Hannah Family

Scaling up hepatitis C virus (HCV) testing and treatment for people who inject drugs (PWID) is essential to achieve HCV elimination. We report a retrospective systems‐informed qualitative process evaluation of HCV care across multiple community‐based settings in a region in Scotland, UK. Using secondary data from 71 semi‐structured interviews with HCV service providers ( n = 40) and service users ( n = 31) from across the whole system, we identified universal barriers and facilitators of delivering HCV care (access, testing, treatment, support) within four settings (i.e., enhanced needle and syringe programme services, prisons, pharmacies and drug treatment centres). HCV care had been delivered. We report only one, universal barrier (staff skills and confidence in HCV testing). Systemic HCV care can be delivered through coordinated, multi‐levelled actions across a given service ecology within a geographical area. Such systemic approaches are needed to achieve HCV elimination targets for the whole PWID population.

Background/Objectives: In England, gay, bisexual, and other men who have sex with men (GBMSM) are eligible for vaccination at NHS sexual health services, including human papillomavirus (HPV), hepatitis A virus (HAV), and hepatitis B virus (HBV) vaccines. However, current research shows limited understanding of the factors influencing vaccination uptake among GBMSM. This study aimed to examine the barriers and facilitators affecting the offer and uptake of these vaccination programmes. Methods: A qualitative interview study following the Person-Based Approach (a systematic method for developing and optimising health interventions) involving GBMSM and sexual health service staff from two regions of England. Purposive sampling aimed to include GBMSM with diverse backgrounds and engagement with sexual health services. Patient and public involvement shaped the study design and interview topic guides. The interviews were recorded, transcribed, and thematically analysed to identify barriers and facilitators which were interpreted using the COM-B model of behaviour change. Results: Twenty GBMSM and eleven staff took part. The findings showed that opportunistic delivery of HPV, HAV, and HBV vaccination within sexual health services is mostly acceptable and feasible for GBMSM and staff, while also highlighting areas for optimization. Despite low knowledge of these viruses and their associated risks, willingness to be vaccinated was high, with healthcare provider recommendations and the convenience of vaccine delivery during routine clinic visits acting as important facilitators. However, the reach of opportunistic models was limited, particularly for individuals underserved by sexual health services or disengaged from GBMSM social networks. System-level barriers such as complex vaccine schedules (particularly when multiple schedules are combined), inconsistent access to vaccination histories, and limited system-level follow-up processes (e.g., automated invites and reminders) were also found to act as obstacles to vaccination uptake and delivery. Conclusions: To improve equitable uptake, sexual health services should explore the feasibility of addressing both individual and structural barriers through additional strategies, including targeted and persuasive communication to increase knowledge, leveraging regular contact with GBMSM to promote uptake, and implementing enhanced approaches to support vaccination completion (e.g., automated prompts or reminders).

Background/Objectives: In England, gay, bisexual and other men-who-have-sex-with-men (GBMSM) are eligible for vaccinations at NHS sexual health services, including human papillomavirus (HPV), hepatitis A virus (HAV), and hepatitis B virus (HBV). However, current research shows limited understanding of the factors influencing vaccination uptake among GBMSM. This study aimed to examine the barriers and facilitators affecting the offer and uptake of these vaccination programmes. Methods: A qualitative interview study following the Person-Based Approach (a systematic method for developing and optimising health interventions) involving GBMSM and sexual health service staff from two regions of England. Purposive sampling aimed to include GBMSM with diverse backgrounds and engagement with sexual health services. Patient and public involvement shaped the study design and interview topic guides. The interviews were recorded, transcribed, and thematically analysed to identify barriers and facilitators which were interpreted using the COM-B model of behaviour change. Results: Twenty GBMSM and eleven staff took part. The findings showed that opportunistic delivery of HPV, HAV and HBV vaccination within sexual health services is mostly acceptable and feasible for GBMSM and staff while also highlighting areas for optimization. Despite low knowledge of these viruses and their associated risks, willingness to be vaccinated was high, with healthcare provider recommendations and the convenience of vaccine delivery during routine clinic visits acting as important facilitators. However, the reach of opportunistic models was limited, particularly for individuals underserved by sexual health services or disengaged from GBMSM social networks. System-level barriers such as complex vaccine schedules (particularly when multiple schedules are combined), inconsistent access to vaccination histories and limited system-level follow-up processes (e.g. automated invites and reminders) were also found to act as obstacles to vaccination uptake and delivery. Conclusions: To improve equitable uptake, sexual health services should explore the feasibility of addressing both individual and structural barriers through additional strategies, including targeted and persuasive communication to increase knowledge, leveraging regular contact with GBMSM to promote uptake and implementing enhanced approaches to support vaccination completion (e.g. prompts or reminders).

