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

David Whiteley (Lead / Corresponding author), Elizabeth M. Speakman, Lawrie Elliott, Helen Jarvis, Katherine Davidson, Michael Quinn, Paul Flowers

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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. 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.

Original languageEnglish
Pages (from-to)E668-E676
Number of pages9
JournalBritish Journal of General Practice
Issue number722
Early online date1 Sept 2022
Publication statusPublished - Sept 2022


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

ASJC Scopus subject areas

  • Family Practice


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