Purpose of Review
This review offers an operational definition of systems engineering (SE) as applied to public health, reviews applications of SE in the field of HIV, and identifies opportunities and challenges of broader application of SE in global health.
SE involves the deliberate sequencing of three steps: diagnosing a problem, evaluating options using modeling or optimization, and providing actionable recommendations. SE includes diverse tools (from process improvement to mathematical modeling) applied to decisions at various levels (from local staffing decisions to planning national-level roll-out of new interventions). Contextual factors are crucial to effective decision-making, but there are gaps in understanding global decision-making processes. Integrating SE into pre-service training and translating SE tools to be more accessible could increase utilization of SE approaches in global health.
SE is a promising, but under-recognized approach to improve public health response to HIV globally.
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Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance
UNAIDS (2018) Miles to go: closing gaps, breaking barriers, righting injustices. Geneva.
Bowen S, Zwi AB. Pathways to “evidence-informed” policy and practice: a framework for action. PLoS Med. 2005;2:e166. https://doi.org/10.1371/journal.pmed.0020166.
Damschroder LJ, Aron DC, Keith RE, Kirsh SR, Alexander JA, Lowery JC. Fostering implementation of health services research findings into practice: a consolidated framework for advancing implementation science. Implement Sci. 2009;4. https://doi.org/10.1186/1748-5908-4-50.
Kapiriri L, Norheim OF, Martin DK. Priority setting at the micro-, meso- and macro-levels in Canada, Norway and Uganda. Health Policy (New York). 2007;82:78–94. https://doi.org/10.1016/j.healthpol.2006.09.001.
Schlager KJ. Systems engineering-key to modern development. IRE Trans Eng Manag. 1956;3:64–6.
Buede D. The engineering design of systems: models and methods. 2nd ed. Hoboken, New Jersey: John Wiley & Sons, Inc; 2009.
NASA (2007) NASA Systems Engineering Handbook.
Rau EP. Combat science: the emergence of operational research in world war II. Endeavour. 2005;29:156–61. https://doi.org/10.1016/j.endeavour.2005.10.002.
Deming WE (2018) The new economics for industry, government, education, third. MIT Press, Cambridge, MA.
Rogers EM. Diffusion of innovations. 5th ed. New York: Free Press; 2003.
Greenhalgh T, Robert G, Macfarlane F, Bate P, Kyriakidou O, Peacock R. Storylines of research in diffusion of innovation: a meta-narrative approach to systematic review. Soc Sci Med. 2005;61:417–30. https://doi.org/10.1016/j.socscimed.2004.12.001.
Berwick DM. Disseminating innovations in health care. JAMA. 2003;289:1969–75. https://doi.org/10.1001/jama.289.15.1969.
Institute of Medicine. Crossing the quality chasm: a new health system for the 21st century. Washington, DC: National Academies Press; 2001.
• Reid PP, Compton WD, Grossman JH, Fanjiang G. Building a better delivery system: a new engineering/health care partnership. Washington, DC: National Academies Press; 2005. This work describes systems engineering applied to health care, both a framework and action plan.
Tu SP, Feng S, Storch R, Yip MP, Sohng HY, Fu M, et al. Applying systems engineering to implement an evidence-based intervention at a community health center. J Health Care Poor Underserved. 2012;23:1399–409. https://doi.org/10.1353/hpu.2012.0190.
Tropello SP, Ravitz AD, Romig M, Pronovost PJ, Sapirstein A. Enhancing the quality of care in the intensive care unit: a systems engineering approach. Crit Care Clin. 2013;29:113–24. https://doi.org/10.1016/j.ccc.2012.10.009.
White BA, Chang Y, Grabowski BG, Brown DF. Using lean-based systems engineering to increase capacity in the emergency department. West J Emerg Med. 2014;15:770–6. https://doi.org/10.5811/westjem.2014.8.21272.
Korenromp E, Komatsu R, Katz I, et al (2007) Operational research on HIV/AIDS, tuberculosis and malaria control in Global Fund-supported programmes: round 1-6 grants. In: 5th European conference on tropical medicine and international health. Amsterdam.
Kopach-Konrad R, Lawley M, Criswell M, Hasan I, Chakraborty S, Pekny J, et al. Applying systems engineering principles in improving health care delivery. J Gen Intern Med. 2007;22:431–7. https://doi.org/10.1007/s11606-007-0292-3.
