Abstract：
BACKGROUND: The World Health Organization (WHO) has called for the elimination of cervical cancer. Unfortunately, the implementation of cost-effective prevention and control strategies has faced significant barriers, such as insufficient guidance on best practices for resource and operations planning. Therefore, we demonstrate the value of discrete event simulation (DES) in implementation science research and practice, particularly to support the programmatic and operational planning for sustainable and resilient delivery of healthcare interventions. Our specific example shows how DES models can inform planning for scale-up and resilient operations of a new HPV-based screen and treat program in Iquitos, an Amazonian city of Peru.
METHODS: Using data from a time and motion study and cervical cancer screening registry from Iquitos, Peru, we developed a DES model to conduct virtual experimentation with \"what-if\" scenarios that compare different workflow and processing strategies under resource constraints and disruptions to the screening system.
RESULTS: Our simulations show how much the screening system\'s capacity can be increased at current resource levels, how much variability in service times can be tolerated, and the extent of resilience to disruptions such as curtailed resources. The simulations also identify the resources that would be required to scale up for larger target populations or increased resilience to disruptions, illustrating the key tradeoff between resilience and efficiency. Thus, our results demonstrate how DES models can inform specific resourcing decisions but can also highlight important tradeoffs and suggest general \"rules\" for resource and operational planning.
CONCLUSIONS: Multilevel planning and implementation challenges are not unique to sustainable adoption of cervical cancer screening programs but represent common barriers to the successful scale-up of many preventative health interventions worldwide. DES represents a broadly applicable tool to address complex implementation challenges identified at the national, regional, and local levels across settings and health interventions-how to make effective and efficient operational and resourcing decisions to support program adaptation to local constraints and demands so that they are resilient to changing demands and more likely to be maintained with fidelity over time.
METHODS: Using data from a time and motion study and cervical cancer screening registry from Iquitos, Peru, we developed a DES model to conduct virtual experimentation with \"what-if\" scenarios that compare different workflow and processing strategies under resource constraints and disruptions to the screening system.
RESULTS: Our simulations show how much the screening system\'s capacity can be increased at current resource levels, how much variability in service times can be tolerated, and the extent of resilience to disruptions such as curtailed resources. The simulations also identify the resources that would be required to scale up for larger target populations or increased resilience to disruptions, illustrating the key tradeoff between resilience and efficiency. Thus, our results demonstrate how DES models can inform specific resourcing decisions but can also highlight important tradeoffs and suggest general \"rules\" for resource and operational planning.
CONCLUSIONS: Multilevel planning and implementation challenges are not unique to sustainable adoption of cervical cancer screening programs but represent common barriers to the successful scale-up of many preventative health interventions worldwide. DES represents a broadly applicable tool to address complex implementation challenges identified at the national, regional, and local levels across settings and health interventions-how to make effective and efficient operational and resourcing decisions to support program adaptation to local constraints and demands so that they are resilient to changing demands and more likely to be maintained with fidelity over time.
摘要：
背景：世界卫生组织（WHO）呼吁消除宫颈癌。不幸的是,实施具有成本效益的预防和控制策略面临重大障碍，例如，对资源和运营规划的最佳做法的指导不足。因此,我们展示了离散事件仿真(DES)在实施科学研究和实践中的价值，特别是支持可持续和有弹性地提供医疗保健干预措施的方案和业务规划。我们的具体示例显示了DES模型如何为Iquitos中基于HPV的新屏幕和治疗计划的扩展和弹性操作提供信息，秘鲁的一个亚马逊城市。
方法：使用来自伊基托斯的时间和运动研究和宫颈癌筛查登记的数据，秘鲁,我们开发了一个DES模型,利用"假设"方案进行虚拟实验,比较资源限制和筛选系统中断情况下的不同工作流程和处理策略.
结果：我们的模拟显示，在当前资源水平下，筛选系统的容量可以增加多少，可以容忍多少服务时间的可变性，以及对资源削减等中断的抵御能力。模拟还确定了为更大的目标人群扩大规模或增强对破坏的抵御能力所需的资源，说明了弹性和效率之间的关键权衡。因此，我们的结果证明了DES模型可以为特定的资源决策提供信息,但也可以突出重要的权衡,并为资源和运营规划提出一般的"规则".
结论：多层次规划和实施挑战并不是子宫颈癌筛查计划的可持续采用所独有的，而是在全球范围内成功扩大许多预防性健康干预措施的共同障碍。DES是一个广泛适用的工具，可以解决国家、区域,以及跨环境和卫生干预措施的地方级别-如何做出有效和高效的运营和资源决策，以支持计划适应当地的限制和需求，以便它们能够适应不断变化的需求，并且更有可能随着时间的推移而保持忠诚。
方法：使用来自伊基托斯的时间和运动研究和宫颈癌筛查登记的数据，秘鲁,我们开发了一个DES模型,利用"假设"方案进行虚拟实验,比较资源限制和筛选系统中断情况下的不同工作流程和处理策略.
结果：我们的模拟显示，在当前资源水平下，筛选系统的容量可以增加多少，可以容忍多少服务时间的可变性，以及对资源削减等中断的抵御能力。模拟还确定了为更大的目标人群扩大规模或增强对破坏的抵御能力所需的资源，说明了弹性和效率之间的关键权衡。因此，我们的结果证明了DES模型可以为特定的资源决策提供信息,但也可以突出重要的权衡,并为资源和运营规划提出一般的"规则".
结论：多层次规划和实施挑战并不是子宫颈癌筛查计划的可持续采用所独有的，而是在全球范围内成功扩大许多预防性健康干预措施的共同障碍。DES是一个广泛适用的工具，可以解决国家、区域,以及跨环境和卫生干预措施的地方级别-如何做出有效和高效的运营和资源决策，以支持计划适应当地的限制和需求，以便它们能够适应不断变化的需求，并且更有可能随着时间的推移而保持忠诚。
