A socioecological exploration of hepatitis c screening utilization and treatment services among vulnerable populations

BACKGROUND – In the U.S., individuals are four times more likely to be diagnosed with hepatitis C than HIV/AIDS. Medical, public health, and community-based organizations play a major role in delivering personal and population-based services. Few studies, however, have explored gaps in access to utilization of screening and treatment of services for Hepatitis C as well as strategies that promote connectivity across public health systems from a socio-ecological perspective. METHODS – Telephone and face-to-face interviews (n= 23) and an email survey (n= 17) were conducted with individuals representing four organizational entities in the public health system: public health departments, hospitals, and community-based organizations. Initial coding was used to understand perceptions, values, and beliefs about hepatitis C. Categorical coding was conducted to identify intrapersonal, interpersonal, organizational and societal factors that influence utilization of screening and treatment services. RESULTS –Overall, public health, clinical and community-based professionals perceived access to treatment, as opposed to screening, as a major concern, especially among persons without or with limited insurance, IV drug users, persons with addictions, and persons with co-morbidities (HIV/AIDS). Socioeconomic status was perceived as a major intrapersonal factor affecting utilization of treatment services; positive communication between a health care provider and connection to social networks were viewed as interpersonal factors that facilitated ongoing use of treatment services. Functional activities (e.g., reporting/follow ups, surveillance, hepatitis A and B immunizations, screening, treatment and disease management, and planning/partnership) provided by these entities varied, but were perceived as potential determinants of levels of organizational capacity. System fragmentation was noted between local health departments that focused more on reporting /follow up activities; medical providers who focused on treatment and disease management; and community-based organizations that provided education and referral support. Limited priority placed on hepatitis C were viewed as societal factors that contribute to ongoing lack of public knowledge. CONCLUSIONS – Resource sharing and integration of public health, medical, and community-based services are vital in addressing fragmentation in hepatitis C treatment. Furthermore, public health-medical-community collaboration is a solution to assist in reducing anticipated and public stigma that vulnerable populations may experience when seeking treatment services.