TABLE 1.

Findings From Conversations With Intervention Providers: Presented as Themes Under the Framework of Structure, Process, and Outcomes

Framework	Aspect	Findings
Structure	Bureaucracy	There were conflicting views on the impact of COVID‐19 on the bureaucracy of conducting test and treat interventions; some reported that it was more challenging because of increased restrictions, while others said that they had more freedom and flexibility than normal.
	Settings	Some providers reported difficulty in engaging with hotel staff and obtaining their consent for testing events to take place on‐site, particularly for clinical procedures such as taking blood.
		Raising awareness of HCV and reducing associated stigma were highlighted as important for gaining engagement from hotel staff.
		The spaces used to conduct testing varied considerably from gazebos in hotel car parks to individual bedrooms. In some cases, a testing van was used, and this was felt to be advantageous because it was versatile, fit for purpose, and, if unmarked, did not contribute to stigmatization.
	Partnership working	Partnership working, particularly with peer supporters and local authority housing teams, was considered by providers as hugely valuable.
Process	Promotional activities	Most providers reported using some sort of promotional materials (such as posters or fliers) to advertise the testing events. To destigmatize there were certain key messages that should be included, such as the different routes of HCV transmission (i.e., not just injecting drugs) and how easy and effective treatment is now.
	Incentives	There were conflicting views among providers about the use of incentives. Some felt that they increased engagement and that clients would encourage others to come along because of the incentives on offer. Others felt that, although incentives might increase the numbers getting tested, clients need to be self‐motivated to complete treatment.
	Testing and treatment	A variety of different testing methods was used, but many providers mentioned that oral swabs and Dried Blood Spot were preferable to venous testing because some clients with a history of injecting drug use might feel embarrassed or stigmatized by their vein health.
		Speed of test to treatment was also felt to be important, so the use of rapid point‐of‐care test machines was considered to be very beneficial in keeping clients engaged.
		Treatment was provided through the standard NHS route.
		Because genotyping causes a delay in treatment initiation, providers were temporarily prioritizing pan‐genotypic drugs for the homeless clients reached through these interventions.
		Most providers were giving clients the full course of medication at treatment initiation because this made it easier to comply with COVID‐19 restrictions and because of the risk of losing contact as clients were regularly moved between temporary accommodations.
		In most areas, ongoing engagement with clients during their treatment was mainly being done by the peer supporters.
	COVID‐19 precautions	Several providers conducted a COVID‐19 risk assessment, including checking for outbreaks or symptoms of COVID‐19 among the clients, and some had a written protocol on COVID‐19.
		Providers were generally confident that appropriate precautions for themselves and other partners had been taken (including PPE). However, many mentioned that clients did not maintain social distancing even when the layout of the setting had been specifically altered to facilitate this. Solutions to this included seeing just one client at a time by having them wait in their rooms until called, or providing clients with oral swabs that they could do without leaving their rooms.
Outcomes	Feedback from clients	Providers felt clients were happy to engage with the testing and often seemed relived by, and sometimes proud of, a negative result. In fact, some clients asked for a record of the result because this was part of their treatment recovery plan and demonstrated their abstinence from risky behaviors.
		Some providers felt that COVID‐19, with the associated lockdown and temporary housing, had given their clients time to reflect and reengage with their own health.
		Some negative feedback from clients was also reported; this included clients feeling targeted and stigmatized by promotional materials.
	Other outcomes	In many settings, additional health and well‐being interventions (such as screening for other diseases, smoking cessation advice, and health checks) were carried out at the same time as the HCV testing.
		In some areas, providers felt conducting the interventions raised awareness of HCV among partner organizations, which may lead to other collaborations in the future and also gave an opportunity to recruit new peer supporters.