•• Monks T. Operational research as implementation science: definitions, challenges and research priorities. Implement Sci. 2016;11:81. https://doi.org/10.1186/s13012-016-0444-0. This text highlights the role of operations research within implementation science and offers practical examples of models used to answer questions that saved time and money.
Pitt M, Monks T, Crowe S, Vasilakis C. Systems modelling and simulation in health service design, delivery and decision making. BMJ Qual Saf. 2016;25:38–45. https://doi.org/10.1136/bmjqs-2015-004430.
Boy GA, Narkevicius JM. Unifying human centered design and systems engineering for human systems integration. Complex Syst Des Manag. 2014:151–62.
Brugha R, Varvasovszky Z. Stakeholder analysis: a review. Health Policy Plan. 2000;15:239–46. https://doi.org/10.1093/heapol/15.3.239.
Okoli C, Pawlowski SD. The Delphi method as a research tool: an example, design considerations and applications. Inf Manag. 2004;42:15–29. https://doi.org/10.1016/j.im.2003.11.002.
Miles MB, Huberman AM. Qualitative data analysis: an expanded sourcebook. 2nd ed. Thousand Oaks, California: SAGE Publications; 1994.
Strauss A, Corbin J. Basics of qualitative research: techniques and procedures for developing grounded theory. Thousand Oaks, California: SAGE Publications; 1998.
•• Sherr K, Gimbel S, Rustagi A, et al. Systems analysis and improvement to optimize pMTCT (SAIA): a cluster randomized trial. Implement Sci. 2014;9:55. https://doi.org/10.1186/1748-5908-9-55. This is an example of three systems engineering tools packaged together into an effective intervention to improve prevention of mother-to-child transmission of HIV in 3 African countries.
Rustagi AS, Gimbel S, Nduati R, et al. Impact of a systems engineering intervention on PMTCT service delivery in Cote d’Ivoire, Kenya, Mozambique: a cluster randomized trial. J Acquir Immune Defic Syndr. 2016;72:e76–82. https://doi.org/10.1097/QAI.0000000000001188.
Bardfield J, Agins B, Akiyama M, Basenero A, Luphala P, Kaindjee-Tjituka F, et al. A quality improvement approach to capacity building in low- and middle-income countries. Acquir Immune Defic Syndr. 2015;29:S179–86. https://doi.org/10.1097/QAD.0000000000000719.
Armitage G, Hodgson I, Wright J, Bailey K, Mkhwana E. Exploring the delivery of antiretroviral therapy for symptomatic HIV in Swaziland: threats to the successful treatment and safety of outpatients attending regional and district clinics. BMJ Qual Saf. 2011;20:52–9. https://doi.org/10.1136/bmjqs.2009.034512.
• Golden LM, Fairlie L, Might F, Mojela S, Motsamai D, Motshepe S, et al. HIV retesting in pregnant women in South Africa: outcomes of a quality improvement project targeting health systems’ weaknesses. South Afr J HIV Med. 2018;19:784. https://doi.org/10.4102/sajhivmed.v19i1.784.
Lang R, Charlton C, Beckthold B, Kadivar K, Lavoie S, Caswell D, et al. HIV misdiagnosis: a root cause analysis leading to improvements in HIV diagnosis and patient care. J Clin Virol. 2017;96:84–8. https://doi.org/10.1016/j.jcv.2017.10.005.
Izudi J, Akot A, Kisitu GP, Amuge P, Kekitiinwa A. Quality improvement interventions for early HIV infant diagnosis in northeastern Uganda. Biomed Res Int. 2016;2016:1–8. https://doi.org/10.1155/2016/5625364.
Izudi J, Mugenyi J, Mugabekazi M, Muwanika B, Tumukunde Spector V, Katawera A, et al. Retention of HIV-positive adolescents in care: a quality improvement intervention in mid-western Uganda. Biomed Res Int. 2018;2018:1–8. https://doi.org/10.1155/2018/1524016.
Jeffery C, Beckworth C, Hadden WC, Ouma J, Lwanga SK, Valadez JJ. Associations with HIV testing in Uganda: an analysis of the lot quality assurance sampling database. AIDS Care. 2016;28:519–23. https://doi.org/10.1080/09540121.2015.1112350.
