Examining Multilevel System Dynamics Affecting HIV Community Viral Load

检查影响 HIV 社区病毒载量的多级系统动力学

• 批准号: 8789092
• 负责人: MARGARET R. WEEKS
• 金额: $ 84.35万
• 依托单位: INSTITUTE FOR COMMUNITY RESEARCH
• 依托单位国家: 美国
• 财政年份: 2015
• 资助国家: 美国
• 起止时间: 2015-03-23 至 2018-01-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8789092
• 关键词: AIDS/HIV problem; Acceleration; Address; Affect; Area; Attention; Blood; Caring; Case Study; Centers for Disease Control and Prevention (U.S.); Child; Cities; Collaborations; Communities; Complex; Data; Data Collection; Drops; Effectiveness; Epidemic; Ethnography; Feedback; Goals; HIV; HIV Infections; High Prevalence; Human immunodeficiency virus test; Individual; Interruption; Intervention; Interview; Link; Measures; Methodology; Methods; Modeling; Monitor; Mothers; Nonlinear Dynamics; Pathway Analysis; Persons; Policies; Population; Prevention; Process; Property; Provider; Qualitative Methods; Research; Research Infrastructure; Research Personnel; Risk; Role; Science; Services; Shapes; Social Network; Staging; Structure; Sum; Surveys; System; Testing; Time; To specify; Viral Load result; Virus; analytical tool; antiretroviral therapy; base; cohort; community intervention; community organizations; density; design; ethnographic method; experience; improved; innovation; longitudinal analysis; metropolitan; model development; models and simulation; novel strategies; pressure; prevent; public health relevance; response; social; systemic intervention; tool; transmission process; treatment adherence; treatment effect; treatment strategy

DESCRIPTION (provided by applicant): This 3-year case study will examine factors that affect efforts to reduce the HIV epidemic at the community level through the promotion of testing and treatment (T&T). The T&T strategy was designed to reduce HIV viral load (VL) to undetectable in all infected persons, thereby lowering each person's infectivity and community viral load (CVL), in order to prevent new cases. These efforts have generated new attention to the problem of people with HIV (PWH) dropping off the T&T continuum before achieving undetectable VL, known as the treatment cascade. Despite multi-sector efforts to tackle it, the HIV epidemic endures because it is complex, embedded in a dynamic system of inter-organizational network structures and interacting social and personal forces that generate non-linear processes affecting efforts to curb the epidemic. It is necessary to unpack these structures and dynamics, identify a scientifically based design to organize service networks, and build "systemic interventions" to achieve better results. Systems science methodologies such as social network analysis, system dynamics modeling, and mixed methods ethnography offer both a conceptual framework and analytical tools to achieve these goals. These systems science methods make it possible to understand the dynamic processes that characterize the treatment cascade from the perspectives and experiences of those directly involved in it at multiple levels of the system. This study has the following aims: (1) Identify inter- organizational network factors (density of linkages, centralization/fragmentation, bridges, bottlenecks, quality of relations) that affect efficient and effective progression of PWH across the T&T continuum by constructing a whole network diagram of local T&T service organizations; (2) Examine the individual, inter-organizational, and community socio-structural factors that generate non-linear system dynamics (time lags, interruptions, positive/ negative feedback, acceleration, reversals) characterizing transitions of PWH through the stages of the T&T continuum using mixed methods to specify, contextualize, and track experiences of PWH and providers over time; and (3) Based on the results of examination of T&T network and systems properties and dynamics, develop an explanatory framework represented by a conceptual SD model that integrates organizational network and SD structural factors and processes that collectively impede progress toward reducing CVL. The study will be conducted in the high prevalence area of metropolitan Hartford, CT, a typical mid-sized, northeast city. Mixed data collection methods (qualitative interviews, inter-organizational network diagramming/analysis, longitudinal cohort survey, case tracking, group elicitation for systems model development and refinement) will be used to elicit perspectives and experiences of PWH and providers across the T&T continuum. Findings will provide an analytically generalizable SD conceptual model of the treatment cascade that can be tested, validated, and replicated in subsequent research. The rich data and the conceptual model also have immediate application value for local stakeholders to develop improved strategies to mitigate the treatment cascade.

描述（由申请人提供）：这项为期三年的案例研究将检查影响努力通过促进测试和治疗（T＆T）在社区层面减少艾滋病毒流行的因素。 T＆T策略旨在减少所有感染者的HIV病毒载荷（VL），从而降低每个人的感染性和社区病毒载荷（CVL），以防止新病例。这些努力引起了人们对艾滋病毒（PWH）患者（PWH）的问题的新关注，在获得无法检测到的VL之前，被称为治疗级联。尽管多部门努力应对它，但艾滋病毒的流行却持久，因为它很复杂，嵌入了组织间网络结构的动态系统中，并相互作用的社会和个人力量产生了非线性过程，影响了遏制流行病的努力。有必要解开这些结构和动态，确定基于科学的设计来组织服务网络，并建立“系统性干预”以取得更好的结果。系统科学方法（例如社交网络分析，系统动态建模和混合方法人种志）提供了实现这些目标的概念框架和分析工具。这些系统科学方法使您可以从系统的多个层面上直接参与其中的人的角度和经验来理解处理级联的动态过程。这项研究的目的是：（1）通过构建当地T＆T服务组织的整个网络图来确定影响PWH跨T＆T连续体的PWH效率高效进展的组织间网络因素（链接的密度，集中化/碎片，桥梁，瓶颈，关系质量）； （2）检查个人，组织间和社区社会结构因素，从而产生非线性系统动态（时间滞后，中断，正/负面反馈，加速，加速度，逆转，逆转），以使用T＆T连续性的阶段来表征PWH的过渡，并使用混合方法来指定，上下文和Processectial和Process poscectial of Pwher和Provence混合PECTECTIAL，和PROCKECTERSECTERS，并及时过时; （3）基于T＆T网络和系统属性和动力学的检查结果，开发了一个解释性框架，该框架由概念的SD模型表示，该模型集成了组织网络和SD结构因素和过程，这些因素和过程共同妨碍了减少CVL的进展。该研究将在康涅狄格州大都会哈特福德的高流行率区域进行，这是一个典型的中型，东北城市。混合数据收集方法（定性访谈，组织间网络图表/分析，纵向队列调查，案例跟踪，系统模型开发和改进的群体启发）将用于在整个t＆t continuum中引起PWH和提供商的观点和经验。调查结果将为可以在随后的研究中进行测试，验证和复制的治疗级联反应的分析性SD概念模型。丰富的数据和概念模型还具有直接的应用程序价值，可让本地利益相关者制定改进的减轻治疗级联的策略。