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Huaju T, Rendie X, Lu X, Mei L, Yue L, Daiying Z, Yanhua C, Jianlan R. The Effect of a Brief Video-Based Intervention to Improve AIDS Prevention in Older Men: Randomized Controlled Trial. JMIR Public Health Surveill 2025; 11:e65674. [PMID: 40249768 PMCID: PMC12025342 DOI: 10.2196/65674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2024] [Revised: 02/12/2025] [Accepted: 02/13/2025] [Indexed: 04/20/2025] Open
Abstract
Background The AIDS epidemic among older people is becoming more serious. Evidence-based, acceptable, and effective preventive interventions are urgently needed. Video-based interventions have become an innovative way to change behaviors, and we have developed a brief video-based intervention named Sunset Without AIDS. Objective In this study, we tested the effectiveness of a brief video-based intervention targeting older men's understanding of AIDS prevention. Methods A randomized controlled trial was conducted from June 20 to July 3, 2023. In total, 100 older men were randomly divided into the intervention group (n=50) and the control group (n=50) using the envelope extraction method. The intervention group was shown the Sunset Without AIDS video; the control group viewed a standard AIDS education video. A questionnaire was used to measure the effect of Sunset Without AIDS after 2 interventions. AIDS-related high-risk behaviors were followed up 1 and 3 months after the intervention. The difference was statistically significant at P≤.05. Results After 2 interventions, the total awareness rates (%) of AIDS-related knowledge in the intervention and control groups were 84% (42/50) and 66% (33/50), respectively (P=.04). The mean stigma attitude scores of the 2 groups were 2.53 (SD 0.45) and 2.58 (SD 0.49), respectively (P=.55), but there was a statistically significant difference in the first dimension (fear of infection) between the 2 groups (P<.001). The mean positive scores of attitudes of AIDS-related high-risk behaviors of the 2 groups were 83.33 (SD 21.56) and 75.67 (SD 26.77), respectively (P=.58). In addition, 82% reported that they were satisfied with the educational content within the Sunset Without AIDS video. At 1- and 3-month follow-ups conducted after the intervention, participants in the 2 groups did not report AIDS-related high-risk behaviors. After watching the 2 videos, more people accepted and were satisfied with Sunset Without AIDS. Conclusions Sunset Without AIDS could improve the ability of older men in China to follow best practices for AIDS prevention and provide a certain basis for the innovation of AIDS education in the older adult population.
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Affiliation(s)
- Tian Huaju
- Department of the Operating Room, the Affiliated Hospital of Southwest Medical University, 25 Taiping Street, Luzhou, Sichuan Province, China
| | - Xie Rendie
- Department of Anesthesiology, the Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Xiao Lu
- Department of the Operating Room, the Affiliated Hospital of Southwest Medical University, 25 Taiping Street, Luzhou, Sichuan Province, China
| | - Li Mei
- School of Nursing, Southwest Medical University, Luzhou, China
| | - Luo Yue
- School of Nursing, Southwest Medical University, Luzhou, China
| | - Zhang Daiying
- Department of the Operating Room, the Affiliated Hospital of Southwest Medical University, 25 Taiping Street, Luzhou, Sichuan Province, China
| | - Chen Yanhua
- Department of Nursing, the Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Ren Jianlan
- Department of the Operating Room, the Affiliated Hospital of Southwest Medical University, 25 Taiping Street, Luzhou, Sichuan Province, China
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Tembo TA, Markham CM, Masiano SP, Sabelli R, Wetzel E, Ahmed S, Mphande M, Mkandawire AM, Chitani MJ, Khama I, Nyirenda R, Mazenga A, Abrams EJ, Kim MH. Intervention Fidelity to VITAL Start (Video Intervention to Inspire Treatment Adherence for Life) in a Randomized Controlled Trial Among Women Living With HIV in Malawi. Health Promot Pract 2025; 26:131-141. [PMID: 37282494 DOI: 10.1177/15248399231177303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
BACKGROUND. Intervention effectiveness in a randomized controlled trial is attributed to intervention fidelity. Measuring fidelity has increasing significance to intervention research and validity. The purpose of this article is to describe a systematic assessment of intervention fidelity for VITAL Start (Video intervention to Inspire Treatment Adherence for Life)-a 27-minute video-based intervention designed to improve antiretroviral therapy adherence among pregnant and breastfeeding women. METHOD. Research Assistants (RAs) delivered VITAL Start to participants after enrolment. The VITAL Start intervention had three components: a pre-video orientation, video viewing, and post-video counseling. Fidelity assessments using checklists comprised self (RA assessment) and observer (Research Officers, also known as ROs) assessment. Four fidelity domains (adherence, dose, quality of delivery, and participant responsiveness) were evaluated. Score scale ranges were 0 to 29 adherence, 0 to 3 dose, 0 to 48 quality of delivery and 0 to 8 participant responsiveness. Fidelity scores were calculated. Descriptive statistics summarizing the scores were performed. RESULTS. In total, eight RAs delivered 379 VITAL Start sessions to 379 participants. Four ROs observed and assessed 43 (11%) intervention sessions. The mean scores were 28 (SD = 1.3) for adherence, 3 (SD = 0) for dose, 40 (SD = 8.6) for quality of delivery, and 10.4 (SD = 1.3) for participant responsiveness. CONCLUSION. Overall, the RAs successfully delivered the VITAL Start intervention with high fidelity. Intervention fidelity monitoring should be an important element of randomized control trial design of specific interventions to ensure having reliable study results.
