Biomedical Sciences ETDs

Publication Date

Fall 12-12-2020

Abstract

Background: The Hepatitis C Virus (HCV) care cascade has been well characterized in the general United States population and other subpopulations. However, information is limited on care cascade outcomes in persons experiencing homelessness now that highly effective medications offer the potential for cure.

Objectives: The main objective of this study is to map the available evidence on HCV care cascade outcomes in homeless and marginally housed cohorts in the United States in the era of direct-acting antiviral agents. Primary and secondary outcomes of interest include linkage to care and sustained virologic response. Exploratory outcomes include other care cascade data.

Sources of Evidence: The PubMed database was the primary information source accessed for this scoping review.

Methods: We characterized the HCV care cascade in homeless and marginally housed populations using sources of evidence published in 2014 onwards that reported rates of linkage to care, sustained virologic response, and other cascade outcomes. We synthesized our results into a scoping review.

Results: The rate of linkage to care for homeless cohorts in this review ranged from 29% to 88.7%. The range of sustained virologic response, or cure, was 5% to 50% in selected studies. Direct-acting antiviral (DAA) initiation, an intermediate cascade step, was between 5% and 58.8%.

Conclusions: These results show that persons experiencing homelessness achieve high rates of linkage to care in community-based settings as compared to the general United States population. However, DAA initiation was found to be a rate-limiting step along the care cascade, resulting in commensurate rates of cure.

Keywords

linkage to care, sustained virologic response

Document Type

Thesis

Language

English

Degree Name

Biomedical Sciences

Level of Degree

Masters

Department Name

Biomedical Sciences Graduate Program

First Committee Member (Chair)

Kimberly Page, PhD, MPH, MS

Second Committee Member

Denece Kesler, MD, MPH

Third Committee Member

Shiraz I. Mishra, MBBS, PhD

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