The homeless population in the Netherlands is growing. Homeless people experience more health problems and have a lower life expectancy compared to the general population. However, they encounter barriers in accessing healthcare services. Consequently, they make use of street medicine initiatives, rather than visiting a general practitioner.This study aims to gain insight into healthcare accessibility for the street medicine population in the Netherlands, with a focus on barriers and facilitators.This study used a mixed-method explanatory sequential design, combining an online survey among Dutch street medicine professionals (N=33) with semi-structured interviews (N=6). Descriptive statistical analysis was conducted in SPSS; thematic analysis in ATLAS.ti.Most survey respondents perceived patient-related barriers (patients’ behaviour (perceived by 91%), lack of health insurance (91%) and stable housing (85%)), as well as provider-related barriers (lack of knowledge (82%) and cooperation (76%)). Qualitative findings were structured around three barriers in (1) Person-centred care, (2) Competencies of care providers, and (3) Healthcare organisation. Low-threshold services, aligned with patients’ contexts was identified as a key facilitator. Professionals’ knowledge, attitudes, and skills could be enhanced through training. Professional networks and collaboration were also essential facilitators.The need for training for providers was emphasized. Regional variations in the provision and organisation of street medicine emerged, and literature supports these findings by advocating tailored approaches of care. Findings highlight the importance of equity-oriented policies and professional collaboration. Future research should include street medicine patient perspectives.Healthcare accessibility for patients engaged in street medicine in the Netherlands is hindered by both patient- and provider-level barriers. Therefore, person-centred care, improvement of care providers’ competencies, and stronger networks and collaboration are needed.

People experiencing homelessness often face substantial barriers to accessing formal healthcare. Mistrust, previous negative encounters, and daily survival demands shape how they perceive and use medical care. Many alternate between the official health system and personal strategies—such as traditional remedies or spiritual resources—to manage physical and mental health.To explore how people living on the streets understand health and illness, how they relate to formal healthcare, and what alternative strategies they use to cope with symptoms. A secondary objective is to compare the experiences of those who trust and regularly use medical services with those who avoid or reject them.This qualitative study forms part of a broader mixed-methods project on homelessness trajectories. We are conducting semi-structured interviews with adults currently experiencing homelessness or recently living on the streets. Data are being analysed thematically using inductive coding. Special attention is paid to narratives about healthcare interactions—such as perceptions of overmedication or lack of understanding—and to descriptions of personal survival strategies (traditional remedies, spiritual support, peer networks). Ethical approval was granted by the Comité de Ética de la Investigación de Aragón (CEICA).Preliminary analysis reveals two contrasting patterns: (1) Participants who trust the medical system report relief in receiving structured care, while also noting fragmented follow-up and challenges adhering to treatment in unstable living conditions. (2) Participants who avoid formal care express stigma, fear of not being understood, and preference for culturally familiar practices or peer-supported strategies. Across both groups, ambivalence, emotional strain, and the need to prioritise daily survival strongly influence health behaviours. Full thematic findings will be presented at the conference.Early findings indicate that healthcare avoidance is not merely a personal choice but is shaped by traumatic past interactions, structural obstacles, and efforts to maintain autonomy. Understanding these perspectives is key for designing accessible, non-stigmatising, and flexible interventions tailored to people living on the streets.This study highlights the coexistence of formal healthcare use and alternative survival strategies among people experiencing homelessness. These insights can inform community health programmes and support more inclusive, person-centred physical and mental healthcare.

