Dissertation Title: Assessing the Feasibility of Expanding Hepatitis C Prevention, Screening, and Treatment Services in Georgia's Medication-Assisted Treatment Centers

Dissertation Chair: Dr. Kevin Maloney

Dissertation Abstract: Hepatitis C virus (HCV) is a significant public health issue in the U.S., especially among people who inject drugs (PWID). While previous studies emphasize the need for HCV care in substance use treatment, there is a need to examine implementation practices in Georgia’s medication-assisted treatment (MAT) programs. MAT centers represent critical points of engagement for individuals at elevated risk for HCV infection and provide an opportunity to expand prevention, testing, and linkage-to-care services. This dissertation examines the feasibility of expanding HCV prevention, screening, and treatment strategies within Georgia’s MAT centers, consistent with priorities outlined in Georgia’s Viral Hepatitis Elimination Plan.

A mixed-methods evaluation was conducted using the Centers for Disease Control and Prevention’s Framework for Program Evaluation in Public Health. Two primary data sources informed the analysis: (1) the 2024 MAT Center Survey administered by the Georgia Department of Public Health (DPH) and (2) de-identified hepatitis C surveillance data from the State Electronic Notifiable Disease Surveillance System (SENDSS) for the years 2018–2022. Descriptive analyses were used to summarize MAT facility characteristics, service availability, and reported barriers to HCV service delivery. A sensitivity analysis was conducted to assess the potential influence of nonresponse bias due to the low survey response rate. Open-ended responses were analyzed by survey topics to identify perceived challenges and opportunities for integrating HCV services within MAT settings. Geographic comparisons were conducted to examine the distribution of MAT centers relative to county-level HCV burden across Georgia

Findings indicated that while many MAT centers reported offering HCV antibody testing or referral for testing, fewer centers provided confirmatory RNA testing or on-site treatment services. Respondents identified key barriers, including limited staffing capacity, insufficient funding, competing clinical priorities, and logistical challenges related to laboratory access and care coordination. Geographic analysis suggested potential service gaps in certain rural and underserved regions with elevated HCV burden.

My recommendations include strengthening HCV testing capacity within MAT centers, a feasible first step toward expanding HCV care. Targeted investments in workforce training, testing infrastructure, and referral partnerships may improve linkage to care and support progress toward hepatitis C elimination goals in Georgia.