Doctor of Philosophy, The Ohio State University, 2023, 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% (open full item for complete abstract)

Committee: JaNelle Ricks (Advisor); Alison Norris (Committee Member); Jose Bazan (Committee Member); Maria Gallo (Committee Member) Subjects: Public Health

MS, University of Cincinnati, 2019, Medicine: Biostatistics (Environmental Health)

In Ghana, men who have sex with men (MSM) are 15 times more likely to live with HIV compared to the general adult population, and rates of engagement in medical care for HIV are low among MSM diagnosed with HIV. Using structured survey interviews, we investigated the impact of HIV-related stigma (deconstructed into four components: enacted, felt normative, vicarious, and internalized HIV stigmas), same-sex behavior stigma, and gender nonconformity stigma on linkage to HIV care in 225 MSM living with HIV in Ghana. We found that vicarious HIV stigma (i.e., hearing stories of HIV discrimination) positively predicted linkage to care, such that MSM were three times more likely to be linked to care for each unit increase in vicarious stigma scale. Conversely, we found felt normative HIV stigma (i.e., perception of pervasiveness of HIV stigmatization) to negatively predict linkage to care, such that odds of being linked to care were decreased by 37% for each unit increase in felt normative scale. Perceived autonomy-supportive healthcare climate was a positive predictor of linkage to care, such that MSM were twice as likely to be linked to care for each unit increase in healthcare climate score. Finally, we identified locational differences in linkage to care, such that MSM in Takoradi were over three to four times more likely to be linked to care compared to MSM in Greater Accra or Kumasi. Ultimately, our findings highlight the nuanced roles that stigmas can play in shaping care-seeking behaviors and illustrate the need for open-minded perspectives of inquiry towards understanding engagement in the HIV care cascade for marginalized populations.

Committee: Marepalli Rao Ph.D. (Committee Chair); LaRon E. Nelson Ph.D. (Committee Member); Jun Ying Ph.D. (Committee Member); Nanhua Zhang Ph.D. (Committee Member) Subjects: Public Health