Examining System Dynamics Affecting HIV Community Viral Load

This study will investigate the HIV test & treat (T&T) continuum of services in Greater Hartford, CT to examine the “treatment cascade.” This refers to people with HIV (PWH) not getting tested to know their status or not getting linked to care and getting on and staying on antiretroviral therapy (ART) in order to achieve viral suppression. PWH who have not achieved viral suppression are more likely to transmit HIV to others, which adds to the total amount of virus in the community, or “community viral load” (CVL). This study is designed to engage multiple community stakeholders, including both providers and PWH, to develop a comprehensive system dynamics model that can be used to understand how systemic processes affect HIV CVL by interrupting the T&T continuum of services and contributing to the treatment cascade. The study aims are: (1) identify inter-organizational network factors that affect the ability of PWH to move efficiently and effectively across the T&T continuum; (2) examine the personal, inter-organizational, and community level factors that interact to generate system dynamics in the movement of PWH through the T&T continuum; and (3) based on these results, develop a conceptual system dynamics model (visual representation) that integrates the inter-organizational network and system dynamics structural factors and processes that collectively impede progress toward reducing CVL. The goal is to be able to use this model, and the new systems understanding of the treatment cascade, to build systemic interventions to reduce HIV CVL to prevent further spread of the virus.

ICR sought and received a continuation of funding to use the model this project created with the Greater Hartford TGA Ryan White Planning Council.

Additional Information:

ICR:
Margaret R. Weeks, Ph.D.
Principal Investigator

Jianghong Li, MD, MSc.
Co-Investigator

Heather Mosher, Ph.D.
Co-Investigator

Maryann Abbott, M.A.
Project Director

Danielle Green, Ph.D.
Research Associate

Lucy Rohena
Outreach Interviewer

Rosely Gonzalez
Outreach Interviewer

Albert Einstein School of Medicine of Yeshiva University:
David Lounsbury, Ph.D.
Co-Investigator

Consultant
Gary B. Hirsch

Modeling Task Force
Merry Bajana
St. Francis Hospital and Medical Center/Gengras Clinic
Christina Cipriani
Hartford Dispensary
Angelique Croasdale-Mills
Ryan White Greater Hartford
Ricardo Cruz
HRA of New Britain
Robin Deutsch, MD
Brownstone Clinic
Linda Estabrook
Hartford Gay & Lesbian Health Collective
Alice Ferguson
Community Member
Nilda Fernandez
CT Children’s Medical Center
Seja Jackson, APRN
Burgdorf Clinic, Hartford Department of Health and Human Services
Heidi Jenkins
CT Department of Public Health
Jen Krebsbach
Gilead Sciences
Shawn Lang
AIDS CT
Clifford Lumpkin
Community Member
John Merz
AIDS CT
Mauricio Montezuma, MD
Community Health Services
Fernando Morales
Latino Community Services (LCS)
Tung Nguyen
Hartford DHHS
Bill Petrosky
Hartford Gay & Lesbian Health Collective
Janette Rodriguez
Community Member
Romario Roper
Community Member
Ashley Rosario
Community Member
Carol Steinke
Hartford DHHS, STI Clinic
LaToya Tyson
AIDS CT
Yolanda Velez
LCS and Burgdorf Clinic
Danielle Warren-Diaz
CT Children’s Medical Center

SD Modeling Facilitation Team
Maryann Abbott
ICR
Marcie Berman
ICR
Natalie Garcia
ICR
Rosie Gonzalez
ICR
Danielle Green
ICR
Jianghong Li
ICR
David Lounsbury
Albert Einstein
Heather Mosher
ICR
Lucy Rohena
ICR
Margaret (Peg) Weeks
ICR

Read the Project Abstract here.

Please read the interim report for the first arm of this study here.

Please read the abstract for this project’s continuation here.

Weeks, M.R., Li, J., Lounsbury, D., Green, H.D., Berman, M., Rohena, L., Gonzalez, R., Lang, S., Mosher, H.I. (2017). Using participatory system dynamics modeling to examine the local HIV test and treatment care continuum in order to reduce community viral load. American Journal of Community Psychology, 60 (3-4): 584-598. PMID: 29154393; PMCID: PMC5729085.

Green, H.D., Weeks, M.R., Berman, M., Mosher, H.I., Abbott, M., Garcia, N. Managing the risk of intimacy: accounts of disclosure and responsiveness among people with HIV and intimate partners of people with HIV. Culture, Health & Sexuality. 2018;20(10):1117-1129. PMID: 29944072; PMCID: PMC6399062.

Green, H.D., Weeks, M.R., Berman, M., Salvi, A., Gonzalez, R., Rohena, L., Ferguson, A., and Li, J. (in press) The impact of perceptions of community stigma on utilization of HIV care services. Forthcoming in Journal of Racial and Ethnic Health Disparities.

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