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 政策制定者和医疗保健提供者越来越多地寻求广泛的、多部门的应对措施， 并最终消灭艾滋病的流行。这种社区卫生成果取决于一个协调和 高效本地艾滋病毒检测和治疗（T&T）服务系统，以发现、治疗和维持所有人的病毒抑制 艾滋病毒感染者（PWH）。系统的改进需要来自整个护理连续体的利益相关者联盟 有能力查明服务差距，制定和执行战略计划，以改善服务一体化 和交付。然而，这些计划可能会受到利益相关者不完整的系统“心智模型”的影响 复杂性和系统动力学（SD）影响人口健康结果。SD模拟模型， 通过参与性模式建设得到发展和验证， 分析工具来实现这些目标。SD模拟建模允许社区联盟了解 系统复杂性和识别可能影响系统改进机制。他们可以假设 单一、多重或有序的干预措施和其他行动，以实现预期的社区一级 和公共卫生结果，然后在投入努力之前通过模型模拟对这些结果进行虚拟测试， 资源来实施。然而，需要更好地了解利益攸关方 联盟可以使用SD模拟模型，模拟是否可以帮助他们设计战略计划， 信心将改善社区水平的卫生结果，以及这一过程如何增强联盟能力 来推进他们的计划我们的3年研究（R 01-MH 103176）使用混合方法和参与性SD 建模，以建立艾滋病毒T&T护理连续体的SD模型在哈特福德，CT。额外资金（R21- MH 110335），我们对专家知识、当地一级和二级数据以及科学证据进行了三角分析， 校准SD模型以进行模拟。SD模拟模型的用户界面工具允许重新校准/ 定制并使SD-modeling-naïve联盟能够使用模拟进行战略规划。这两年的更新 我们目前的R 01将解决以下新的具体目标，这些目标超出了目前的范围， 问题研究采用定性和定量相结合的研究方法，记录和衡量：目标1： 新的利益相关者联盟的战略规划过程时，使用经过验证的SD模拟模型， 艾滋病毒T&T系统制定预期减少社区一级艾滋病毒的战略;目标2：比较战略 计划设计和选择的联盟之前和之后的培训，并在整个迭代使用， 艾滋病毒T&T系统的SD模拟模型;目标3：联盟能力的变化，包括成员， 关系能力和组织能力，预计将提高其执行拟议计划的能力， 实现长期的系统改进。更新研究的结果将用于制作工具包 这将使其他社区的联盟能够复制可持续发展模拟建模方法 以便于在随后的实施研究中进行严格的多站点测试。

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