Agent-based models for understanding the impact of transitions between community and criminal justice settings on HIV transmission and opioid mortality: implications for intervention development

Anna Hotton, PhD, MPH
John Schneider, MD, MPH
University of Chicago Medicine

ABSTRACT:
Criminal justice involvement (CJI) has important public health and social consequences, affecting social and sexual network stability, employment and housing opportunities, and access to medical care, all of which can lead to cycles of socioeconomic marginalization and adverse health outcomes. CJI populations are disproportionately impacted by HIV and substance use disorders, which can be exacerbated by frequent cycling between communities and criminal justice settings. However, such settings also offer opportunities for delivery of treatment and prevention interventions, such as PrEP, ART, and medication assisted therapy to populations who may not otherwise access these services. Guidance is needed to determine how interventions for CJI populations can be most effectively deployed, but logistical and ethnical challenges make empirical research difficult in contexts that often include marginalized communities that are highly mobile, have significant loss to follow-up, and cycle frequently between criminal justice and community settings. Agent-based models (ABMs) can generate insights about the processes that drive HIV transmission and opioid related mortality and provide a platform for virtually evaluating potential candidate interventions, thus facilitating more efficient and focused intervention development. By illuminating mechanisms associated with intervention success and providing the ability to parameterize the relevant individual-level heterogeneity via detailed, local data, ABMs allow for exploration of complex interventions, enabling the investigation of specific intervention ingredients and mechanisms likely to have the most impact on the HIV and opioid epidemics in the US. We present early applications of ABMs for evaluating interventions for CJI populations with nascent examples in HIV and opioid mortality, and discuss implications for structural, policy, and network-based interventions.