Coastline is a drop-in centre for homeless individuals based in an area of deprivation in West Cornwall.  In 2013 an outreach sexual health clinic was piloted within the centre. The pilot was assessed as being a valuable service for those using the centre and has continued on a fortnightly basis. This review of clinic usage may help to inform decisions around future service delivery. 
Method:
The ‘drop-in’ clinic runs twice monthly. Signed permission is gained from all clients on registration for results to be shared with the Health for Homeless (HfH) GP service, for results management. 
Results:
During 2015 and 2016 22 clinics were run, with 92 clinic attendances (male 69; female 23).  The ratio of attendances (Coastline) M 0.75 : F 0.25 compared with GU M 0.43 : F 0.57.  On average, there were 4.2 clients per clinic.  61 individuals seen (male 45; female 16).  Of the 61 clients seen, 45 (73%) have presented solely to the Coastline Service - not seen in other RCHT Sexual Health Services.  The age range was: males 19-65y; mean 36years (GU mean = 48y); females 19-50 y; mean age 31y (GU mean = 46y).  Of those offered examination, 32% accepted.  Of the 45 males seen: 39 (87%) had at least one T4 screen; 26 (58%) tested for HBV/HCV; 9 (20%) identified as being an intravenous drug user; 4 (9%) vaccinated for HBV; 2 (4.5%) identified as a sex worker; and 2 (4.5%) identified as MSM.  Of the 16 females seen, 12 (75%) had at least one T4 screen; 8 (50%) tested for HBV/HCV; 5 (31%) identified as being an intravenous drug user; 2 (12.4%) vaccinated for HBV; and 4 (25%) accepted cervical cytology screening.  The male diagnoses were: urethral chlamydia 1.6%; genital warts 3.3%; molluscum contagiosum 1.6%.  The female diagnoses were: cervical gonorrhoea 1.6%.
Conclusion: 
This is an extremely vulnerable population, with the majority of individuals not accessing mainstream GU services. Male clients predominate. 

Most clients required screening for STIs and blood-borne viruses. Of those individuals offered examination only 32% accepted and most genital screens 
utilised self-taken sampling. Genital examination may be challenging for people with poor access to washing facilities (ref. 1) 

Coastline clients appear to have a much lower rate of STIs than overall GU attendees in Cornwall (local coding and chlamydia screening data) 

Useful interventions such as Hepatitis B vaccination and cervical cytology were accepted by some clients, complementing work done by the HfH GP 
Service and resident drug and alcohol services 

This is a low-volume clinic so relatively expensive to run; cost-effectiveness has been maximised by the B6/B2 staffing model and shared-care 
arrangements, with no room hire or receptionist costs. 

Shared-care including sharing of both negative and positive results with the HfH GP service is acceptable to clients and provides a fail-safe for 
communicating results 

In order to increase numbers of service users and add value to the service for clients, dual training of staff and provision of a full range of contraception including long acting methods is planned.

A Review of Sexual Health Provision at Coastline Homeless Day Centre

The Joint Annual Conference of the British Association for Sexual Health and HIV & the Society for the Study of Sexually Transmitted Diseases in Ireland