable intervention by this community and could contribute to HCV elimination efforts, linkage to other facets of care is currently being evaluated.