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Laura Sweet Dissertation HCV.pdf (1.74 MB)

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Correlates to Hepatitis C Virus Infection and Linkage to Care

Sweet, Laura Louise
http://orcid.org/0000-0003-4250-1658
http://rave.ohiolink.edu/etdc/view?acc_num=osu1672971163769515

Abstract Details

2023, Doctor of Philosophy, Ohio State University, Public Health.
Introduction: Hepatitis C virus (HCV) causes more morbidity and mortality in the US than any other bloodborne infectious disease, despite highly effective treatments. Significant challenges remain in identifying patients with HCV and linking them to care. IV drug use is widely recognized as the most important driver of current HCV transmission. However, other routes, such as sexual transmission, also occur but are comparatively understudied except in certain subpopulations such as men who have sex with men (MSM). It is unknown how gender and sexual orientation interact to modify the importance of sexual risk factors for HCV for the entire population. This research aimed to explore correlates to HCV seropositivity across patient subpopulations and investigate factors associated with linkage to care. Methods: For 14,718 patients tested for HCV between 2017-2020 at the Columbus, Ohio public health department, multivariate logistic regression was used to investigate how HCV seropositivity was associated with patient characteristics, health behaviors, and history of sexually transmitted infections (STI) including HIV, and how gender and sexual orientation modified these associations. A second analysis of correlates to linkage to care used logistic regression models to explore how patient characteristics and Medicaid policy changes were associated with linkage to care outcomes, using data from the Ohio Disease Reporting System (ODRS) for a cohort of HCV RNA-positive patients in urban central Ohio. Results: There were differences in how sexual risk behaviors were associated with HCV between strata of gender and sexual orientation in multivariate models. IV drug use was positively associated with HCV for all strata; however, number of sexual partners was associated with HCV for MSM (AOR 1.01; 95% CI 1.00-1.02) and WSM (AOR 1.02; 95% CI 1.00-1.03) but not MSW or WSW. Sex with an IV drug user was positively associated with HCV across all strata except MSM (AOR 6.72; 95% CI 4.38-10.32 for MSW; AOR 6.28; 95% CI 3.14-12.55 for WSM; AOR 9.40; 95% CI 3.19-27.68 for WSW). Linkage to care was associated with older age (AOR 1.03; 95% CI 1.02-1.04) and White race compared to Black race (AOR 1.50; 95% CI 1.12-2.01), and incarceration was associated with lower odds of linkage to care (AOR 0.10; 95% CI 0.02-0.41). Diagnosis before Medicaid coverage was expanded was associated with lower odds of linkage to care (AOR 0.41; 95% CI 0.22-0.80). Conclusions: This work identified differences in HCV risk factors across gender and sexual orientation. The observed stronger association between HCV and sexual risk factors for women could be suggestive of either higher risk of HCV sexual transmission, social factors related to unmeasured IV drug use, or a combination of these factors. While Ohio Medicaid rules expanding treatment coverage was associated with overall greater linkage to care, disparities in care access remained, most strikingly for people who were incarcerated. This illustrates that improving equity in care access is a human rights issue, as well as an important strategy in the fight to end HCV as a public health problem through treatment as prevention.
JaNelle Ricks (Advisor)
Alison Norris (Committee Member)
Jose Bazan (Committee Member)
Maria Gallo (Committee Member)
126 p.
Public Health
hepatitis C linkage to care sexual transmission sexual orientation gender MSM access to care health equity continuum of care

Recommended Citations

Citations

  • Sweet, L. L. (2023). Correlates to Hepatitis C Virus Infection and Linkage to Care [Doctoral dissertation, Ohio State University]. OhioLINK Electronic Theses and Dissertations Center. http://rave.ohiolink.edu/etdc/view?acc_num=osu1672971163769515

    APA Style (7th edition)

  • Sweet, Laura. Correlates to Hepatitis C Virus Infection and Linkage to Care. 2023. Ohio State University, Doctoral dissertation. OhioLINK Electronic Theses and Dissertations Center, http://rave.ohiolink.edu/etdc/view?acc_num=osu1672971163769515.

    MLA Style (8th edition)

  • Sweet, Laura. "Correlates to Hepatitis C Virus Infection and Linkage to Care." Doctoral dissertation, Ohio State University, 2023. http://rave.ohiolink.edu/etdc/view?acc_num=osu1672971163769515

    Chicago Manual of Style (17th edition)

osu1672971163769515
103
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This open access ETD is published by The Ohio State University and OhioLINK.