Participatory System Dynamics Modeling to Simulate HIV Test-and-Treat Improvements

用于模拟 HIV 检测和治疗改进的参与式系统动力学建模

• 批准号: 9203307
• 负责人: MARGARET R. WEEKS
• 金额: $ 29.51万
• 依托单位: INSTITUTE FOR COMMUNITY RESEARCH
• 依托单位国家: 美国
• 财政年份: 2016
• 资助国家: 美国
• 起止时间: 2016-07-15 至 2018-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9203307
• 关键词: Action Research; Address; Behavior; Behavioral; Biological Models; Centers for Disease Control and Prevention (U.S.); Cities; Communities; Complex; Computer Simulation; Conflict (Psychology); Consensus; Critiques; Data; Data Analyses; Data Sources; Documentation; Effectiveness; Elements; Epidemic; Epidemiology; Evaluation; Feedback; Foundations; Funding; Future; Grant; HIV; Human immunodeficiency virus test; Individual; Intervention; Investments; Lead; Linear Models; Literature; Manuals; Measures; Modeling; Modification; Nonlinear Dynamics; Online Systems; Outcome; Pattern; Performance; Policies; Population; Procedures; Process; Psyche structure; Public Health; Research Personnel; Resources; Review Literature; Science; Scientist; Services; Specific qualifier value; Structure; Sum; System; Testing; Time; Validation; Viral Load result; Virus; Visual system structure; Work; care systems; cohort; cost effective; design; dynamic system; experience; implementation research; improved; improved functioning; model building; model development; models and simulation; operation; prevent; service utilization; simulation; social; surveillance data; tool; trend

ABSTRACT The CDC has increasingly promoted Test & Treat (T&T) as a promising approach to prevent HIV at the population level by reducing community viral load (CVL), or the sum of all virus in a community. However, inadequate or interrupted procedures in the T&T service system generate a treatment cascade. Prior efforts to model the cascade have inadequately addressed complex and dynamic drives of CVL and city level HIV service effectiveness across the entire T&T continuum. Social, behavioral, and public health scientists increasingly call for systems science, such as system dynamics (SD) modeling, to understand and solve dynamic, complex problems like the HIV treatment cascade. This 2-year model development study, called “Participatory System Dynamics Modeling to Simulate HIV Test-and-Treat Improvements,” is designed to build a computational and simulation model of the full HIV service system using a SD modeling approach. Communities could benefit from participating with researchers to build such a model of their local T&T service system, which can elucidate time delays and feedback loops within the structure of the system that lead to non-linear patterns or unintended consequences in the behavior of the system. This model and the resulting simulation tool would allow diverse stakeholders to understand the T&T continuum as a holistic, dynamic HIV care system, to identify weaknesses and negative drivers of the system, and to project and compare future impact of different systems level intervention options through simulation without significant resource investment. We will use group model building (GMB) and multiple secondary data sources, supported by our recently funded in-depth study of the local T&T service system in Hartford, CT (R01-MH103176), to build the SD computational/simulation model of that system. Using GMB, diverse community stakeholders will work with researchers to develop, validate, and test the model. The aims are: (1) to engage a group of community stakeholders (N=20) in an iterative, participatory GMB process to develop, refine, and critique a computational SD model of Hartford's HIV T&T service system designed to simulate CVL over time in order to uncover system performance problems; (2) to combine GMB estimates, secondary data analysis (from the R01 and local/state/national epidemiological/ service utilization data), and relevant literature to calibrate/parameterize and formulate variables in the computational SD model and develop reference modes (epidemic trends) to validate the simulation model throughout the GMB process; (3) to demonstrate use of the SD computational model and web-based simulator app as a pilot analytical and practical tool that allows stakeholders to predict and compare impacts of different intervention options to reduce HIV CVL at the city/population level. The SD computational model and simulator tool may be transferrable to other cities seeking to reduce HIV CVL with modifications using local data and stakeholder input. This study lays the foundation for an R01 implementation study to test community stakeholder use of the tool to design long-term structural interventions to reduce CVL.

抽象的 CDC 越来越多地推广“检测与治疗”(T&T)，将其作为一种有前景的方法来预防艾滋病毒 通过减少社区病毒载量（CVL）或社区中所有病毒的总和来降低人口水平。 T&T 服务系统中程序的不充分或中断会导致先前的治疗连锁反应。 级联模型没有充分解决 CVL 和城市层面 HIV 的复杂和动态驱动因素 整个 T&T 连续体的服务有效性。 越来越多地需要系统科学，例如系统动力学（SD）建模来理解和解决 这项为期 2 年的模型开发研究称为 HIV 治疗级联等动态、复杂问题。 “模拟艾滋病毒检测和治疗改进的参与式系统动力学模型”旨在构建 使用 SD 建模方法的完整 HIV 服务系统的计算和模拟模型。 社区可以通过与研究人员一起建立这样的本地 T&T 服务模型而受益 系统，它可以阐明系统结构内的时间延迟和反馈循环，从而导致 该模型及其结果的非线性模式或意外后果。 模拟工具将使不同的利益相关者能够将 T&T 连续体理解为一个整体的、动态的 HIV 护理系统，识别系统的弱点和负面驱动因素，并预测和比较未来 通过模拟无需大量资源即可了解不同系统级干预选项的影响 我们将使用群体模型构建（GMB）和多个二手数据源，并由我们的支持。 最近资助对康涅狄格州哈特福德当地的T&T服务系统进行深入研究（R01-MH103176），以建立 使用该系统的 SD 计算/模拟模型，不同的社区利益相关者将与之合作。 研究人员开发、验证和测试该模型的目的是：（1）吸引社区团体的参与。 利益相关者（N = 20）参与迭代、参与式 GMB 流程，以开发、完善和批评计算 哈特福德 HIV T&T 服务系统的 SD 模型旨在随着时间的推移模拟 CVL，以便发现 系统性能问题；（2）结合GMB估算、二次数据分析（来自R01和 地方/州/国家流行病学/服务利用数据）以及用于校准/参数化的相关文献 并在计算SD模型中制定变量并开发参考模式（流行趋势）以 (3) 演示SD计算的使用 模型和基于网络的模拟器应用程序作为试点分析和实用工具，允许利益相关者进行预测 并比较不同干预措施在城市/人口层面降低 HIV CVL 的影响。 计算模型和模拟器工具可以转移到其他寻求减少 HIV CVL 的城市 使用本地数据和利益相关者的意见进行修改 本研究为 R01 实施奠定了基础。 研究测试社区利益相关者使用该工具来设计长期结构性干预措施以减少 CVL。