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Affiliation(s)
- Tapiwa A Tembo
- Baylor College of Medicine Children's Foundation, Lilongwe, Malawi
| | - Christine M Markham
- Health Promotion and Behavioral Sciences, The University of Texas Health Center at Houston School of Public Health, Houston, TX, USA
| | - Steven P Masiano
- Baylor College of Medicine Children's Foundation, Lilongwe, Malawi
| | - Rachael Sabelli
- Department of Public Health and Community Medicine, Tufts University, Medford, MA, USA
| | - Elizabeth Wetzel
- Baylor College of Medicine Children's Foundation, Lilongwe, Malawi
- Baylor College of Medicine International Paediatric AIDS Initiative, Texas Children's Hospital, Houston, TX, USA
| | - Saeed Ahmed
- Baylor College of Medicine Children's Foundation, Lilongwe, Malawi
- Baylor College of Medicine International Paediatric AIDS Initiative, Texas Children's Hospital, Houston, TX, USA
| | - Mtisunge Mphande
- Baylor College of Medicine Children's Foundation, Lilongwe, Malawi
| | | | - Mike J Chitani
- Baylor College of Medicine Children's Foundation, Lilongwe, Malawi
| | - Innocent Khama
- Baylor College of Medicine Children's Foundation, Lilongwe, Malawi
| | | | - Alick Mazenga
- Baylor College of Medicine Children's Foundation, Lilongwe, Malawi
| | - Elaine J Abrams
- ICAP at Columbia, Mailman School of Public Health and Vagelos College of Physicians & Surgeons, Columbia University, NY, USA
| | - Maria H Kim
- Baylor College of Medicine Children's Foundation, Lilongwe, Malawi
- Baylor College of Medicine International Paediatric AIDS Initiative, Texas Children's Hospital, Houston, TX, USA
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Nakalega R, Mawanda D, Nabisere-Arinaitwe R, Mukiza N, Ndikuno Kuteesa C, Menge R, Nakabiito C, Nabakooza J, Kakuru A, Atuyambe L, Musoke P, Fowler MG, Lukyamuzi Z. Video-based education messaging to enhance optimal uptake of malaria preventive therapy in pregnant women: a mixed methods study involving pregnant women and midwives in Uganda. Malar J 2024; 23:391. [PMID: 39695763 DOI: 10.1186/s12936-024-05223-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2024] [Accepted: 12/11/2024] [Indexed: 12/20/2024] Open
Abstract
BACKGROUND Malaria prevention during pregnancy significantly minimizes maternal-fetal adverse events. However, optimal uptake of malaria preventive therapy in pregnancy (MPTp) remains a major challenge for both women living with HIV and those without. In Uganda, suboptimal uptake of MPTp is primarily due to inadequate knowledge among women. This study aimed to develop and assess the feasibility and acceptability of an educational video to improve knowledge of MPTp among pregnant women living with and without HIV. METHODS This study describes the second phase of a mixed methods study conducted among pregnant women (living with and without HIV) and midwives from a public antenatal care clinic in Kampala, Uganda. The study was conducted from October 2022 to Jan 2024, and the first phase involved qualitative data collection from pregnant women, health workers, and Ministry of Health officials to develop a video-based intervention to enhance uptake of MPTp. The second phase involved administration of the developed intervention to a group of purposively selected pregnant women living with and without HIV. Questionnaires, focus group discussions, and interviews were used to collect data among women and midwives, and to assess feasibility and acceptability of the intervention. Quantitative data were summarized using descriptive statistics and analysed using different scales of measurement including the modified system usability scale and the Evidence-based Practice and Attitude Scale (EBPAS), which assessed acceptability among pregnant women and midwives, respectively. The qualitative data were coded and analysed using inductive and deductive thematic methods in Atlas ti.8. RESULTS A total of 45 women and six midwives were enrolled in the current study phase. The mean age (± standard deviation, SD) of the women was 26 ± 6 years, and the median gestational age (interquartile range, IQR) was 24 (20-32) weeks, and less than half (42%, n = 19) were living with HIV. On the system usability scale, most women (91%, n = 41) rated the intervention as good or excellent, and most (93%, n = 42) were satisfied or very satisfied with the intervention. On the EBPAS, midwives perceived the intervention as reliable with Cronbach's alpha of 0.74, and all midwives found the intervention appropriate and feasible in their facility. All women comprehended and highly accepted the intervention. CONCLUSION The video-based intervention for uptake of MPTp was found acceptable among women and midwives and was feasible and appropriate to a public health facility. Future studies would test the effectiveness of the intervention in improving knowledge and uptake of MPTp.
