Optimizing an HIV testing program using a system dynamics model of the continuum of care

Realizing the full individual and population-wide benefits of antiretroviral therapy for human immunodeficiency virus (HIV) infection requires an efficient mechanism of HIV-related health service delivery. We developed a system dynamics model of the continuum of HIV care in Vancouver, Canada, which...

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Bibliographic Details
Published in:Health care management science 2015-09, Vol.18 (3), p.334-362
Main Authors: Kok, Sarah, Rutherford, Alexander R., Gustafson, Reka, Barrios, Rolando, Montaner, Julio S. G., Vasarhelyi, Krisztina
Format: Article
Language:English
Subjects:
Acquired immune deficiency syndrome
AIDS
Anti-Retroviral Agents - therapeutic use
Antiretroviral Therapy, Highly Active
British Columbia - epidemiology
Business and Management
Chronic illnesses
Computer Simulation
Continuity of Patient Care
Disease prevention
Disease transmission
Drug therapy
Econometrics
Epidemics
Health Administration
Health care delivery
Health Informatics
Health services
HIV
HIV Infections - diagnosis
HIV Infections - drug therapy
HIV Infections - economics
HIV Infections - epidemiology
HIV Infections - prevention & control
Human immunodeficiency virus
Humans
Immune system
Infections
Management
Medical tests
Operations research
Operations Research/Decision Theory
Optimization
Population
Public health
Resource Allocation - economics
Resource Allocation - methods
Studies
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Summary:Realizing the full individual and population-wide benefits of antiretroviral therapy for human immunodeficiency virus (HIV) infection requires an efficient mechanism of HIV-related health service delivery. We developed a system dynamics model of the continuum of HIV care in Vancouver, Canada, which reflects key activities and decisions in the delivery of antiretroviral therapy, including HIV testing, linkage to care, and long-term retention in care and treatment. To measure the influence of operational interventions on population health outcomes, we incorporated an HIV transmission component into the model. We determined optimal resource allocations among targeted and routine testing programs to minimize new HIV infections over five years in Vancouver. Simulation scenarios assumed various constraints informed by the local health policy. The project was conducted in close collaboration with the local health care providers, Vancouver Coastal Health Authority and Providence Health Care.
ISSN:1386-9620
1572-9389
DOI:10.1007/s10729-014-9312-0