Pintye J, Kinuthia J, Roberts DA, Wagner AD, Mugwanya K, Abuna F, et al. Integration of PrEP services into routine antenatal and postnatal care: experiences from an implementation program in Western Kenya. Acquir Immune Defic Syndr. 2018;79:590–5. https://doi.org/10.1097/QAI.0000000000001850.
Baddour AA, Saleh HA. Use Six Sigma approach to improve healthcare worker safety. Int J Pure Appl Sci Technol. 2013;18:54–68.
Monroe-Wise A, Reisner E, Sherr K, Ojakaa D, Mbau L, Kisia P, et al. Using lean manufacturing principles to evaluate wait times for HIV-positive patients in an urban clinic in Kenya. Int J STD AIDS. 2017;28:1410–8. https://doi.org/10.1177/0956462417711624.
Institute for Healthcare Improvement (IHI) science of improvement: how to improve. www.ihi.org/resources/pages/howtoimprove/scienceofimprovementhowtoimprove.aspx. Accessed 19 Jan 2017.
Wagner AD, Mugo C, Bluemer-Miroite S, Mutiti PM, Wamalwa DC, Bukusi D, et al. Continuous quality improvement intervention for adolescent and young adult HIV testing services in Kenya improves HIV knowledge. Acquir Immune Defic Syndr. 2017;31:S243–52. https://doi.org/10.1097/QAD.0000000000001531.
Kohler PK, Namate D, Barnhart S, Chimbwandira F, Tippet-Barr BA, Perdue T, et al. Classification and rates of adverse events in a Malawi male circumcision program: impact of quality improvement training. BMC Health Serv Res. 2016;16:61. https://doi.org/10.1186/s12913-016-1305-x.
Institute for Healthcare Improvement (IHI) Run Chart Tool. www.ihi.org/resources/pages/tools/runchart.aspx. Accessed 19 Jan 2017.
Alistar SS, Long EF, Brandeau ML, Beck EJ. HIV epidemic control-a model for optimal allocation of prevention and treatment resources. Health Care Manag Sci. 2014;17:162–81. https://doi.org/10.1007/s10729-013-9240-4.
El-Rifai O, Garaix T, Augusto V, Xie X. A stochastic optimization model for shift scheduling in emergency departments. Health Care Manag Sci. 2015;18:289–302. https://doi.org/10.1007/s10729-014-9300-4.
Gimbel S, Voss J, Mercer MA, Zierler B, Gloyd S, Coutinho MJ, et al. The prevention of mother-to-child transmission of HIV cascade analysis tool: supporting health managers to improve facility-level service delivery. BMC Res Notes. 2014;7. https://doi.org/10.1186/1756-0500-7-743.
Njuguna IN, Wagner AD, Otieno VO, et al. Hospitalized children reveal health systems gaps in the mother-child HIV care cascade in Kenya. AIDS Patient Care STDs. 2016;30:119–24. https://doi.org/10.1089/apc.2015.0239.
Sibanda EL, Weller IV, Hakim JG, Cowan FM. The magnitude of loss to follow-up of HIV-exposed infants along the prevention of mother-to-child HIV transmission continuum of care: a systematic review and meta-analysis. Acquir Immune Defic Syndr. 2013;27:2787–97. https://doi.org/10.1097/QAD.0000000000000027.
Deo S, Topp SM, Garcia A, Soldner M, Yagci Sokat K, Chipukuma J, et al. Modeling the impact of integrating HIV and outpatient health services on patient waiting times in an urban health clinic in Zambia. PLoS One. 2012;7:e35479. https://doi.org/10.1371/journal.pone.0035479.
Gonsalves GS, Paltiel AD, Cleary PD, Gill MJ, Kitahata MM, Rebeiro PF, et al. A flow-based model of the HIV care continuum in the United States. J Acquir Immune Defic Syndr. 2017;75:548–53. https://doi.org/10.1097/QAI.0000000000001429.
Liu N, Stone PW, Schnall R. Impact of mandatory HIV screening in the emergency department: a queuing study. Res Nurs Health. 2016;39:121–7. https://doi.org/10.1002/nur.21710.
Kok S, Rutherford AR, Gustafson R, et al. Optimizing an HIV testing program using a system dynamics model of the continuum of care. Health Care Manag Sci. 2015;18:334–62. https://doi.org/10.1007/s10729-014-9312-0.
