-->PONE-D-25-61140-->-->Barriers and facilitators to hepatitis C patient engagement: interview study with General Practitioners in England-->-->PLOS One

Dear Dr. Stuart,

Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process.

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Please note that we have only been able to secure a single reviewer to assess your manuscript. We are issuing a decision on your manuscript at this point to prevent further delays in the evaluation of your manuscript. Please be aware that the editor who handles your revised manuscript might find it necessary to invite additional reviewers to assess this work once the revised manuscript is submitted. However, we will aim to proceed on the basis of this single review if possible.

The reviewer raised a number of major concerns. They recommend that the manuscript clarify that most of the GPs are from London which may limit the generalizability of the study. They also made suggestions to improve the readability and structure of the manuscript.

Could you please carefully revise the manuscript to address all comments raised?

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Please submit your revised manuscript by Mar 22 2026 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org. When you're ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file.

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We look forward to receiving your revised manuscript.

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Katherine Demi Kokkinias, Ph.D.

Staff Editor

PLOS One

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Reviewers' comments:

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-->Comments to the Author

1. Is the manuscript technically sound, and do the data support the conclusions?

The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented. -->

Reviewer #1: Yes

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-->2. Has the statistical analysis been performed appropriately and rigorously? -->

Reviewer #1: Yes

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-->3. Have the authors made all data underlying the findings in their manuscript fully available?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.-->

Reviewer #1: Yes

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-->4. Is the manuscript presented in an intelligible fashion and written in standard English?

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Reviewer #1: Yes

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-->5. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)-->

Reviewer #1: This study investigated the role of hepatitis C (HCV) General Practitioners (GPs) in identifying and re-engaging patients with HCV. Using semi-structured interviews and a dual analytical framework (a multi-level model and the COM-B behavioral framework), the authors identified barriers and facilitators to HCV care at the system level (e.g., NHS incentives, primary care pressures) and the provider level (e.g., GP knowledge, capacity, motivation) . They found that, while the GP Champion role is beneficial in terms of capacity, motivation, and collaboration, persistent system-level barriers (like lack of financial incentives and fragmented processes) hinder wider success. The study attempted to address a critical public health gap- finding “lost” patients to achieve HCV elimination goal. However, this is a purely qualitative study, lack of quantitative data is the key limitation. Additionally, the concerns listed below must be addressed.

1. The participant sample is heavily weighted toward London-based GPs (10 of 14), which may limit the representativeness of the findings across England. This should be clearly acknowledged in the limitations section.

2. The manuscript title appears to overstate the generalizability of the findings. As the participants were predominantly hepatitis C GP Champions (12 of 14), rather than general GPs, the title should be revised to more accurately reflect the study population.

3. The Introduction section is somewhat lengthy. A light condensation would improve clarity and focus. In particular, the discussion of international decentralization efforts could be slightly shortened.

4. The Introduction would benefit from a more explicit and concise statement of the research gap that this study aims to address.

5. The phrasing in lines 47–50 is ambiguous, particularly regarding the relationship between progress made and the remaining disease burden. Clarification would improve readability.

6. The Conclusion section is overly long and reads as descriptive rather than synthetic. Repeated use of the phrase “they reported” gives the section a results-like tone. The authors may consider tightening this section and emphasizing a clearer, more focused final takeaway.

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Reviewer #1: No

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Barriers and facilitators to hepatitis C patient engagement: interview study with General Practitioner Champions in England

PONE-D-25-61140R1

Dear Dr. Stuart,

We’re pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it meets all outstanding technical requirements.

Within one week, you’ll receive an e-mail detailing the required amendments. When these have been addressed, you’ll receive a formal acceptance letter and your manuscript will be scheduled for publication.

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Kind regards,

Ilhem Berrou, PhD

Academic Editor

PLOS One

Additional Editor Comments (optional):

Reviewers' comments:

Reviewer's Responses to Questions

-->Comments to the Author

1. If the authors have adequately addressed your comments raised in a previous round of review and you feel that this manuscript is now acceptable for publication, you may indicate that here to bypass the “Comments to the Author” section, enter your conflict of interest statement in the “Confidential to Editor” section, and submit your "Accept" recommendation.-->

Reviewer #1: All comments have been addressed

Reviewer #2: (No Response)

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-->2. Is the manuscript technically sound, and do the data support the conclusions?

The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented. -->

Reviewer #1: Yes

Reviewer #2: Partly

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-->3. Has the statistical analysis been performed appropriately and rigorously? -->

Reviewer #1: N/A

Reviewer #2: N/A

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-->4. Have the authors made all data underlying the findings in their manuscript fully available?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.-->

Reviewer #1: Yes

Reviewer #2: Yes

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-->5. Is the manuscript presented in an intelligible fashion and written in standard English?

PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.-->

Reviewer #1: Yes

Reviewer #2: Yes

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-->6. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)-->

Reviewer #1: Thank you for carefully revising your manuscript. You responded satisfactorily to the reviewers' comments. The revised manuscript now meets the journal's publication requirements, and I am pleased to recommend that it be accepted for publication.

Reviewer #2: With the questions within line 147 in Table 1. Example topic guide questions per COM-B domain - by definition, Capability was defined as 'physical and psychological skills of the person that make behaviour possible'. The Example question for this section includes 'What are some strategies that GP practices could implement to monitor and improve on re-engaging hepatitis C patients?' This question is addressed the GP practice system strategies rather than skills of a person. Additionally - should this be classed as an opportunity - rather than capability? Within S1 Appendix 1 - this question may be linked to Q20 which relates to as an example 'could they join up with drug and alcohol services, ODNs?' Is this the GP practice? If so - how is this 'psychological capability-behavioural regulation'? Is this not the physical environment to make behaviour possible i.e. opportunity? Please can this be reviewed and clarified.

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-->7. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files.

If you choose “no”, your identity will remain anonymous but your review may still be made public.

Do you want your identity to be public for this peer review?  For information about this choice, including consent withdrawal, please see our Privacy Policy.-->

Reviewer #1: No

Reviewer #2: No

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