Journal
HEALTH CARE MANAGEMENT SCIENCE
Volume 18, Issue 3, Pages 334-362Publisher
SPRINGER
DOI: 10.1007/s10729-014-9312-0
Keywords
HIV/AIDS; Health service delivery; Public health; Treatment as Prevention; System dynamics; HIV testing; Optimization; Resource allocation
Categories
Funding
- Canadian Institutes for Health Research [126782]
- British Columbia Centre for Excellence in HIV/AIDS
- Vancouver Coastal Health Authority
- Providence Health Care
- MITACS
- Merck, Canada
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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.
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