Date of Award

January 2026

Document Type

Open Access Thesis

Degree Name

Medical Doctor (MD)

Department

Medicine

First Advisor

Frederick Altice

Abstract

People who use drugs (PWUD) are at high risk of contracting Hepatitis C Virus (HCV) and often face significant barriers in accessing healthcare. Treatment of HCV is highly effective, but previous studies show low rates of successful treatment in practice due to multiple points of failure along the treatment cascade. Harm reduction and outreach programs such as syringe services programs (SSPs) and drug treatment programs including medication for opioid use disorder (MOUD) have emerged as possible points of leverage in advancing people through the cascade of care. To better understand how people who use drugs access HCV treatment and elucidate the association of drug treatment and outreach programs with treatment outcomes, we examined the HCV cascade of care among people who use drugs in New Haven, Connecticut. We analyzed New Haven site data from Project Needle EXchange Utilization Survey, a cross-sectional survey of PWUD recruited from syringe services programs (SSPs) in the US during 2021 to 2022 with concurrent HCV rapid antibody and RNA testing. Independent variables were identified based on Liz Gelberg/Ron Andersen’s Behavioral Model for VulnerablePopulations characterized with univariate analysis to assess demographics, harm reduction practices, and experiences with healthcare. We constructed a cascade of care for HCV to identify gaps in HCV care and used logistic regression analysis to assess the association of current engagement with outreach and drug treatment programs with cascade of care outcomes. In addition, we assessed accuracy of participants’ self-reported HCV status with a weighted Cohen’s Kappa and assessed the association of perceived HCV status as well as healthcare touchpoints with syringe sharing behaviors. The 309 NEXUS survey participants experienced high rates of negative social determinants of health, including homelessness (63%), unemployment (70%) and polysubstance use. Among the 306 participants who were tested for HCV, 21% were currently HCV positive and 31% were previously infected. There were high rates of lifetime HCV screening but poor rates of routine screening within the last year among active injection drug users who reported sharing injection equipment with others (48% in the last year). Of the participants with any evidence of past or present infection, only 38.8% had been treated for HCV; among the participants with evidence of active infection within the last year, only 16% had been linked to care. In addition, understanding of HCV status was only fair, with only 55-60% agreement between actual and laboratory testing. In logistic regression models, MOUD emerged as a key healthcare touchpoint with consistent positive associations across the HCV treatment cascade. Statistical power was limited by sample size, but 6-month use of MOUD had a statistically significant positive association with HCV treatment as well as a statistically significant negative association with receptive syringe sharing. SSP engagement had less consistent associations across the cascade but was an important source of HCV screening. This analysis demonstrates important gaps in HCV screening, awareness, and linkage to care among PWUD in New Haven, CT. Although statistical analysis is significantly limited by underlying data, it provides additional support to previous research showing that MOUD engagement can support people through the HCV cascade of care and demonstrates that there may be opportunities for continued efforts to support HCV care at SSPs.

Comments

This is an Open Access Thesis.

Download
Open Access

This Article is Open Access

Share

COinS