Palliative care units increasingly admit patients whose primary needs are social rather than medical, particularly in countries with limited long-term care, guardianship, and community-based support systems. Individuals experiencing homelessness with alcohol-related neurocognitive disorders represent a highly vulnerable population.This case highlights the challenges of managing a case with suspected Wernicke–Korsakoff syndrome who remained hospitalized for weeks due to the absence of family support, legal guardianship mechanisms, and feasible discharge options.This situation illustrates a profound structural inequity in access to basic living conditions, raising concerns regarding justice, dignity-centered care, freedom of vulnerable individuals to access safety and appropriate services.A 59-year-old homeless man with a history of long-term alcohol use was brought to the emergency department with transient unresponsiveness and impaired speech. Initial evaluation revealed hyponatremia, elevated CRP, leukopenia, and bilateral lower-lobe pneumonia.  After treatment for pneumonia, patient was transferred to palliative care because he lacked a caregiver, safe housing, or cognitive capacity for self-care. Neurological examination demonstrated findings were consistent with Wernicke encephalopathy, and high-dose thiamine therapy was initiated, alongside nutritional support. Psychiatry noted fluctuating orientation, episodic hallucinations, and suspected alcohol-related neurocognitive disorder but no indication for inpatient psychiatric admission. Social services indicated that institutional placement required a medical board report and that Turkey lacks a structured, rapidly functioning adult guardianship system. Despite medical stabilization, the patient's prolonged hospitalization solely due to lack of social support represents a violation of principles of equity and fair access to healthcare.-This case demonstrates how homelessness, cognitive impairment, and fragmented social support structures can transform medical problems into prolonged and preventable hospitalizations. International guidelines emphasize that palliative care addresses psychosocial and social suffering alongside physical distress. However Turkey lacks an efficient mechanism for placing non-terminal adults who require protective and custodial social care. In this context, the palliative care team became a “last safety net,” underscoring the ethical responsibility and solidarity shown by healthcare professionals.Strengthening community-based services, developing adult guardianship mechanisms, and ensuring that vulnerable individuals have the freedom and opportunity to access safe housing and long-term care are essential for humanistic and to uphold dignity in primary care.

People experiencing homelessness (PEH) have higher rates and more severe forms of frailty than the general population. Frailty also manifests earlier with 40–50-year-olds experiencing frailty scores equivalent to 70–80-year-olds who are housed. Early detection and management of frailty can halt progression and reverse its trajectory. In the elderly population, management centres on integrated care models of screening and holistic assessments, and interventions targeting exercise, nutrition, medication optimisation and reablement. The applicability of these models to frail PEH remains unclear.  With growing evidence for frailty affecting younger populations, more proactive, tailored strategies are needed to meet the unique needs of PEH.   Explore the evidence for frailty management in PEH in community settings.   A search strategy using terms for ‘homelessness’, ‘frailty’ and ‘community care’ was conducted on 7 databases. Following deduplication, screening and full text review was carried out by three reviewers based on predetermined eligibility criteria (PROSPERO CRD420251143337). Data extraction, quality assessment using the Mixed Methods Appraisal Tool, and a narrative synthesis approach was undertaken. People with lived experience of homelessness were involved from conception of the research question through to results synthesis.  Three studies were reviewed. Interventions consisted of a frailty health promotion education programme coupled with nurse case management, a drop-in exercise programme with nutritional supplementation, and a geriatric care model within a respite service. No significant effects on frailty were observed however the geriatric care model observed decreases in A&E visits, hospital admission and length of stay, cost of care and successful transition into permanent housing.    This review highlights the dearth of frailty intervention research amongst PEH despite a high prevalence of frailty, further exacerbating health inequalities. Effectiveness of tested interventions may be limited by low intensity programmes, poor retention rates due to competing priorities (e.g. addiction), and lack of self-identification with ‘frailty’ as a diagnosisFuture interventions should be delivered at the “right time, in the right place, and by the right person” to maximise effectiveness. Service design needs to account for the specific drivers of frailty in PEH, a phenomenon still poorly understood, and should no longer discriminate based on age criteria.

Despite advancements in the management of Human Immunodeficiency Virus (HIV), challenges remain in achieving early diagnosis, particularly in contexts with sociocultural and structural barriers.This study examined factors associated with late diagnosis (LD) among people living with HIV (PLWH) in Oman from 1992 to 2024.Of the 549 patients studied, 30.1% had a late diagnosis for treatment. Among late diagnoses, 72.1% were infected via sexual transmission, 64.8% were asymptomatic, and 52.5% had no comorbidities. Younger age groups had significantly higher adjusted relative risks (aRR) of late diagnosis: 5.66 (95% CI: 2.26–14.21) for ages 18–27, 3.25 (95% CI: 1.33–7.94) for ages 28–37, and 3.51 (95% CI: 1.40–8.77) for ages 38–47, compared to those aged ≥48 years. Notably, low haemoglobin levels (<10 g/dL) were associated with an increased risk of late diagnosis (aRR = 3.03; 95% CI: 1.42 - 6.67). Patients who were asymptomatic or classified as stage 1 (aRR = 7.34; 95% CI: 3.12–14.29) and those with advanced symptoms or stage 3 disease (aRR = 2.93; 95% CI: 1.40–5.68) were more likely to present late compared to individuals with severe symptoms or stage 4 disease, according to WHO clinical staging. Additionally, patients with heart disease (aRR = 5.38; 95% CI: 1.36–21.31) and hypertension (aRR = 3.34; 95% CI: 1.13–9.91) demonstrated increased likelihood of late diagnosis compared to those without comorbidities.This study identifies key factors influencing the timing of HIV diagnosis in Oman from 1992 to 2024, providing critical evidence to support data-driven decision-making. Late diagnosis was more prevalent among younger patients, those with disease stages 1 and 3, and those with cardiovascular comorbidities.However, those with low haemoglobin were diagnosed early. These findings emphasize the need for enhanced early testing strategies, tailored clinical care, stigma reduction, and timely psychosocial interventions to improve outcomes and support Oman’s 95-95-95 targets.

