Date of Award

Spring 5-1-2012

Document Type

Thesis

Degree Name

Master of Science in Public Health (MSPH)

First Advisor

Robert Heimer

Second Advisor

Andre Sofair

Abstract

Background: 17,000 HCV infections occurred in the US in 2007. New Haven accounted for 16.1% of reported infections in CT between 2007-2009. Follow-up of cases allows linkage to treatment and services as well as secondary prevention. CTDPH has requested that all local health jurisdictions (LHJs) follow up with reported cases, however only three agencies do so.

Objectives: This mixed-methods study aimed to improve transitions from HCV diagnosis to treatment and services in New Haven, CT. The state of the surveillance system was documented and evaluated; a community resources assessment was conducted; and a pilot follow-up program protocol, resource guide, and evaluation tool were developed.

Methods: The state of the surveillance system was documented using state and LHJ staff interviews. Community resources were assessed using surveys with key stakeholders, which were analyzed using NVivo 9. The pilot follow-up program development utilized the institutional knowledge of LHJ staff currently conducting follow-up as well as educational materials.

Results: Qualitative analysis revealed that screening is inadequate, and many cases are lost to follow-up post-screening. Assays used may systematically exclude acute cases from surveillance. Programs may or may not treat cases suffering from comorbidities, but few facilities in general have the capacity, expertise, and inclination to provide treatment. Assessment of capacity is difficult due to high rates of referral and low rates of treatment and engagement. Interdisciplinary teams using mid-level practitioners may provide higher quality treatment and services. Lastly, monoinfection constitutes a barrier to treatment and services.

Conclusions: Screening is justified only if it benefits participants, making poor follow up a significant problem. Because monoinfected cases, in comparison to those with comorbidities, are unable to access treatment and services, it is unclear if monoinfected patients can leverage the information provided during follow-up. Recommendations include statewide rollout of systematic HCV follow-up programs in every LHJ, concentrating on the northeast and northwest corners of the state. Formative evaluations will supply data needed to identify and target groups systematically omitted from follow-up efforts. Programs providing funding to monoinfected patients are needed in order to address this significant barrier to treatment and services.

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