A Systems Thinking Approach to Understanding and Demonstrating the Role of Peer-Led Programs and Leadership in the Response to HIV and Hepatitis C: Findings From the W3 Project

Abstract

The central role of community and peer-led programs has been a key characteristic of the Australian partnership response to HIV and hepatitis C since the beginning of the epidemics. Despite this, peer-led programs continue to have limited capacity to demonstrate their role and value as part of a multi-sectoral response. What makes one peer-led program a better investment than another? What role does the rest of the sector have in ensuring we gain the most value from these investments? To investigate this, we facilitated interactive systems thinking methods with 10 programs working within communities of people who inject drugs, gay men, sex workers and people living with HIV across Australia. This included articulating program theories in diagram and textual form to help us understand the role of peer-based programs promoting peer leadership within the Australian HIV and hepatitis C responses. Our aim was to develop a framework for monitoring and evaluation that could be applied to peer led programs at different levels and in different contexts. We found that for peer-led programs to fulfill their role, and to navigate the rapid changes occurring in the both epidemics, they need to: demonstrate the credibility of their peer and community insights; continually adapt to changing contexts and policy priorities in tandem with their communities; and maintain influence in both community and policy systems. We developed a framework of four key functions (Engagement, Alignment, Adaptation, and Influence) which peer-based programs need to demonstrate, which form the basis for identifying quality indicators. This article presents a new way of framing and monitoring investments in peer-led programs and peer eadership actions by these programs. If health policy is committed to strengthening the leadership shown by affected communities, then we need to understand, enhance, monitor and value the role of peer-led programs and peer leadership within the overall prevention system. We believe the W3 framework, drawing on systems thinking and modeling, can support funders, policy-makers and programs to achieve this.

Achieving meaningful participation of people who use drugs and their peer organizations in a strategic research partnership

“…Participation of stakeholders was a central component to the methodology used within the W3 Project [29]. Drawing on peer insights and experience for both data and analysis ensured the understanding of the complex experiences of PWUD, and the cultural role of peer organizations within PWUD communities remained central to the study.…”

“…For example, the way the policy, health, justice, and research organizations enable, constrain, enhance, or resist PWUD peer organizations and their communities is an important part of understanding the role and impact of PWUD peer organizations in their system. The full methods of the W3 Project, and the development of the W3 Framework, are described in detail elsewhere [29]. Below, we have summarized these methods, with a focus on the role of peer participation and leadership throughout the study.…”

“…Below, we have summarized these methods, with a focus on the role of peer participation and leadership throughout the study. We have added the partnership building prior to the project commencing and the subsequent trial and application of the W3 Framework, which have not been previously described [29].…”

“…In reflecting on the challenges and opportunities of research that engages with peer organizations and experience, this paper draws on the experiences and findings of the What Works and Why (W3) Project [26–28]. The project was a 5-year collaborative study with peer-led and community-based organizations that sought to develop a practice-based program theory and framework for peer programs, and then trial the application of this work within partner organizations [29]. The W3 Project provides insight into the nuances of community-engaged research practice and the ongoing benefits, barriers, and enablers of the meaningful involvement of PWUD peers and peer organizations in strategic research.…”

Facilitating engagement with PrEP and other HIV prevention technologies through practice‐based combination prevention

“…A few existing frameworks and models for combination HIV prevention do exist, and include among others the Multiple Domain Model , the Dynamic Social Systems Model , the Network‐Individual‐Resource Model , the HIV prevention cascade and Complex Systems theory . Each of these models and frameworks usefully highlight how a range of factors influence each other in complex ways, with implications for how individuals effectively deploy HIV prevention technologies or behaviours.…”