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: 9792390
• 负责人: MARGARET R. WEEKS
• 金额: $ 82.24万
• 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 2021-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9792390
• 关键词: Address; Affect; Caring; Cessation of life; Communities; Community Health; Complex; Continuity of Patient Care; Critiques; Data; Development; Discrimination; Documentation; Epidemic; Evolution; Exercise; Funding; Goals; HIV; HIV Infections; Health; Health Personnel; Health Services; Health Status; Human immunodeficiency virus test; Infection; Institution; Instruction; Intervention; Knowledge; Lead; Learning; Measures; Methodology; Methods; Modeling; Outcome; Performance; Policy Maker; Privatization; Process; Psyche structure; Public Health; Research; Research Methodology; Resources; Risk; Services; Strategic Planning; System; Testing; Thinking; Time; Training; Update; Viral; Viral Load result; Visual; analytical tool; care systems; cohort; community organizations; comparative; design; evidence base; improved; innovation; insight; member; model building; model development; models and simulation; pandemic disease; population health; prevent; recruit; response; service gap; simulation; tool; urban area; virtual

ABSTRACT Policy makers and healthcare providers increasingly seek broad, multi-sectoral responses to manage, mitigate, and eventually eliminate the HIV epidemic. Such community health outcomes depend on a coordinated and highly effective local HIV test-and-treat (T&T) service system to find, treat and maintain viral suppression in all people with HIV (PWH). System improvements require stakeholder coalitions from across the care continuum with capacity to identify service gaps and develop and carry out strategic plans to improve service integration and delivery. However, such plans may suffer from stakeholders' incomplete `mental models' of system complexity and system dynamics (SD) that affect population health outcomes. A SD simulation model that has been developed and validated through participatory model building offers conceptual, methodological and analytical tools to achieve these goals. SD simulation modeling allows community coalitions to learn about system complexity and identify mechanisms likely to affect system improvements. They can hypothesize single, multiple, or sequenced interventions and other actions expected to achieve desired community-level and public health outcomes, then test those virtually through model simulation before expending effort and resources to implement them. However better understanding is needed of the process by which stakeholder coalitions can use SD simulation models, whether simulation can help them design strategic plans they have confidence will improve community-level health outcomes, and how this process enhances coalition capacities to move their plans forward. Our 3-year study (R01-MH103176) used mixed methods and participatory SD modeling to build a SD model of the HIV T&T care continuum in Hartford, CT. With additional funding (R21- MH110335) we triangulated expert knowledge, local primary and secondary data, and scientific evidence to calibrate the SD model for simulation. User interface tools of the SD simulation model allow recalibration/ tailoring and enable SD-modeling-naïve coalitions to use simulation for strategic planning. This 2-year renewal of our current R01 will address the following new specific aims that are outside the scope of the current studies. Using mixed qualitative and quantitative research methods, document and measure: Aim 1: the strategic planning process of a new stakeholder coalition when using a validated SD simulation model of the HIV T&T system to develop strategies expected to reduce community-level HIV; Aim 2: comparative strategic plans designed and selected by the coalition before and after training in, and throughout iterative use of, the SD simulation model of the HIV T&T system; and Aim 3: changes in coalition capacities, including member, relational, and organizational capacities, expected to improve their ability to implement proposed plans to achieve long-term system improvements. Findings from this renewal study will be used to produce a Toolkit that will make possible replication of the SD simulation modeling approach by coalitions in other communities to facilitate rigorous multisite testing in a subsequent implementation study.

摘要

项目成果

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

模拟艾滋病毒护理连续体的系统动态，以实现治疗即预防。

• DOI: 10.1371/journal.pone.0230568
• 发表时间: 2020
• 期刊: PloS one
• 影响因子: 3.7
• 作者: Weeks,MargaretR;Lounsbury,DavidW;Li,Jianghong;Hirsch,Gary;Berman,Marcie;Green,HelenaD;Rohena,Lucy;Gonzalez,Rosely;Montezuma-Rusca,JairoM;Jackson,Seja
• 通讯作者: Jackson,Seja

Managing the risk of intimacy: accounts of disclosure and responsiveness among people with HIV and intimate partners of people with HIV.

管理亲密的风险：艾滋病毒患者和亲密伴侣的披露和响应能力的解释。

• DOI: 10.1080/13691058.2018.1479535
• 发表时间: 2018-10
• 期刊: Culture, health & sexuality
• 作者: Green HD;Weeks MR;Berman M;Mosher HI;Abbott M;Garcia N
• 通讯作者: Garcia N

Using participatory system dynamics learning to support Ryan White Planning Council priority setting and resource allocations.

• DOI: 10.1016/j.evalprogplan.2022.102104
• 发表时间: 2022-08
• 期刊: EVALUATION AND PROGRAM PLANNING
• 影响因子: 1.6
• 作者: Weeks, Margaret R.;Montaque, Helena D. Green;Lounsbury, David W.;Li, Jianghong;Ferguson, Alice;Warren-Dias, Danielle
• 通讯作者: Warren-Dias, Danielle

The Impact of Perceptions of Community Stigma on Utilization of HIV Care Services.

社区耻辱感对艾滋病毒护理服务利用的影响。

• DOI: 10.1007/s40615-019-00667-9
• 发表时间: 2020
• 期刊: Journal of racial and ethnic health disparities
• 影响因子: 3.9
• 作者: Green,HelenaDanielle;Weeks,MargaretR;Berman,Marcie;Salvi,Apoorva;Gonzalez,Rosely;Rohena,Lucy;Ferguson,Alice;Li,Jianghong
• 通讯作者: Li,Jianghong