Simulating Patterns of Patient Engagement, Treatment Adherence, and Viral Suppression: A System Dynamics Approach to Evaluating HIV Care Management

Abstract

System dynamics (SD) modeling belongs to the rapidly evolving, interdisciplinary field of system science research. This field adds value to more traditional health research by contributing to the design and testing of complex integrated models of change, to examine health system performance and patient outcomes. Using selected milestones in HIV care management to frame our simulation research, we created a SD model to examine three patient subgroups of women of color (WOC) represented in our multi-site cohort, classified by their health care seeking status at baseline. Asked to reflect on their circumstance 6 months prior to enrollment in the MSE cohort, 53% noted they were receiving some care (In Care, n = 341), 31% that they had been seeking care (Seeking Care, n = 201), and 16% that they were undecided about seeking care (i.e., answered that they may or may not look for care) for treatment of their HIV (May or May Not Seek Care, n = 103). Our SD model compared simulated patterns of patient retention over 24 months in relation to: (1) access to antiretroviral therapy (ART), (2) adherence to ART, and (3) viral suppression. Assessed patterns yielded insights about system capacities and constraints in the context of the SPNS initiative under evaluation.

A Social Ecological Model of Syndemic Risk affecting Women with and At‐Risk for HIV in Impoverished Urban Communities

“…System dynamics (SD) modeling methodology is finding a place in the growing number of comparative effectiveness methodologies with utility in health intervention development and implementation science (Homer and Hirsch 2006;Mabry et al 2008;Milstein 2008;Lounsbury et al 2015;Palma et al in press;Trochim et al 2006). SD models are mathematical simulation tools that have great potential for fostering deeper understanding of complex public health problems (Hirsch et al 2007).…”

Using Participatory System Dynamics Modeling to Examine the Local HIV Test and Treatment Care Continuum in Order to Reduce Community Viral Load

“…System dynamics modeling has been used as a tool to bring stakeholders together to examine complex problems at the community level, from environmental concerns (Arquitt & Johnstone, ; Stave, ; Van den Belt, ), to urban and rural development (Hoard et al., ; Richardson, ), to public health problems (Gillen et al., ; Hirsch, Homer, Evans & Zielinski, ; Hovmand & Ford, ; Lounsbury, Hirsch, Vega & Schwartz, ), including HIV and AIDS (Batchelder et al., ; Lounsbury et al., ; Martin et al., ). The unique mechanism by which SD modeling supports community solutions to tackle systemic problems is through the engagement of stakeholders in a “systems thinking” process (Best et al., ; Trochim, Cabrera, Milstein, Gallagher & Leischow, ).…”

“…In most communities, the full T&T continuum is an amalgam of agents and institutions with different structures and policies. Competing pressures, time lags, and other complex processes shape experiences across the continuum and disrupt service coordination (Lounsbury, Schwartz, Palma & Blank, ). Achieving community‐level goals to eliminate the HIV epidemic requires coordinated efforts through community consortia (Foster‐Fishman, Berkowitz, Lounsbury, Jacobson & Allen, ; Roussos & Fawcett, ; Weeks et al., ) with a common purpose and effective tools to guide the change process.…”

The Special Projects of National Significance Women of Color Initiative

“…Finally, Lounsbury et al 22 present a thought-provoking systems dynamic model based upon findings of the initiative. Adopted from efforts to understand the interplay of and feedback among many component parts and activities of a healthcare system, this model has great potential in helping programs, cities and even states to analyze the inputs, processes, and outputs of their prevention, testing and treatment programs.…”