A qualitative model of the HIV care continuum in Vancouver, Canada

Benny Wai; Krisztina Vasarhelyi; Alexander R Rutherford; Chris Buchner; Reka Gustafson; Miranda Compton; Mark Hull; Jf Williams; Rolando Barrios

doi:10.1080/20476965.2021.1906762

A qualitative model of the HIV care continuum in Vancouver, Canada

Health Syst (Basingstoke). 2021 Apr 4;11(2):84-97. doi: 10.1080/20476965.2021.1906762. eCollection 2022.

Authors

Benny Wai¹, Krisztina Vasarhelyi^{2

3}, Alexander R Rutherford¹, Chris Buchner⁴, Reka Gustafson³, Miranda Compton³, Mark Hull⁵, Jf Williams¹, Rolando Barrios⁵

Affiliations

¹ Department of Mathematics, Simon Fraser University, Burnaby, Canada.
² Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada.
³ Vancouver Coastal Health Research Institute, Vancouver Coastal Health, Vancouver, Canada.
⁴ Population and Public Health, Fraser Health, Surrey, Canada.
⁵ British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada.

Abstract

A team of health care stakeholders and researchers collaboratively developed a qualitative model and graphic representation of the continuum of HIV care in Vancouver to inform delivery of antiretroviral therapy and other HIV health services. The model describes the patient journey through the HIV care continuum, including states of infection, health services, and care decisions. We used a Unified Modelling Language (UML) activity diagram to capture patient and provider activities and to guide the construction of a UML state machine diagram. The state machine diagram captures model agent states in a formalism that facilitates the development of system dynamics or agent-based models. These quantitative models can be applied to optimizing the allocation of resources, and to evaluate potential strategies for improved patient care and system performance. The novel approach of combining UML diagrams we present provides a general method for modelling capacity ---management strategies within complex health systems.

Keywords: Continuum of HIV care; HIV testing; HIV treatment; qualitative operation research; unified modelling language.

Grants and funding

This research was supported through a MITACS Accelerate grant to ARR (grant#: IT07845), with matching funds from Providence Health Care. Additional funding was provided through an operational grant to KV from the Canadian Institutes of Health Research (Grant #: HHP-126782); Canadian Institutes of Health Research [HPP-126782];Mitacs [IT07845];