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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

Elizabeth M Speakman

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.

Journal Article Type Article
Acceptance Date Mar 10, 2022
Online Publication Date May 23, 2022
Publication Date 2022-09
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
Volume 72
Pages e668-e676
Keywords general practice, hepatitis C, primary health care, qualitative research,Scotland, therapeutics
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