Marginally housed persons experience several risk factors for neurocognitive impairment, including viral infections, psychiatric illness, and substance use. Although interventions exist, marginalized persons often obtain inadequate health services, based upon personal and structural barriers. In study one, we employed structural equation modeling to assess determinants of neurocognition (i.e., viral infections, psychiatric symptoms), predicting that any impairment would impede healthcare access. Our findings revealed that greater exposure to viral infections and more severe psychiatric symptoms were similarly associated with poorer neurocognition. Additionally, more frequent opioid use/less frequent alcohol and marijuana use was associated with better neurocognition. Only viral infections directly predicted healthcare use, an association that was positive despite the negative impact viral infections held with neurocognition. In study two, we assessed whether spontaneous clearance of Hepatitis C (HCV) is associated with reversal of neurocognitive impairments by comparing three groups: cleared-HCV, active-HCV, and no exposure to HCV. Our findings did not confirm improved neurocognition with HCV clearance, nor did we find any differences between groups exposed to HCV versus those never exposed to the virus after controlling for the effects of Hepatitis B (HBV). Nevertheless, our findings revealed that HCV conveys adverse health in marginalized persons (i.e., HCV exposure is associated with increased rates of HIV, liver dysfunction, etc.). Overall, these findings confirm the detrimental impact of viral infections on neurocognition in marginalized persons. Moreover, although neurocognition did not emerge as a personal barrier to accessing care in marginalized settings, structural level barriers may be operating. Specifically, our results point to a system where health care is selectively utilized and may not be targeted towards all persons, such as those experiencing elevated psychiatric symptoms.
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Thesis advisor: Thornton, Allen
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