Simulating system dynamics of the HIV care continuum to achieve treatment as prevention

Abstract

The continuing HIV pandemic calls for broad, multi-sectoral responses that foster community control of local prevention and care services, with the goal of leveraging high quality treatment as a means of reducing HIV incidence. Service system improvements require stakeholder input from across the care continuum to identify gaps and to inform strategic plans that improve HIV service integration and delivery. System dynamics modeling offers a participatory research approach through which stakeholders learn about system complexity and about ways to achieve sustainable system-level improvements. Via an intensive group model building process with a task force of community stakeholders with diverse roles and responsibilities for HIV service implementation, delivery and surveillance, we designed and validated a multi-module system dynamics model of the HIV care continuum, in relation to local prevention and care service capacities. Multiple sources of data were used to calibrate the model for a three-county catchment area of central Connecticut. We feature a core module of the model for the purpose of illustrating its utility in understanding the dynamics of treatment as prevention at the community level. We also describe the methods used to validate the model and support its underlying assumptions to improve confidence in its use by stakeholders for systems understanding and decision making. The model's generalizability and implications of using it for future community-driven strategic planning and implementation efforts are discussed.

Qualitative System Dynamics Modeling to Support Community Planning in Opioid Overdose Prevention

“…Although there is no one way to organize these sessions, a successful GMB identifies important insights and helps stakeholders build a common understanding of a given problem (Rouwette et al, 2002). However, logistical concerns about stakeholder burden, particularly during the COVID-19 pandemic, restricted our options for engaging communities in conventional GMB as we had done in prior community studies (Swierad et al, 2020;Weeks et al, 2020;Zimmerman et al, 2016). Instead, we adapted the methodology to leverage extensive qualitative interview data that were collected from community stakeholders at baseline and ongoing meeting notes from community coalition meetings during the initial phases of HCS-NYS.…”

“…In SD, qualitative models are often presented as causal loop diagrams (CLDs) that elucidate interdependencies among actors, factors, and sectors that contribute to a problem. These feedback loops, or structures, define a working hypothesis of the dynamics that define a focal problem (Lounsbury, Hirsch et al, 2014;Lounsbury, Wylie-Rossett et al, 2015;Weeks, Li et al, 2017;Weeks, Lounsbury et al, 2020). In this paper, we present the process and outcome of this qualitative SD modeling approach in the first 8 counties in HCS-NYS, with the specific aims of (1) elucidating the interdependencies and feedback structures among drivers of opioid use, overdose, and fatality at the local level; and (2) Identifying EBP implementation challenges and opportunities based on a clearer understanding of this complex system.…”

Applications of Participatory System Dynamics Methods to Public Health

“…29,30,34,42,46,47,61,69,70 Subtheme 1.5: Opportunity for advancing equity and justice A major benefit of PSD methods discussed in several articles within this review was the opportunity to advance health equity. 25,28,29,31,[34][35][36]38,42,44,45,47,53,[57][58][59][60][61][69][70][71][72][73][74][75] PSD methods facilitate equity by allowing a diverse set of stakeholders to provide expertise to inform a model and necessarily include the engagement and participation of stakeholders with proximity to the issue being investigated. Community-based system dynamics, a specific approach under the umbrella of PSD, explicitly includes directly impacted populations in the modeling process to combat epistemic violence and imbue the problem-structuring and theory-building processes with perspectives that have historically been excluded from the scientific process.…”

“…Several articles note that because the CLDs produced during PSD workshops are qualitative and community context-specific, the results are not generalizable. 26,28,29,32,33,35,[39][40][41]52,62,64,69,70,72,75,78,79 However, it has been argued by prominent system dynamicists that the primary value of this method is not in the generalizability of results but in the creation of a shared understanding of an issue and collective perspective on how it might be addressed. For example, Vennix argues that the context-specific nature of CLDs is a strength of the method, as more generalizable, quantitative models may lose their relevance and meaning to stakeholders engaged in a participatory process, which may lessen feelings of stakeholder ownership and commitment to change.…”

Meanings and significance attributed by people with HIV/aids to their lives with this virus/disease

“…To confront this social stigma and the other adversities that result from the HIV infection, especially those related to its chronic nature and its instable course, resilience, as a form of positive adaptation or of resisting adversities, has been an important protective individual strategy and an opportunity for interventions to improve health outcomes, considering not only the control of HIV, but also the prevention of the transmission of the virus in society, with the objective of reducing or eliminating the epidemic (6)(7)(8) .…”