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; 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 疾病预防控制中心已增加了测试和治疗（T＆T）作为预防艾滋病毒的承诺方法 通过减少社区病毒负荷（CVL）或社区中所有病毒的总和来通过人口水平。然而， T＆T服务系统中的过程不足或中断的程序会产生治疗级联。先前的努力 级联的模型不足以解决CVL和城市级艾滋病毒的复杂而动态的驱动器 整个T＆T连续性的服务有效性。社会，行为和公共卫生科学家 越来越呼吁系统科学（例如系统动力学（SD）建模）来理解和解决 动态，复杂的问题，例如HIV治疗级联。这项为期两年的模型开发研究称为 “参与性系统动态建模以模拟HIV测试和治疗改进，”旨在建立 使用SD建模方法的完整HIV服务系统的计算和仿真模型。 社区可能会受益于与研究人员一起建立这样的本地T＆T服务模型 系统，可以阐明系统结构内的时间延迟和反馈循环 系统行为中的非线性模式或意外后果。这个模型和结果 仿真工具将使潜水员利益相关者能够将T＆T连续性理解为整体，动态的艾滋病毒 护理系统，确定系统的弱点和负面驱动因素，并计划和比较未来 通过模拟而没有大量资源的不同系统级干预选项的影响 投资。我们将使用小组模型构建（GMB）和多个辅助数据源，由我们的支持 最近对康涅狄格州哈特福德的本地T＆T服务系统进行了深入研究（R01-MH103176），以构建 该系统的SD计算/仿真模型。使用GMB，潜水员社区利益相关者将与 研究人员开发，验证和测试模型。目的是：（1）与一群社区互动 在迭代，参与GMB的过程中，利益相关者（n = 20）开发，完善和关键 Hartford的HIV T＆T服务系统的SD模型旨在随着时间的流逝模拟CVL，以发现 系统性能问题； （2）结合GMB估计值，辅助数据分析（从R01和 本地/州/国家流行病学/服务利用数据）以及校准/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） 在整个GMB过程中验证仿真模型； （3）证明使用SD计算 模型和基于Web的模拟器应用程序作为试点分析和实用工具，使利益相关者可以预测 并比较不同干预措施的影响，以减少城市/人口水平的HIV CVL。 SD 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输入进行修改。这项研究为R01实施奠定了基础 研究以测试社区利益相关者使用该工具来设计长期结构干预以减少CVL的研究。