Date of Award

Fall 2025

Degree Type

Project

Degree Name

Doctor of Nursing Practice (DNP)

Department

School of Nursing

First Advisor

Dr. Jennifer Stewart-Glenn

Abstract

This project addressed the issue of loss to follow-up (LTFU) among patients infected with hepatitis C virus (HCV), a significant barrier to achieving sustained virologic response (SVR) and improving outcomes. LTFU is particularly critical among marginalized and rural populations who face socioeconomic barriers, stigma, and other social determinants of health (SDOH) that affect treatment adherence. Grounded in the Social Ecological Model (SEM), this project examined systemic, community, interpersonal, and individual factors influencing LTFU (Ahmed et al., 2022; Al-Khazraji et al., 2019; Kilanowski, 2017).

This Doctor of Nursing Practice (DNP) quality improvement initiative sought to improve patient retention in HCV care by identifying barriers through a structured survey. A five-point Likert-scale survey was administered to adult patients presenting for HCV treatment, with domains reflecting SEM constructs, including individual-level factors (health literacy, personal responsibilities), interpersonal-level factors (social support, provider communication), community-level factors (transportation access, financial strain), and systemic-level factors (scheduling convenience, clinic environment).

Findings demonstrated strong interpersonal and systemic support, including trust in providers and positive perceptions of the clinic staff. However, financial concerns and competing personal responsibilities emerged as the most significant barriers, while transportation was not reported as a major challenge. Results were disseminated to clinic stakeholders, providing evidence-based recommendations to improve engagement, reduce LTFU, and promote health equity in underserved Appalachian populations.

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