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Developing a primary care-initiated hepatitis C treatment pathway in Scotland: a qualitative study

Whiteley, David; Speakman, Elizabeth M; Elliott, Lawrie; Jarvis, Helen; Davidson, Katherine; Quinn, Michael; Flowers, Paul


David Whiteley

Lawrie Elliott

Helen Jarvis

Katherine Davidson

Michael Quinn

Paul Flowers


Background: The ease of contemporary hepatitis C virus (HCV) therapy has prompted a global drive towards simplified and decentralised treatment pathways. In some countries, primary care has become an integral component of community-based HCV treatment provision. In the UK, however, the role of primary care providers remains largely focused on testing and diagnosis alone.

Aim: To develop a primary care-initiated HCV treatment pathway for people who use drugs, and recommend theory-informed interventions to help embed that pathway into practice.

Design and setting: A qualitative study informed by behaviour change theory. Semi-structured interviews were undertaken with key stakeholders (n = 38) primarily from two large conurbations in Scotland.

Method: Analysis was three-stage. First, a broad pathway structure was outlined and then sequential pathway steps were specified; second, thematic data were aligned to pathway steps, and significant barriers and enablers were identified; and, third, the Theoretical Domains Framework and Behaviour Change Wheel were employed to systematically develop ideas to enhance pathway implementation, which stakeholders then appraised.

Results: The proposed pathway structure spans broad, overarching challenges to primary care-initiated HCV treatment. The theory-informed recommendations align with influences on different behaviours at key pathway steps, and focus on relationship building, routinisation, education, combating stigmas, publicising the pathway, and treatment protocol development.

Conclusion: This study provides the first practicable pathway for primary care-initiated HCV treatment in Scotland, and provides recommendations for wider implementation in the UK. It positions primary care providers as an integral part of community-based HCV treatment, providing workable solutions to ingrained barriers to care.


Whiteley, D., Speakman, E. M., Elliott, L., Jarvis, H., Davidson, K., Quinn, M., & Flowers, P. (in press). Developing a primary care-initiated hepatitis C treatment pathway in Scotland: a qualitative study. British Journal of General Practice,

Journal Article Type Article
Acceptance Date Mar 10, 2022
Online Publication Date May 23, 2022
Deposit Date Jun 9, 2022
Publicly Available Date Jun 9, 2022
Journal British Journal of General Practice
Print ISSN 0960-1643
Electronic ISSN 1478-5242
Publisher Royal College of General Practitioners
Peer Reviewed Peer Reviewed
Keywords general practice, hepatitis C, primary health care, qualitative research,Scotland, therapeutics
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