자료유형  

 학위논문

Control Number  

0016935959

International Standard Book Number  

9798380596381

Dewey Decimal Classification Number  

614.4

Main Entry-Personal Name  

Estadt, Angela Theresa.

Publication, Distribution, etc. (Imprint  

[S.l.] : The Ohio State University., 2023

Publication, Distribution, etc. (Imprint  

Ann Arbor : ProQuest Dissertations & Theses, 2023

Physical Description  

1 online resource(170 p.)

General Note  

Source: Dissertations Abstracts International, Volume: 85-04, Section: A.

General Note  

Advisor: Lancaster, Kathryn.

Dissertation Note  

Thesis (Ph.D.)--The Ohio State University, 2023.

Restrictions on Access Note  

This item must not be sold to any third party vendors.

Restrictions on Access Note  

This item must not be added to any third party search indexes.

Summary, Etc.  

요약An estimated 2.4 million people in the U.S. are currently infected with the hepatitis C virus (HCV). The number of people with acute HCV infection has risen steadily since 2011 due to increased injection drug use (IDU). Among the estimated 6.6 million people who have ever injected drugs, the prevalence of HCV is 43%. The growth of IDU has disproportionately contributed to acute HCV infections in rural communities as their incidence rates are more than twice those of urban areas. The most injected drug in rural communities is heroin, but nearly 60% of people living with opioid use disorders (OUD) have a non-alcohol co-occurring substance use disorder. Stimulant use, defined as the use of methamphetamines, amphetamines, or cocaine, is resurging. The polysubstance use of opioids and stimulants provide a synergistic high, balance opioid effects to help people function "normally" and is associated with a higher likelihood of syringe sharing. While IDU of both opioids and stimulants is increasing, it is unclear if opioids, stimulants, or the polysubstance use of both increases the risk of HCV infection in rural areas.Management of HCV infection is described using the HCV cascade of care, including screening, access to care and treatment, and achieved sustained virologic response (SVR). A fraction of people who inject drugs (PWID) achieve each level of the Cascade of Care; the annual HCV testing rate is only 8% among those clinically identified as PWID in the U.S. Among rural PWID who have tested positive for HCV, 59% contacted a healthcare provider within 18 months of receipt of their results, 14% reported seeking HCV treatment, and only 8% reported receiving HCV treatment. Overall, HCV treatment adherence does not appear to be affected by opioid use; the impact of stimulant use is unclear. The association of opioids, stimulants, and concurrent use on the HCV Cascade of Care have not been evaluated in rural areas, where the barriers to HCV care are unique. Further, opioid, stimulant, and polysubstance use result in differing neurological effects that may uniquely influence HCV treatment completion.The availability and access to HCV treatment in rural communities have not met HCV's rising prevalence in the U.S. Only 51% of all substance use treatment services offer HCV education, counseling, and support, and 24% provide HCV screening. The CDC conducted a county-level exploratory analysis to identify factors related to acute HCV incidence rates in the United States. The limitations of the CDC study included ecological bias, a dependent variable prone to measurement errors, and the absence of indicators such as the presence of harm reduction services. Six of the vulnerable counties identified by the CDC comprise the OHOP study. These counties also had acute and total HCV incidence rates higher than the average county rates from 2013-2017. It is unknown what factors are associated with HCV testing and treatment uptake, specifically among PWUD rural Appalachian Ohio, and if these indicators align the CDC's analysis. My specific aims include:Aim 1. Estimate the associations of opioid use, stimulant use, and polysubstance use of opioids and stimulants with the presence of HCV infection among PWID in eight geographical U.S. rural populations. Our hypothesis was that those who report recent polysubstance use of both opioids and stimulants are more likely to ever be infected with HCV than those who have recently injected a single substance. We used cross-sectional data of substance use and demographics in collaboration with eight Rural Opioid Initiative (ROI) UG3-funded studies, including Kentucky, Illinois, Ohio, Oregon, New England, North Carolina, West Virginia, and Wisconsin. PWID who recently injected opioids, alone or with stimulants, were more likely to test positive for HCV antibodies.Aim 2. Measure the association of opioid, stimulant, and polysubstance (opioid and stimulant) use on HCV testing and treatment completion in rural populations. Our hypothesis was that a history of HCV testing and treatment and HCV antibody positivity differed across substance use patterns. We used cross-sectional data in collaboration with the ROI UG3 infrastructure. There was no difference across HCV testing history by substance patterns. Compared to participants who recently used substances other than opioids and stimulants, those who recently used and opioids and stimulants were less likely to report receiving HCV treatment. Across the HCV Cascade of Care, participants who recently used drugs other than opioids and stimulants had the highest proportions of completing each self-reported step of the HCV Cascade of Care.Aim 3. Identify and compare individual-level factors associated with HCV testing, treatment, and HCV antibody positivity among rural people who use drugs in southwestern Ohio with national, county-level indicators identified by the CDC with acute HCV incidence. We hypothesized that engaging in substance use treatment and syringe service programs and not experiencing substance use-related stigma from providers were factors associated with increased prevalence of HCV testing and treatment among rural PWUD in Ohio. We used cross-sectional data and HCV antibody test results from the Ohio Opioid Project to identify factors associated with HCV testing, treatment, and antibody positivity and determined if the ecological fallacy was present by comparing individual versus aggregate-level significant indicators of HCV.A substantial proportion of rural PWUD are living with HCV while engaging in both opioid and stimulant use. To quell the current HCV outbreaks in these rural communities, there is a need to improve the linkage to HCV care to ultimately reduce HCV transmission and HCV-related mortality attributable to cirrhosis and liver cancer. This dissertation calls attention to the complexities of the fourth wave of the opioid overdose epidemic in the rural U.S. It outlines future directions and considerations for addressing this public health crisis in rural communities.

Subject Added Entry-Topical Term  

Epidemiology.

Subject Added Entry-Topical Term  

Public health.

Subject Added Entry-Topical Term  

Pharmaceutical sciences.

Subject Added Entry-Topical Term  

American studies.

Index Term-Uncontrolled  

Substance use

Index Term-Uncontrolled  

Opioids

Index Term-Uncontrolled  

Injection drug use

Index Term-Uncontrolled  

Hepatitis C virus

Index Term-Uncontrolled  

Rural communities

Index Term-Uncontrolled  

HCV care

Added Entry-Corporate Name  

The Ohio State University Public Health

Host Item Entry  

Dissertations Abstracts International. 85-04A.

Host Item Entry  

Dissertation Abstract International

Electronic Location and Access  

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Control Number  

joongbu:642758