Negoescu DM, Owens DK, Brandeau ML, Bendavid E. Balancing immunological benefits and cardiovascular risks of antiretroviral therapy: when is immediate treatment optimal? Clin Infect Dis. 2012;55:1392–9. https://doi.org/10.1093/cid/cis731.
Negoescu DM, Zhang Z, Bucher HC, Bendavid E, Swiss HIV Cohort Study. Differentiated human immunodeficiency virus RNA monitoring in resource-limited settings: an economic analysis. Clin Infect Dis. 2017;64:1724–30. https://doi.org/10.1093/cid/cix177.
Enns EA, Brandeau ML. Inferring model parameters in network-based disease simulation. Health Care Manag Sci. 2011;14:174–88. https://doi.org/10.1007/s10729-011-9150-2.
Enns EA, Brandeau ML. Link removal for the control of stochastically evolving epidemics over networks: a comparison of approaches. J Theor Biol. 2015;371:154–65. https://doi.org/10.1016/j.jtbi.2015.02.005.
Enns EA, Brandeau ML, Igeme TK, Bendavid E. Assessing effectiveness and cost-effectiveness of concurrency reduction for HIV prevention. Int J STD AIDS. 2011;22:558–67. https://doi.org/10.1258/ijsa.2011.010322.
Sharma M, Smith JA, Farquhar C, Ying R, Cherutich P, Golden M, et al. Assisted partner notification services are cost-effective for decreasing HIV burden in western Kenya. Acquir Immune Defic Syndr. 2018;32:233–41. https://doi.org/10.1097/QAD.0000000000001697.
•• Francke JA, Penazzato M, Hou T, Abrams EJ, MacLean RL, Myer L, et al. Clinical impact and cost-effectiveness of diagnosing HIV infection during early infancy in South Africa: test timing and frequency. J Infect Dis. 2016;214:1319–28. https://doi.org/10.1093/infdis/jiw379. This is an example of using a complex mathematical model to decide between introduction of a new infant HIV testing timepoint or optimizing system performance for existing timepoints.
Suraratdecha C, Stuart RM, Manopaiboon C, Green D, Lertpiriyasuwat C, Wilson DP, et al. Cost and cost-effectiveness analysis of pre-exposure prophylaxis among men who have sex with men in two hospitals in Thailand. J Int AIDS Soc. 2018;21:E25129. https://doi.org/10.1002/jia2.25129.
Price JT, Wheeler SB, Stranix-Chibanda L, Hosek SG, Watts DH, Siberry GK, et al. Cost-effectiveness of pre-exposure HIV prophylaxis during pregnancy and breastfeeding in sub-Saharan Africa. J Acquir Immune Defic Syndr. 2016;72:S145–53. https://doi.org/10.1097/QAI.0000000000001063.
Smith JA, Sharma M, Levin C, Baeten JM, van Rooyen H, Celum C, et al. Cost-effectiveness of community-based strategies to strengthen the continuum of HIV care in rural South Africa: a health economic modelling analysis. Lancet HIV. 2015;2:e159–68. https://doi.org/10.1016/S2352-3018(15)00016-8.
Mitchell KM, Lepine A, Terris-Prestholt F, et al. Modelling the impact and cost-effectiveness of combination prevention amongst HIV serodiscordant couples in Nigeria. Acquir Immune Defic Syndr. 2015;29:2035–44. https://doi.org/10.1097/QAD.0000000000000798.
Alistar SS, Owens DK, Brandeau ML. Effectiveness and cost effectiveness of oral pre-exposure prophylaxis in a portfolio of prevention programs for injection drug users in mixed HIV epidemics. PLoS One. 2014;9:e86584. https://doi.org/10.1371/journal.pone.0086584.
•• Cherutich P, Farquhar C, Wamuti B, et al. HIV partner services in Kenya: a cost and budget impact analysis study. BMC Health Serv Res. 2018;18:721. https://doi.org/10.1186/s12913-018-3530-y. This is an example of a budget impact analysis that had direct impact on national policy in Kenya and accelerated translation of randomized controlled trial efficacy findings to programmatic scale up.
• de Savigny D, Adam T. Systems thinking for health systems strengthening. Geneva, Switzerland: World Health Organization; 2009. Excellent introduction to systems thinking in practical terms, with focus on context.
