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

Abstract

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.

Citation

Whiteley, D., Speakman, E. M., Elliott, L., Jarvis, H., Davidson, K., Quinn, M., & Flowers, P. (2022). Developing a primary care-initiated hepatitis C treatment pathway in Scotland: a qualitative study. British Journal of General Practice, 72, e668-e676. https://doi.org/10.3399/bjgp.2022.0044

• 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
• DOI: https://doi.org/10.3399/bjgp.2022.0044
• Keywords: general practice, hepatitis C, primary health care, qualitative research,Scotland, therapeutics
• Public URL: http://researchrepository.napier.ac.uk/Output/2877371