TITLE: Addressing Social Determinants of Health in Linkage-to-Care Interventions for Hepatitis C: A systematic review 
AUTHORS: Hasheemah Afaneh , Gabrielle Gonzalez, Olivia Sugarman, Edward Trapido, Susanne Straif-Bourgeois, Evrim Oral, Ashley Wennerstrom

[DESCRIPTION]
<div class = "text-blocks"><div class = "text-block">    As of 2017, there were more than three million individuals in the United States infected with Hepatitis C virus (HCV) [1]. Because most cases are asymptomatic, leading to a higher rate of unreported cases, this number is suspected to be much higher. Furthermore, there is a rise of HCV cases, and this increase documented since 2013 is primarily due to injection drug transmission alongside the rise of the opioid epidemic [2]. The Centers for Disease Control and Prevention (CDC) encourages HCV testing for all adults at least once in their lifetime, and those that test positive for HCV should be linked to treatment [3]. In 2013, only 13%-18% of patients with HCV received treatment in that year, indicating that there are barriers to treatment, such as lack of treatment acceptance, co-existing conditions, extensive treatment, side-effects, and access to treatment[4]. Thus, health disparities may ensue and the eradication of HCV as a public health issue becomes even more challenging. Edlin and Winkelstein (2014) suggested that to achieve optimal HCV eradication, social determinants of health, such as homelessness, need to be addressed [5]. Because there is room for improvement in linkage-to-care opportunities, it is important to explore whether linkage-to-care interventions address social determinants of health, and if so, which ones, to obtain a better understanding of what may help improve patient outcomes.</div><div class = "text-block">References: </div><div class = "text-block"><span>U.S. Department of Health and Human Services. 2019.Retrieved June 11, 2020, from</span><a href="https://www.hhs.gov/opa/reproductive-health/fact-sheets/sexually-transmitted-diseases/hepatitis-c/index.html" style = "text-decoration:underline;color:blue;cursor:pointer;"><span style = ":;:UNDERLINE;">https://www.hhs.gov/opa/reproductive-health/fact-sheets/sexually-transmitted-diseases/hepatitis-c/index.html</span></a></div><div class = "text-block"><span>Centersfor Disease Control and Prevention(CDC). 2019. Commentary portion of U.S. 2017 Surveillance Data for Viral Hepatitis. Retrieved June 11, 2020, from</span><a href="https://www.cdc.gov/hepatitis/statistics/2017surveillance/index.htm" style = "text-decoration:underline;color:blue;cursor:pointer;"><span style = ":;:UNDERLINE;">https://www.cdc.gov/hepatitis/statistics/2017surveillance/index.htm</span></a></div><div class = "text-block"><span>Schillie, S., Wester, C., Osborne, M., Wesolowski, L., & Ryerson, A.B. (2020). CDC Recommendations for Hepatitis C Screening Among Adults – United States, 2020. MMWR Recommendations & Reports, 69(2), 1-17.</span><a href="https://www.cdc.gov/mmwr/volumes/69/rr/rr6902a1.htm" style = "text-decoration:underline;color:blue;cursor:pointer;"><span style = ":;:UNDERLINE;">https://www.cdc.gov/mmwr/volumes/69/rr/rr6902a1.htm</span></a><span></span></div><div class = "text-block"><span>Infectious Disease Society of America. 2019. HCV Testing and Linkage to Care: HCV Guidance. Retrieved June 23, 2020, from</span><a href="https://www.hcvguidelines.org/evaluate/testing-and-linkage" style = "text-decoration:underline;color:blue;cursor:pointer;"><span style = ":;:UNDERLINE;">https://www.hcvguidelines.org/evaluate/testing-and-linkage</span></a></div><div class = "text-block"><span>Edlin, B. & Winkelstein, E. (2014). “Can Hepatitis C be eradicated in the U.S.?”Antiviral Research.110: 79-93.</span><a href="https://dx.doi.org/10.1016/j.antiviral.2014.07.015" style = "text-decoration:underline;color:blue;cursor:pointer;"><span style = ":;:UNDERLINE;">https://dx.doi.org/10.1016/j.antiviral.2014.07.015</span></a><span></span></div></div>

[STEPS]
?. [Objective]
What social determinants of health do Hepatitis C Linkage-to-Care interventions address?
?. [Methods]
This section will include the methods and guidelines by which the systematic review will be conducted.
?. Inclusion CriteriaA) Peer-reviewed articlesB) Published between 2010-2020C) Limited to the United StatesD) Focus of the article is on linkage-to-care interventions for Hepatitis C patients AND social determinants of healthE) English languageF) Full-text articlesExclusion criteriaA) Not peer-reviewed, such as gray literatureB) Published over 10 years agoC) Not in the United StatesD) Focus is not linkage-to-care interventionsE) Study does not mention any social determinants of healthF) Not in EnglishG) Not full-textH) Not specific to Hepatitis C
?. Information SourcesDatabases to be used:A) PubMedB) CINAHLCompleteC) ProQuestGray literature will not be used. Study authors will not be contacted.
?. AnalysisThis section includes the analysis plan for the systematic review.
?. Search Strategy (following the PRISMA Guidelines)2.3.1. Identifying ArticlesA) Search each database listed above to identify articles that are eligible according to the inclusion criteria above. Apply the following filters:-publication date-species-language-full-text availability.B) Conduct searches using the Boolean keyword method (AND/OR). Record use of keywords in an Excel spreadsheet with and without filters. Such keywords include: (linkage to care OR linkage to cure OR interventions OR social determinants of health OR community health) AND (hepatitis C OR social determinantsof health).2.3.2. Title ScreeningA) Conduct a preliminary screening for duplicated articles.  Record the number of duplicated articles in an Excel spreadsheet.B) Screen titles for the inclusion criteria (and by default, relevance to the research question, Hepatitis C and linkage to care interventions). Record the number of those excluded and included. 2.3.3. Abstract ScreeningA) Screen abstracts of remaining articles for relevance to the inclusion criteria (and by default, relevance to the research question, Hepatitis C and linkage to care interventions). Record the number of those excluded and included. 2.3.4. Article Screening A) Screen remaining full articles according to the inclusion and exclusion criteria. Record the number of those excluded and included, and the reason as to why those excluded were so. 2.3.5. PRISMAA) Fill in PRISMA diagram.
?. Data from the reviewed publications will be extracted individually by the researchers and compared.Findings from the studies will be compiled in a categorical matrix. Data extracted will include: state where study occurred; linkage-to-care definition/element; linkage-to-care setting (i.e. clinic, prison, jail); sample size; study intervention; social determinants of health; and outcomes. Authors will describe the extracted data.
?. Outcomes of InterestAlongside data on whether or not the intervention was successful in linking Hepatits C patients to care, data on how social determinants of health were addressed in linkage-to-care interventions will be sought out.