Background Despite high level of health care need amongst people experiencing homelessness, poor access is a major concern. This is sometimes due to organisational and bureaucratic barriers, but also because they often feel stigmatised and treated badly when they do seek health care. The COVID-19 pandemic and the required social distancing measures have caused unprecedented disruption and change for the organisation of primary care, particularly for people experiencing homelessness. Against this backdrop there are many questions to address regarding whether the recent changes required to deliver services to people experiencing homelessness in the context of COVID-19 will help to address or compound problems in accessing care and inequalities in health outcomes. Methods An action led and participatory research methodology will be employed to address the study objectives. Interviews with people experiencing homelessness were will be conducted by a researcher with lived experience of homelessness. Researchers with lived experience are able to engage with vulnerable communities in an empathetic, non-judgemental way as their shared experience promotes a sense of trust and integrity, which in turn encourages participation in research and may help people speak more openly about their experience. The experiences of health professionals and stakeholders delivering and facilitating care for people experiencing homelessness during the pandemic will also be explored. Discussion It is important to explore whether recent changes to the delivery of primary care in response to the COVID-19 pandemic compromise the safety of people experiencing homelessness and exacerbate health inequalities. This could have implications for how primary healthcare is delivered to those experiencing homelessness not only for the duration of the pandemic but in the future.

Background The COVID-19 pandemic has caused unprecedented disruption and change for the organisation of primary care, including for people experiencing homelessness who may not have access to a phone. Little is known about whether the recent changes required to deliver services to people experiencing homelessness will help to address or compound inequality in accessing care. Aim To explore the experience and impact of organisational and technology changes in response to COVID-19 on access to healthcare for people experiencing homelessness. Design and setting An action led and participatory research methodology was employed in 3 case study sites made up of primary care services delivering care for people experiencing homelessness. Method Individual semi-structured interviews were conducted with 21 people experiencing homelessness and 22 clinicians and support workers. Interviews were analysed using a framework approach. Results The move to remote telephone consultations highlighted the difficulties experienced by participants in accessing healthcare. These barriers including problems at the practice level associated with remote triage as participants did not always have access to a phone or the means to pay for a phone call. This fostered increased reliance on support workers and clinicians working in the community to provide or facilitate a primary care appointment. Conclusion The findings have emphasised the importance of addressing practical and technology barriers as well as supporting communication and choice for mode of consultation. We argue that consultations should not be remote ‘by default’ and instead take into consideration both the clinical and social factors underpinning health.

Introduction: People who experience homelessness have poor oral health and limited access to dental services. Aim: To examine whether 'Peer Education' could yield improved plaque management among people experiencing homelessness. Methods: A quasi-experimental, one-group pretest-posttest study was conducted, with follow-up at 1 and 2 months. Participants were living in temporary accommodation in Plymouth, UK. Plaque levels were assessed using the Simplified Oral Hygiene Index. A questionnaire and the Oral Health Impact Profile (OHIP-14) were administered. Patient satisfaction and barriers to dental care were explored by interviews. Results: The baseline sample included 24 people with a mean age of 36.88±10.26 years. The mean OHIP-14 score was 25.08±19.56; finding it uncomfortable to eat and being embarrassed attracted the highest values (2.46±1.53 and 2.33±1.63, respectively). Plaque levels decreased by month 1 and month 2, though the changes were not statistically significant. Positive changes in confidence in tooth brushing at month 2 were identified (p=0.01). Conclusion: Experiencing pain and the opportunity to access treatment were key drivers of study participation. The study indicated that it is feasible to conduct oral health promotion projects for people in temporary accommodation. Adequately powered studies examining the impact of peer education on improving homeless people's oral health are warranted.

Objectives: The present study aimed to identify strategies to improve oral health behaviours, access to and provision of dental care for people experiencing homelessness. Method:We conducted focus groups with people living in a residential homeless centre and semi-structured interviews with other stakeholders working with or supporting people experiencing homelessness. Following an inductive approach, thematic analysis was used to synthesise the findings on NVivo software.Results: Participants included 11 British males experiencing homelessness and 12 other stakeholders from various professional backgrounds. Themes identified included awareness and empowerment; supportive environment and dental health system; flexible and holistic care; outreach and community engagement; collaboration with other health and social services; and effective communication.Conclusions: Efforts to improve oral health among people experiencing homelessness via improved oral health habits and engagement with services need to be directed at both the recipients of care and the healthcare teams. Well-powered empirical studies are needed to evaluate whether the strategies identified can improve engagement and care provision for this population.

Highlights practices that can be used to successfully engage people experiencing homelessness with oral health promotion activities. Provides a set of resources that can be used in other projects and settings to promote oral health for people experiencing homelessness. Presents key learning points from the perspective of participants, support workers, clinicians and researchers.

IntroductionPeople who are homeless experience higher morbidity and mortality than the general population. These outcomes are exacerbated by inequitable access to healthcare. Emerging evidence suggests a role for peer advocates—that is, trained volunteers with lived experience—to support people who are homeless to access healthcare.Methods and analysisWe plan to conduct a mixed methods evaluation to assess the effects (qualitative, cohort and economic studies); processes and contexts (qualitative study); fidelity; and acceptability and reach (process study) of Peer Advocacy on people who are homeless and on peers themselves in London, UK. People with lived experience of homelessness are partners in the design, execution, analysis and dissemination of the evaluation.Ethics and disseminationEthics approval for all study designs has been granted by the National Health Service London—Dulwich Research Ethics Committee (UK) and the London School of Hygiene and Tropical Medicine’s Ethics Committee (UK). We plan to disseminate study progress and outputs via a website, conference presentations, community meetings and peer-reviewed journal articles.

Aims: Type 1 diabetes is characterised by the destruction of pancreatic βcells. Significant levels of βcells remain at diagnosis. Preserving these cells improves glucose control and protects from long-term complications. We undertook a systematic review and meta-analyses of all randomised controlled trials (RCTs) of interventions to preserve βcell function in people newly diagnosed with type 1 diabetes. This paper reports the results of interventions for improving glucose control to assess whether they preserve βcell function. Methods: Searches for RCTs in MEDLINE, Embase, Cochrane CENTRAL, ClinicalTrials.gov and WHO International Clinical Trials Registry. Eligible studies included newly diagnosed patients with type 1 diabetes, any intervention to improve glucose control and at least 1 month of follow-up. Data were extracted using a predefined data-extraction sheet with 10% of extractions checked by a second reviewer. Results: Twenty-eight studies with 1662 participants were grouped by intervention into six subgroups (alternative insulins, subcutaneous and intravenous insulin delivery, intensive therapy, glucose sensing, adjuncts). Only three studies demonstrated an improvement in glucose control as well as βcell function. These interventions included intensive insulin therapy and use of an alternative insulin. Conclusions: This is the largest comprehensive review of RCTs in this area. It demonstrates a lack of robust evidence that interventions to improve glucose control preserve βcell function in new onset type 1 diabetes, although analysis was hampered by low-quality evidence and inconsistent reporting of studies.Development of guidelines to support the design of trials in this field is a priority.

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