Planning for resilience in screening operations using discrete event simulation modeling: example of HPV testing in...

Area of Science:

• Implementation Science
• Health Systems Research
• Operations Research

Background:

• Cervical cancer elimination requires effective prevention strategies, yet faces operational planning barriers.
• Guidance on best practices for resource and operations planning is insufficient for healthcare interventions.
• Discrete event simulation (DES) offers a valuable tool for programmatic and operational planning.

Purpose of the Study:

• To demonstrate the value of discrete event simulation (DES) in implementation science.
• To support programmatic and operational planning for sustainable and resilient healthcare interventions.
• To inform planning for scale-up and resilient operations of an HPV-based screen and treat program in Iquitos, Peru.

Main Methods:

• Developed a DES model using data from a time and motion study and screening registry in Iquitos, Peru.
• Conducted virtual experimentation with "what-if" scenarios to compare workflow and processing strategies.
• Analyzed strategies under resource constraints and potential disruptions to the screening system.

Main Results:

• Simulations quantified potential increases in screening system capacity at current resource levels.
• Identified tolerance for variability in service times and resilience to resource disruptions.
• Determined resources needed for scale-up and increased resilience, highlighting efficiency-resilience tradeoffs.

Conclusions:

• Planning and implementation challenges are common barriers to scaling up preventative health interventions globally.
• DES is a broadly applicable tool for addressing complex implementation challenges at multiple levels.
• DES supports effective and efficient operational and resourcing decisions for program adaptation and long-term fidelity.