World Health Organization. Everybody’s business: strengthening health systems to improve health outcomes: WHO’s framework for action. Geneva, Switzerland; 2007.
Hoffmann CJ, Milovanovic M, Kinghorn A, et al (2018) Value stream mapping to characterize value and waste associated with accessing HIV care in South Africa.
Alamo ST, Wagner GJ, Ouma J, Sunday P, Marie L, Colebunders R, et al. Strategies for optimizing clinic efficiency in a community-based antiretroviral treatment programme in Uganda. AIDS Behav. 2013;17:274–83. https://doi.org/10.1007/s10461-012-0199-9.
Kwena ZA, Njoroge BW, Cohen CR, Oyaro P, Shikari R, Kibaara CK, et al. The feasibility, time savings and economic impact of a designated time appointment system at a busy HIV care clinic in Kenya: a randomized controlled trial. J Int AIDS Soc. 2015;18:19876. https://doi.org/10.7448/IAS.18.1.19876.
Henley C, Forgwei G, Welty T, Golden M, Adimora A, Shields R, et al. Scale-up and case-finding effectiveness of an HIV partner services program in Cameroon: an innovative HIV prevention intervention for developing countries. Sex Transm Infect. 2013;40:909–14. https://doi.org/10.1097/OLQ.0000000000000032.
Cherutich P, Golden MR, Wamuti B, Richardson BA, Ásbjörnsdóttir KH, Otieno FA, et al. Assisted partner services for HIV in Kenya: a cluster randomised controlled trial. Lancet HIV. 2017;4:e74–82. https://doi.org/10.1016/S2352-3018(16)30214-4.
World Health Organization (2016) Guidelines on HIV self-testing and partner notification: supplement to consolidated guidelines on HIV testing services.
Balas EA, Boren SA. Managing clinical knowledge for health care improvement. Yearb Med Inform. 2000;1:65–70.
•• Masyuko S, Mukui I, Njathi O, Kimani M, Oluoch P, Wamicwe J, et al. Pre-exposure prophylaxis rollout in a national public sector program: the Kenyan case study. Sex Health. 2018;15:578–86. https://doi.org/10.1071/SH18090. This is an example of a partnership between Kenyan Ministry of Health and technical modeling experts to design a rollout strategy for HIV pre-exposure prophylaxis using a publically available and user-friendly simplified model interface.
Avenir Health (2018) SPECTRUM.
Bhavaraju N, Muther K, Kiragu M, et al. Who, where, and how? Developing scenarios for the rollout of oral PrEP in Kenya. Paris, France: International AIDS Society; 2017.
AVAC PrEPWatch: OPTIONS plan 4 PrEP tool offers countries support for rollout. www.prepwatch.org/plan-4-prep-tool/. Accessed 30 Nov 2018.
Deo S, Crea L, Quevedo J, Lehe J, Vojnov L, Peter T, et al. Implementation and operational research: expedited results delivery systems using GPRS technology significantly reduce early infant diagnosis test turnaround times. J Acquir Immune Defic Syndr. 2015;70:e1–4. https://doi.org/10.1097/QAI.0000000000000719.
Jani IV, Meggi B, Loquiha O, Tobaiwa O, Mudenyanga C, Zitha A, et al. Effect of point-of-care early infant diagnosis on antiretroviral therapy initiation and retention of patients. Acquir Immune Defic Syndr. 2018;32:1453–63. https://doi.org/10.1097/QAD.0000000000001846.
Gimbel S, Chilundo B, Kenworthy N, Inguane C, Citrin D, Chapman R, et al. Donor data vacuuming in global health partnerships. Med Anthropol Theory. 2018;5:79–99. https://doi.org/10.17157/mat.5.2.537.
Wagenaar BH, Sherr K, Fernandes Q, Wagenaar AC. Using routine health information systems for well-designed health evaluations in low- and middle-income countries. Health Policy Plan. 2016;31:129–35. https://doi.org/10.1093/heapol/czv029.
Gloyd S, Wagenaar BH, Woelk GB, Kalibala S. Opportunities and challenges in conducting secondary analysis of HIV programmes using data from routine health information systems and personal health information. J Int AIDS Soc. 2016;19:20847. https://doi.org/10.7448/IAS.19.5.20847.
