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 3 年的案例研究将研究影响通过促进检测和治疗 (T&T) 减少社区层面艾滋病毒流行的努力的因素。 T＆T策略旨在将所有感染者的HIV病毒载量（VL）降低至检测不到的水平，从而降低每个人的传染性和社区病毒载量（CVL），以预防新病例。这些努力引起了人们对 HIV 感染者 (PWH) 在达到不可检测的 VL 之前脱离 T&T 连续体的问题的新关注，即治疗级联。尽管多部门努力应对这一问题，但艾滋病毒流行之所以持续存在，是因为它很复杂，植根于一个由组织间网络结构以及相互作用的社会和个人力量组成的动态系统，这些系统产生了影响遏制该流行病的努力的非线性过程。有必要解开这些结构和动力，确定科学的设计来组织服务网络，并建立“系统干预措施”以取得更好的效果。社会网络分析、系统动力学建模和混合方法民族志等系统科学方法为实现这些目标提供了概念框架和分析工具。这些系统科学方法使人们能够从系统多个层面直接参与治疗级联的人员的观点和经验来理解表征治疗级联的动态过程。本研究有以下目的：（1）通过构建整个网络，确定影响 PWH 在 T&T 连续体中高效和有效进展的组织间网络因素（联系密度、集中/碎片化、桥梁、瓶颈、关系质量）本地电讯传输服务机构图； (2) 检查产生非线性系统动力学（时滞、中断、正/负反馈、加速、逆转）的个人、组织间和社区社会结构因素，表征 PWH 在 T&T 连续体阶段的转变使用混合方法来指定、情境化和跟踪一段时间内感染者和提供者的经历； (3) 根据 T&T 网络和系统属性和动态的检查结果，开发一个以概念性 SD 模型为代表的解释框架，该模型整合了组织网络和 SD 结构因素和过程，这些因素和过程共同阻碍了减少 CVL 的进展。该研究将在康涅狄格州哈特福德大都市的高发区进行，这是一个典型的东北部中型城市。将使用混合数据收集方法（定性访谈、组织间网络图表/分析、纵向队列调查、病例跟踪、系统模型开发和完善的小组启发）来引出整个 T&T 连续体中的 PWH 和提供者的观点和经验。研究结果将提供一个治疗级联的分析上可推广的 SD 概念模型，可以在后续研究中进行测试、验证和复制。丰富的数据和概念模型对于当地利益相关者也具有直接的应用价值，可以帮助他们制定改进的策略来减轻治疗级联的影响。