Prescribing direct-acting antivirals for hepatitis C treatment: a scoping review of factors that influence primary care providers.

Abstract

Hepatitis C is a significant public health challenge in Australia, particularly in diagnosis, treatment access, and ongoing care among people who inject drugs. Despite the availability of highly effective direct-acting antivirals and government subsidisation, treatment uptake has declined among this population in recent years, beyond what would be expected from the initial treatment of easier-to-reach patients. This rapid scoping review aimed to identify barriers and enablers affecting primary care providers in prescribing direct-acting antivirals for hepatitis C treatment. Studies were included if they: were published after 2014, focused on DAA treatment, included primary care provider perspectives, contained primary data, identified barriers/enablers to treatment, and were conducted in high-income countries. Two databases (Web of Science and Google Scholar) were searched for peer-reviewed articles. Primary care stakeholders were consulted through an online survey (n = 10) and telephone interviews (n = 7) to contextualise and validate findings. Data were charted using a standardised form capturing author, year, location, aim, participants, study details, and main findings. Analysis used a deductive approach to identify key themes. Twenty-three articles, mostly quantitative studies, were included in the review. The analysis identified four key domains influencing direct-acting antiviral prescription: provider characteristics, healthcare systems and service delivery, models of care, and societal and structural issues. This review provides insights into contemporary challenges in hepatitis C care delivery models and highlights critical structural, sociocultural, and interpersonal factors affecting testing and treatment, particularly for people who inject drugs. These findings have implications for improving direct-acting antiviral prescription rates in primary care settings.