Background: Testing for HIV, linkage to treatment, and access to pre-exposure prophylaxis (PrEP) (medication that reduces the risk of acquiring HIV) is essential for early HIV diagnosis, treatment, and prevention. General practice could play a key role in maximising HIV testing opportunities and supporting access to PrEP. Aim: To develop an intervention for general practice to increase HIV testing and facilitate access to PrEP. Design and setting: This was a person-based approach (PBA) intervention development study using the capability, opportunity, motivation, behaviour model in South West England. Method: A scoping review and semi-structured interviews with healthcare professionals (HCPs) and local organisation representatives with an interest in HIV prevention/health care were conducted to understand the challenges and find potential solutions to increase HIV testing and facilitate access to PrEP in general practice. Intervention development used focus groups with HCPs and the public. Purposive sampling ensured diversity of practices and participants. Data were analysed using the PBA table of planning and the collaborative and intensive pragmatic qualitative approach. Results: Barriers identified included lack of clinician knowledge of HIV and PrEP, concern about stretched resources, and a lack of systematic testing methods. Proposed strategies included simpler testing approaches to normalise testing and reduce HIV stigma. The intervention developed consists of: education, a prompt to test, simplified and standardised testing, PrEP signposting processes, patient information, and practice champions. Conclusion: Research is needed to explore the feasibility and the effectiveness of this multicomponent intervention to increase testing and access to PrEP within general practice. Funding barriers also need to be addressed.

Objectives: To develop and implement a community pharmacy pre-exposure prophylaxis (PrEP) awareness raising and initiation pilot, informed by a literature review and interviews with pharmacists and community members. Methods: Using the Person-Based Approach and the Capability, Opportunity, Motivation– Behaviour change (COM-B) model, the pilot aimed to improve HIV/PrEP knowledge/capability and motivation through pharmacist and community awareness-raising. Opportunity was addressed by integrating PrEP consultations into pharmacy services and offering STI, HIV, and estimated glomerular filtration rate (eGFR) home test kits. Financial incentives also aimed to motivate pharmacists. Pharmacists identified eligible community members, initiated PrEP discussions, and provided home testing kits. Individuals opting to start PrEP completed the tests and posted them to a local sexual health clinic, where staff reviewed the results, confirmed eligibility, and prescribed PrEP remotely. NHS policy restrictions on pharmacies stocking NHS-procured PrEP informed the delivery model. The pilot evaluation focused on staff training impact, number/type of consultations, and feasibility and acceptability of pharmacy PrEP delivery for staff and community members. Results: The pilot was conducted in five pharmacies across Bristol, North Somerset, and South Gloucestershire from October 2024 to April 2025. A total of 55 consultations were held with individuals aged 18–69 (n=23 male, n=31 female, n=1 transgender). Visit reasons included emergency contraception (n=14), PrEP (n=14), and opioid substitution therapy (n=11). Twenty-eight community members expressed interest in PrEP; 22 accepted a home testing kit, seven returned it, and four were prescribed PrEP. Pharmacists and community members viewed the service positively. Barriers included pharmacists’ initial lack of confidence initiating PrEP discussions and limited public awareness of PrEP availability in pharmacies. Conclusion: Community pharmacies represent a promising site for PrEP delivery. Successful scale-up requires pharmacist training, public health education, structural and policy changes to support accessible PrEP provision beyond sexual health clinics to reduce inequities. Key messages: What is already known on this topic: There are inequities in access to and uptake of PrEP due to a lack of awareness of PrEP, stigma, geographical proximity and access to sexual health clinics. PrEP awareness raising and initiation via community pharmacies could improve access and uptake. What this study adds: This is the first UK pharmacy-based PrEP awareness raising and initiation pilot targeting underserved community members not currently accessing PrEP. Findings show pharmacy PrEP awareness raising and initiation to be acceptable and feasible for pharmacists and community members. Pharmacies have the potential to be valuable community assets for PrEP in addition to traditional sexual health clinics, particularly for underserved community members. Improved community awareness of PrEP and pharmacist confidence in delivering the service could help optimise pharmacy PrEP delivery. How this study might affect research, practice or policy: Community pharmacy PrEP delivery needs to be supported by appropriate training that equips pharmacists with the capabilities and confidence required to provide a comprehensive service. This should be facilitated by policy frameworks and funding that allow provision of PrEP outside of sexual health clinics.

