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Dissertation
The Importance of Place and Space: Individual and Community-level Determinants of Hepatitis C Virus in Philadelphia, PA
Doctor of Philosophy (Ph.D.), Drexel University
Jun 2023
DOI:
https://doi.org/10.17918/00001581
Abstract
Hepatitis C virus (HCV) is a bloodborne infectious disease that has increased in prevalence across the United States. In recognition of this issue, the U.S. has committed to eliminating HCV infection by the year 2030. Although we have made strides in expanding availability of HCV screening and curative therapies, eliminating HCV will require a more granular understanding of the drivers behind HCV infection, including the importance of contextual and structural barriers. This dissertation harnesses the inherent strengths of surveillance data while simultaneously addressing epidemiologic biases that often plague these ubiquitous data sources. Surveillance data collected by the Philadelphia Department of Public Health (PDPH) will examine and explore contextual and individual risk factors of HCV infection and subsequent treatment in three chapters. The first study explores the association between availability of healthcare and HCV, geospatially. The second study corrects for misclassification of treatment of HCV then uses this corrected measure to quantify the relationship between healthcare availability and HCV treatment within a multilevel logistic model. In our final study, we use propensity scores to measure and model the impact of selection within the data source, then correct for this bias. We hope this research will contribute to the growing body of HCV literature, as well as highlight the importance of considering structural, contextual factors that affect testing and treatment of HCV. Given the limited resources of public health departments, a coordinated approach to testing and treatment among particularly high-need, high-risk communities are integral towards eliminating HCV in the next ten years.
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Details
- Title
- The Importance of Place and Space
- Creators
- Rini Jose
- Contributors
- Seth Welles (Advisor)
- Awarding Institution
- Drexel University
- Degree Awarded
- Doctor of Philosophy (Ph.D.)
- Publisher
- Drexel University; Philadelphia, Pennsylvania
- Number of pages
- xii, 208 pages
- Resource Type
- Dissertation
- Language
- English
- Academic Unit
- Dana and David Dornsife School of Public Health; Epidemiology and Biostatistics; Drexel University
- Other Identifier
- 991020340713604721