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

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

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

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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. However, in the UK, 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 design informed by behaviour change theory. Semi-structured interviews were undertaken with key stakeholders (n=38) primarily from two large urban conurbations in Scotland.
Method: Analysis was three-stage. First, we outlined a broad pathway structure, and then specified sequential pathway steps. Second, thematic data were aligned to pathway steps, and significant barriers and enablers identified. 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 to 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 the UK. It positions primary care providers as an integral part of community-based HCV treatment, providing workable solutions to ingrained barriers to care.
Original languageEnglish
JournalBritish Journal of General Practice
Early online date21 Mar 2022
Publication statusE-pub ahead of print - 21 Mar 2022


  • general practice
  • hepatitis C
  • primary health care
  • qualitative research
  • Scotland
  • therapeutics


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