I have it with a SeaFrogs A6700, but it's the same port system as A7IV. Unlike the A6xxx housing, a focus gear is available, but it is not terribly useful, as it takes a lot of knob revolutions to make any meaningful change. The primary use case is to lock focus at minimum distance and then move the camera until the subject comes into focus. It is also quite finicky to set up, as it is really easy to bump the focus ring into the back (MF-only) position while inserting the camera into the housing. In case you don't have the lens yet; the big focus ring on it moves backwards and forwards - in the forward position, the lens autofocuses, but if you choose MF or DMF in the camera menu, you can use it for manual focus, but in the backward position, it is locked in MF mode, and you can't AF at all. The side button (I believe it is focus hold; never actually used it) is not accessible, and neither are the two switches (stabilization on/off and focus range limiter), so take care not to bump the latter switch while setting up the camera, or it can be a very frustrating dive.
Regarding AF, I've used it with A6300 and A6700, and the experience is radically different - on the former, it is slow and requires at least several seconds of the camera and subject being stationary in order to focus. A moving subject - say, a small nudibranch on some seaweed swaying in a current - is basically impossible to focus on. On A6700, it focuses near instantly and tracks moving subjects reliably. I believe, although I don't have personal experience with, that the A6700 experience is shared with A7RV, A1 and A7CR/A7CII, whereas all the older bodies, including A7IV, are closer to the A6300/A6500 in this respect.