| Sumario: | 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.
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