Wagenaar BH, Gimbel S, Hoek R, Pfeiffer J, Michel C, Manuel JL, et al. Effects of a health information system data quality intervention on concordance in Mozambique: time-series analyses from 2009-2012. Popul Health Metrics. 2015;13:9. https://doi.org/10.1186/s12963-015-0043-3.
Njoroge A, Dunbar M, Betz B, et al (2016) Feasibility and acceptability of a biometric identification system using iris recognition in routine HIV services in Kenya. In: 9th International AIDS Society Conference (IAS). Durban, South Africa.
Gimbel S, Coutinho J, Kawakyu N, et al (2018) Usability and feasibility of a provider decision support smartphone application for frontline health workers in Kenya and Mozambique. In: 5th Global Symposium on Health Services Research. Liverpool, UK.
Saywell D, Crocker J. Process learning on partnerships: building functioning research and practice organizational relationships. Waterlines. 2019;38:3–19. https://doi.org/10.3362/1756-3488.18-00014.
Walker RM, Damanpour F, Devece CA. Management innovation and organizational performance: the mediating effect of performance management. J Public Adm Res Theory. 2010;21:367–86. https://doi.org/10.1093/jopart/muq043.
Boyko JA, Riley BL, Willis CD, Stockton L, Zummach D, Kerner J, et al. Knowledge translation for realist reviews: a participatory approach for a review on scaling up complex interventions. Heal Policy Res Syst. 2018;16:101. https://doi.org/10.1186/s12961-018-0374-1.
Petkovic J, Welch V, Jacob MH, Yoganathan M, Ayala AP, Cunningham H, et al. The effectiveness of evidence summaries on health policymakers and health system managers use of evidence from systematic reviews: a systematic review. Implement Sci. 2016;11:162. https://doi.org/10.1186/s13012-016-0530-3.
Mijumbi-Deve R, Rosenbaum SE, Oxman AD, Lavis JN, Sewankambo NK. Policymaker experiences with rapid response briefs to address health-system and technology questions in Uganda. Heal Res Policy. 2017;15:37. https://doi.org/10.1186/s12961-017-0200-1.
Murthy L, Shepperd S, Clarke MJ, Garner SE, Lavis JN, Perrier L, et al. Interventions to improve the use of systematic reviews in decision-making by health system managers, policy makers and clinicians. Cochrane Database Syst Rev. 2012;9:CD009401. https://doi.org/10.1002/14651858.CD009401.pub2.
Tricco AC, Cardoso R, Thomas SM, Motiwala S, Sullivan S, Kealey MR, et al. Barriers and facilitators to uptake of systematic reviews by policy makers and health care managers: a scoping review. Implement Sci. 2016;11:4. https://doi.org/10.1186/s13012-016-0370-1.
• Kruk ME, Gage AD, Arsenault C, Jordan K, Leslie HH, Roder-DeWan S, et al. High-quality health systems in the sustainable development goals era: time for a revolution. Lancet Glob Heal. 2018;6:e1196–252. https://doi.org/10.1016/S2214-109X(18)30386-3. These three texts frame the need for systems engineering within the global focus on quality.
• Berwick D, Snair M, Nishtar S. Crossing the global health quality chasm: a key component of universal health coverage. JAMA. 2018;320:1317–8. https://doi.org/10.1001/jama.2018.13696. These three texts frame the need for systems engineering within the global focus on quality.
• World Health Organization, World Bank (2018) Delivering quality health services: a global imperative for universal health coverage. Geneva, Switzerland. These three texts frame the need for systems engineering within the global focus on quality.
ADW was supported by F32HD088204, JC was supported by R01MH113435, BHW was supported by K01MH110599, and support was provided by the Implementation Science Core of the University of Washington/Fred Hutch Center for AIDS Research, an NIH-funded program under award number AI027757 which is supported by the following NIH Institutes and Centers: NIAID, NCI, NIMH, NIDA, NICHD, NHLBI, NIA, NIGMS, and NIDDK. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.
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Anjuli D. Wagner and Jonny Crocker co-first authors
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Wagner, A.D., Crocker, J., Liu, S. et al. Making Smarter Decisions Faster: Systems Engineering to Improve the Global Public Health Response to HIV. Curr HIV/AIDS Rep 16, 279–291 (2019). https://doi.org/10.1007/s11904-019-00449-2