Background: Hepatitis C Virus is a global health burden, particularly affecting people who inject drugs. Direct‐acting antiviral treatment can cure almost all people infected with hepatitis C. However, the longer‐term impacts on within people's life trajectories are unknown, although some suggest it may lead to fundamental behavioural changes. Design: A cross‐sectional exploratory retrospective qualitative design. Methods: We interviewed 30 people who inject(ed) drugs and who had previously been treated with direct‐acting antivirals on average 18 months before the interview (range: 12–24 months). Most were male, aged 36–55 years, and had been treated in urban community‐based needle and syringe programmes in Scotland. All interviews were semi‐structured, conducted over the phone by either peer or academic researchers, and analysed thematically. Results: We present three discernible post‐treatment life‐trajectories. Firstly, ‘ A cure that was like totally new life’ involved identity transformation, often associated with controlled or zero drug use, and improved physical and mental health. Secondly, ‘ There isn't much afterwards ’ comprised poor quality of life and social isolation, often due to participants' disengagement from former drug use and support networks. Thirdly, ‘ I'm getting tested every year now’ detailed a few life changes but normalized hepatitis C testing and treatment. Conclusion: Our thematic analysis reinforces the positive impacts on mental well‐being, physical health and self‐transformation of direct‐acting antiviral treatment in the short‐ and long‐term. However, there is an urgent need for psychosocial interventions to maintain health behaviour changes and self‐management, and social support for individuals post hepatitis C treatment.

Background: Testing for HIV, linkage to treatment and access to pre-exposure prophylaxis (PrEP) (medication which reduces the risk of acquiring HIV) is essential for early HIV diagnosis, treatment, and prevention. General practice could play a key role in maximising H IV testing opportunities and supporting access to PrEP. Aim: To develop an intervention for general practice to increase HIV testing and facilitate access to PrEP. Design and setting: A person-based approach (PBA) intervention development study using the Capability, Opportunity, Motivation, Behaviour (COM-B) Model in South West England. Method: A scoping review and semi-structured interviews with healthcare professionals (HCPs) and local organisation representatives with an interest in HIV prevention/healthcare) were conducted to understand the challenges and find potential solutions to increase HIV testing and facilitate access to PrEP in general practice. Intervention development used focus groups with HCPs and the public. Purposive sampling ensured diversity of practices and participants. Data was analysed using the PBA table of planning and CLIP-Q approach. Results: Barriers identified included lack of clinician knowledge of HIV and PrEP, concern about stretched resources and a lack of systematic testing methods. Proposed strategies included simpler testing methods to normalise testing and reduce HIV stigma. The intervention developed consists of: education, a prompt to test, simplified and standardised testing and PrEP signposting processes, patient information, and practice champions. Conclusion: Research is needed to explore the feasibility and the effectiveness of this multicomponent intervention to increase testing and access to PrEP within general practice. Funding barriers also need to be addressed. How this fits in: General practice could play a key role in maximising HIV testing opportunities and supporting access to pre-exposure prophylaxis (PrEP). Opportunities to carry out HIV testing continue to be missed in general practice leading to late HIV diagnosis which is associated with reduced life expectancy, increased mortality and greater treatment costs. Patient acceptability for HIV testing is high but testing rates are low and variable and patients experience barriers to accessing PrEP through sexual health clinics. This research reports the development of a multi-faceted approach to increase HIV testing and access to PrEP in general practice using the person-based approach. This included investigating public and healthcare professional perceptions about a range of approaches including training, opt-out testing, and the provision of decision-making aids. Targeting capability, opportunity and motivation barriers the intervention encompasses HIV and PrEP education and training, and the provision of simpler and systematic approaches to testing.

