Date of Award

Summer 2026

Language

English

Embargo Period

7-30-2026

Document Type

Dissertation

Degree Name

Doctor of Public Health (DrPH)

College/School/Department

Department of Epidemiology and Biostatistics

Program

Epidemiology

First Advisor

Tomoko Udo

Committee Members

Mark Kuniholm, Carmen Morano

Keywords

hepatitis C, PWID, persons who inject drugs, co-located models, implmementation science, evaluation, service utilization

Abstract

Hepatitis C virus (HCV) is the most prevalent blood-borne infection in the United States and is primarily transmitted through the sharing of unsterilized drug injection equipment. With surges in opioid overdose deaths, there has been an increase in people diagnosed with HCV that can be attributed to persons who inject drugs (PWID) in the United States. PWID have therefore been identified as a priority population to achieve the goal of eliminating HCV as a public health threat. Despite the availability of safe and effective direct-acting antiviral (DAA) therapies that can cure people with HCV, uptake of HCV treatment in PWID is low due to multiple competing priorities (e.g., other health issues, lack of housing and insurance) and structural barriers (e.g., past experiences with stigma from medical providers).

The NYS Department of Health (DOH) funded three pilot programs to co-locate HCV treatment in settings where PWID are comfortable accessing services called the Innovative Models of HCV care and treatment for PWID initiative, referred to as the Innovative Models, to identify strategies that improve uptake and completion of HCV treatment among PWID in New York State (NYS). These programs are designed to promote uptake and completion of HCV treatment among PWID by providing services in a non-traditional setting and addressing the unique and complex needs of PWID in a non-judgmental and stigma-free environment. Based on preliminary data from the Innovative Models initiative, there is evidence that these co-located models have a higher treatment initiation rate than HCV care provided in traditional hospital care settings.

The aims of this study were to comprehensively describe demographic characteristics of clients enrolled in the Innovative Models, investigate the amount of time clients progressed through the care cascade from program enrollment to treatment completion, quantify the services beyond HCV care and treatment that kept clients engaged in the Innovative Models, and determine what factors were associated with treatment initiation and completion. The Social Ecological Model (SEM) and the Integrated Framework of access to HCV care for PWID were used as frameworks to understand how the Innovative Models delivered services to engage clients and promote HCV treatment. These views provided a guiding lens for the Innovative Models across individual, interpersonal, and organizational environments, allowing a more complete understanding of service use, treatment uptake, and completion among PWID in co-located HCV treatment models.

Results from the bivariate analysis showed that males were more likely to initiate and complete HCV treatment than females. On average, PWID clients took 15.54 days (SD = 20.62) to initiate HCV treatment, the longest amount of time across the HCV treatment cascade. Data showed that Innovative Models clients with higher service usage were associated with treatment initiation, such as education, care coordination, outreach, non-HCV medical services, and SDOH services.  While not statistically significant, similar trends of increased care coordination and outreach service usage were evident among clients who completed treatment. Logistic regression modeling estimated the odds of clients initiating and completing HCV treatment, while accounting for client demographics and services provided by Innovative Models. There were significant associations between treatment initiation and older clients (AOR = 1.06, 95% CI = 1.01, 1.11, p = 0.01) and treatment-naïve clients (AOR = 10.43, 95% CI = 2.31, 47.11, p = 0.002). The logistic regression for treatment completion found a treatment disparity among female PWID (AOR = 0.41, 95% CI =0.18, 0.96, p = 0.04).

The findings underscore the importance of providing ancillary services to PWID in non-traditional settings, where they have access to these services, to increase engagement and improve their access to HCV care and treatment. Future research into barriers that both female and young PWID populations experience in disproportionate access to HCV treatment and how to better engage this population in healthcare services should be conducted to improve HCV treatment uptake. Promotion of treatment as prevention among younger PWID populations to address the increasing HCV cases in this population could improve them as candidates for treatment. The Integrated Framework of access to HCV care for PWID could prove effective in guiding future research efforts to increase HCV treatment initiation and completion rates among PWID.

License

This work is licensed under the University at Albany Standard Author Agreement.

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