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Background Although the availability of fully funded direct‐acting antivirals (DAAs) and the eligibility of primary care providers (PCPs) to provide hepatitis C virus (HCV) have removed barriers related to access to hospital‐based HCV treatment in Australia, there are still many barriers to the provision of HCV treatment in community settings. There is a lack of knowledge regarding the barriers to, and enablers of HCV treatment in community settings in Australia. This study aimed to identify barriers and enablers for the provision of community‐based HCV treatment. Methods This study was a part of a mixed‐method case study of the Cure‐It programme. The programme was studied to better understand barriers and enablers experienced by stakeholders of such programmes. The programme is delivered through the Prince Charles Hospital in Brisbane, Australia, and aimed to improve access to HCV treatment in community settings. Data were collected using semi‐structured interviews with 12 healthcare providers and nine patients between July and December 2018. Purposive sampling was used to ensure diverse views were captured. The interview transcripts were analysed using inductive thematic analysis. Results Ease of access to specialist support, easy and high value treatment, co‐location with or providing other services and motivated patients enabled PCPs to be engaged with the Cure‐It programme. Several interconnected factors related to patients’ characteristics and health system acted synergistically to enable patients to initiate and complete treatment. These included a desire to remove HCV as a source of shame, having children, awareness of HCV consequences, access to DAAs for free, ease of access to general practices and drug and alcohol services, and access to a safe and enabling environment. The identified barriers were interconnected at the levels of patients, PCPs and primary care systems and acted synergistically to prevent patients and PCPs from becoming engaged with HCV treatment. PCPs’ related barriers included a lack of knowledge, their perception of HCV as a specialist area and of patients with HCV as ‘hard to manage’ patients along with the practice preferences and priorities. Patients’ related barriers included their socioeconomic characteristics, internalized stigma, perception of not being sick and lack of knowledge. Additionally, the unavailability of support for patients and existence of stigma in primary health care, along with poor communication between the hospital and primary care system, and the unavailability of FibroScan® in primary care discouraged PCPs and patients engagement specifically with the provision of community‐based HCV treatment. Conclusion Various strategies are needed to improve PCPs and patients’ knowledge and awareness of HCV treatment. Training and support for PCPs need to be easy to access and should cover both clinical and social aspect of HCV. Connecting PCPs to other related services may improve PCPs’ and patients’ engagement with HCV treatment.

There is a strong prima facie case linking the abuse of psychiatry with difficulties about the concept of mental illness. However, a survey of recent Soviet literature showed that the concept of disease employed in the former USSR (where abuse was for a time widespread) was similar to its counterparts in the UK and USA in being strongly scientific in nature. A number of factors--legal, bureaucratic and professional--are important in abuse becoming widespread. These, however, fail to explain why psychiatry, rather than physical medicine, should be vulnerable to abuse. It is here that the concept of disease could be important. A scientific model of disease suggests that a significant vulnerability factor is the relatively underdeveloped status of psychiatry as a science. This leaves room for poor standards of scientific work in clinical research and practice, factors which are recognised as important in the Soviet case. In addition to the scientific element, there is an evaluative element of meaning in the concept of disease. Hence a second vulnerability factor could be the evaluatively problematic nature of judgements of mental illness. It is concluded that a failure to recognise this factor greatly increases the vulnerability of psychiatry, not only to gross abuses, but also to inadvertent misuses of involuntary treatment in everyday practice. This conclusion, far from undermining the role of science in psychiatry, is a step towards clarifying its proper role.

Ethnic nepotism theory predicts that even in times of communal peace altruism is more pronounced within than between ethnic groups. The present study tested the hypothesis that altruism in the form of alms giving would be greater within than between ethnic groups, and greater between more closely related groups than between more distant groups. The three groups chosen for study were ethnic Russians, Moldavians, and Gypsies. Russians are genetically closer to Moldavians than to Gypsies. Observations were made of 128 ethnic Russian, 25 Moldavian, and 25 Gypsy beggars receiving gifts from ethnic Russians in Moscow trains. The Gypsies were mainly girls, contrary to the Russian sample. Multivariate analysis identified three main strategies: active, personified, and appeasing-undirected. Russian strategies were most variable. Gypsies presented strong charity releasers: 84% were children who played music and sang and showed appeasing-undirected behavior. The few adults were highly submissive or friendly. Nevertheless, their success was limited compared with that of ethnic Russians despite the latter's demanding behavior and their being mostly mature or elderly persons. Moldavians received an intermediate amount of charity. The hypothesis was supported.

Summary Several community‐based models for treating hepatitis C virus (HCV) infection have been implemented to improve treatment accessibility and health outcomes. However, there is a lack of knowledge regarding how well these models achieve the desired goals. We conducted a mixed‐method systematic review of quantitative and qualitative evidence about clinical effectiveness, cost effectiveness and acceptability of community‐based HCV treatment models. Seventeen databases were researched for published and unpublished studies. Methodological quality was assessed using The Joanna Briggs Institute Critical Appraisal tools. Quantitative findings were synthesized in narrative form and qualitative findings were synthesized using meta‐synthesis. Forty‐two quantitative and six qualitative studies were included. No relevant cost effectiveness studies were found. Five categories of community‐based models were identified: telehealth, integration of HCV and addiction services, integration of HCV and HIV services, integration of HCV and primary care, and implementation by a home care and health care management company. The range of reported outcomes included; end of treatment response: 48.7% to 96%, serious side effects: 3.3% to 27.8%, sustained virological response: 22.3% to 95.5%, relapse: 2.2% to 16.7%, and treatment completion: 33.4% to 100%. Inconsistent measures of uptake and adherence were used; uptake ranged from 8.3% to 92%, and 68.4% to 100% of patients received ≥80% of prescribed doses. Patient reported experiences included trusted and supportive care providers, safe and trusted services, easily accessible care, and positive psychological and behavioural changes. The clinical effectiveness and acceptability reported from the included studies are similar to or better than reported outcomes from systematic reviews of studies in tertiary settings. Studies of the cost effectiveness of community‐based models for treating HCV are needed.

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