Tuberculosis (TB) is a bacterial infectious disease that remains a major public health challenge in XXX due to its high incidence. The homeless population (HP) is approximately 56 times more likely to contract TB than the general population, indicating an association between social vulnerability and disease transmission. Directly Observed Therapy (DOT) is a strategy in which patients take their prescribed medication under the supervision of a health care professional. This approach aims to improve treatment adherence and reduce treatment default rates, particularly among vulnerable populations.This study aimed to comparatively assess the impact of DOT on disease outcomes among HP and the general population.This is a quantitative, descriptive study, that used TB case notification data from XXX between 2015 and 2024, recorded in the National Disease Notification System (SINAN).The outcomes analyzed were treatment default, death due to TB, and drug-resistant TB (DR-TB) — collectively defined as unfavorable outcomes — and cure, defined as the favorable outcome. The comparison of DOT impacts on TB outcomes between HP and the general population was performed using the Mantel–Haenszel chi-square test.During the study period, 612,577 new TB cases with defined outcomes were reported nationwide, of which 11,621 were among HP; 5,614 of these individuals received DOT. After adjusting for differences in DOT implementation between HP and the general population, individuals who received DOT had 2.37-fold higher odds of cure compared with those who did not (Mantel–Haenszel Odds Ratio [ORMH] = 2.37; CI95% [ORMH] = [2.26–2.48]; p < 0.001). When analyzed separately, DOT was associated with 2.31-fold higher odds of cure in the general population, whereas among HP this effect was even greater, with 3.62-fold higher odds, indicating that the beneficial impact of the strategy is particularly pronounced in this vulnerable group.These findings corroborate existing evidence linking DOT to improved TB treatment outcomes, as the strategy enhances adherence to appropriate therapy.Therefore, implementing DOT within Primary Health Care strengthens patient engagement with the health system and should be encouraged by public health authorities as an effective means of controlling TB progression.

People experiencing homelessness face major obstacles to healthcare access, often relying on emergency services instead of primary care and resulting in poorer health outcomes. The community project “Salut Sense Barreres” (Health without Barriers) was launched by a primary care centre located on a catalan neighbourhood with high deprivation rates in coordination with a Social Gym acting as a reference community agent for homeless people. This project established a weekly administrative and health care point in the social Gym to bring this population closer to the public health care system.To evaluate the impact of the project "Salut Sense Barreres" in reducing barriers to health care access for homeless individuals in a deprivated district of a big city.A descriptive study was conducted from February 2024 to January 2025, using weekly registers and health records for all homeless individuals attended during this period at the community point, with local ethics committee approval.A total of 322 users registered for the weekly advice point, of whom 266 people were included in the primary care electronic health record. At the end of the period, 10.53% obtained a definitive sanitary identification number. Primary care linkage with a doctor and nurse assigned was achieved for 18.42% in the intervention primary care centre and 28% to other primary care centers. Of the visits they made to the reference centre, 9.04% were to emergencies. This population accounted for 0.27% of total emergency visits. When a health professional was assigned, 64.19% of appointments were with them. The sociodemographic profile shows a male population (95.34%), with a mean age of 32.37 years, and mainly from Algeria (31.70) and Morocco (27.60%). Administratively, passport possession represents 53.40%.The outcomes are consistent with other studies showing that having health coverage diminishes emergency use.This study shows that flexible, community-based healthcare delivered in trusted community spaces can reduce access barriers for people systematically excluded from the health system. This project proves to be a promising approach to strengthen engagement with primary care and promote more equitable access to essential health services.