Background: Co-use of benzodiazepines and/or ‘z-drugs’ along with opioids is linked to the rise in drug related deaths (DRD) in the UK. Understanding patterns of co-use could inform harm reduction strategies for reducing DRDs. This study explored how people co-use, including dosages, timings, methods of administration, use of other substances and desired effects sought. Methods: Forty-eight semi-structured interviews across Glasgow in Scotland (n = 28), Bristol (n = 10) and Teesside (n = 10) in England with individuals who co-use illicit and/or prescribed opioids and benzodiazepines/z-drugs were conducted. Eighteen interviews were co-facilitated with qualitatively trained local peer researchers. Interviews were analysed using the Framework method. Results: Six co-use patterns were generated: (1) co-use to aid sleep or come down, (2) curated co-use, opioid agonist therapy (OAT) only (3) morning and evening benzodiazepine doses with opioids throughout the day (4) co-use binges (5) co-use throughout the day, (6) benzodiazepine use throughout the day plus OAT. Patterns one to three reflected more controlled co-use with a focus on self-medicating to give confidence, manage anxiety, promote sleep and come-down from cocaine/ketamine. Patterns four to six involved greater poly-drug use, and less controlled co-use with a focus on seeking euphoria (“warm glow”, “gouching out”) or oblivion (to escape untreated mental health conditions and trauma). Patterns two, three, five and six involved daily co-use. People switched between patterns depending on available resources (e.g. finances) or changes to prescriptions (opioids or benzodiazepines). Near-fatal overdoses were reported by participants across all co-use patterns. Patterns four to six were conceptualised as presenting greater overdose risk due to less controlled co-use and more extensive polydrug use. Conclusions: The patterns identified provide opportunities for future harm reduction strategies, tailoring advice to patterns of use, updated prescribing guidance and policies, and the need for better access to mental health care, for people who co-use benzodiazepines and opioids to reduce DRDs.

Aim: We aimed to explore participant perspectives on social prescribing (SP) for mental health and well-being and the acceptability of community pharmacists (CP) as members of SP pathways that support people with mild to moderate depression and anxiety. Background: SP aims to support people with poor health related to socio-demographic determinants. Positive effects of SP on self-belief, mood, well-being, and health are well documented, including a return to work for long-term unemployed. Methods: The study was set in a city in southwest England with diverse cultural and socio-demographics. We recruited SP stakeholders, including CP, to either one of 17 interviews or a focus group with nine members of the public. Findings: An inductive iterative approach to thematic analysis produced four superordinate themes: (1) offering choice a non-pharmacological option, (2) supporting pharmacy communities – ‘it is an extension of what we do’, (3) stakeholder perspectives – pharmacists are very busy and their expertise unknown by some, and (4) potential for pharmacy in primary care. Stakeholders viewed CP as local to and accessible by their community. Pharmacists perceived referral to SP services as part of their current role. General practitioner participants considered pharmacy involvement could reduce their workload and expand the primary healthcare team. Importantly, general practitioners and CP viewed SP as a non-pharmacological alternative to prescribing unnecessary antidepressants and reduce associated adverse effects. All participants voiced concerns about pharmacy dispensing busyness as a potential barrier to involvement and pharmacists requesting mental health training updates. Key findings suggest CP offer a potential alternative to the general practitioner for people with mild to moderate depression and anxiety seeking access to support and health information. However, CP need appropriately commissioned and funded involvement in SP, including backfill for ongoing dispensing, medicines optimization, and mental health first aid training.