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Affiliation(s)
- Rita Nakalega
- Makerere University-Johns Hopkins University (MU-JHU) Research Collaboration, Kampala, Uganda
| | | | | | | | | | - Robert Menge
- Center for Gender Studies, Umeå University, Sweden, Umeå
| | - Clemensia Nakabiito
- Makerere University-Johns Hopkins University (MU-JHU) Research Collaboration, Kampala, Uganda
| | | | - Abel Kakuru
- Infectious Diseases Research Collaboration, Kampala, Uganda
| | | | - Philippa Musoke
- Makerere University-Johns Hopkins University (MU-JHU) Research Collaboration, Kampala, Uganda
| | | | - Zubair Lukyamuzi
- Makerere University-Johns Hopkins University (MU-JHU) Research Collaboration, Kampala, Uganda
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Hunt JH, Peay HL, Henderson GE. Facilitators and Barriers to Adherence to Anti-Retroviral Treatment Among Pregnant or Breastfeeding Women Living with HIV and Perinatally Infected Infants: A Scoping Review. AIDS Behav 2024; 28:2910-2925. [PMID: 38767727 DOI: 10.1007/s10461-024-04373-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/07/2024] [Indexed: 05/22/2024]
Abstract
In 2022, 54% of 1.5 million children (age 0-14) living with HIV had access to anti-retroviral medication (ART). Adherence to ART for pregnant or breastfeeding HIV + women is critical for maintaining their personal health and to prevent mother-to-child-transmission (MTCT). For HIV + infants, adherence is essential to establish early viremic control and is contingent on caregiver administration. We conducted a scoping review to systematically identify and categorize the influences on ART adherence for pregnant or breastfeeding HIV + women and their HIV + infants. We searched databases in June 2023 and employed the Social-Ecological Model (SEM) to organize facilitators and barriers to adherence referenced in published articles. All articles published before 2016 were excluded due to updated guidelines from WHO on MTCT and ART. Our analysis included 52 articles. 50/52 took place in Africa and used cross-sectional and mixed-methods design. Barriers to adherence for pregnant or breastfeeding HIV + women included maternal education, self-efficacy, social support, and social/economic context. Barriers to infant adherence included development, nutrition, age of treatment initiation, disclosure, and ART side effects. Additional facilitators and barriers to adherence are presented at family, extra-familial, and socio-cultural SEM levels. Stigma was the most salient barrier referenced across the entire continuum of HIV care and all SEM levels. This review revealed a dearth of literature focusing on HIV + infants who are dependent on their caregivers for ART adherence and lack of a standard adherence measure. We identified multi-leveled influences on adherence impacting both the mother and infant and are amenable to public health intervention.
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Affiliation(s)
- Joanne H Hunt
- Department of Sociology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
| | - Holly L Peay
- Research Triangle International, Durham, NC, USA
| | - Gail E Henderson
- Department of Social Medicine, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, USA
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Jenner E, Walsh S, Henley C, Demby H, Leger R, Falk G. Randomized Trial of a Sexual Health Video Intervention for Black and Hispanic Adolescent Females. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2023; 24:262-271. [PMID: 36735143 PMCID: PMC10764370 DOI: 10.1007/s11121-023-01499-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/22/2023] [Indexed: 02/04/2023]
Abstract
Despite significant declines, adolescent birth rates in the USA are higher than other industrialized countries, with black and Hispanic youth disproportionately affected. This study assessed the efficacy of a single-session, entertainment-education sexual health video intervention for these populations. Using an individual-level randomized controlled trial, 1770 18- to 19-year-old black and Hispanic females were assigned to watch Plan A (n = 886) or a control video (n = 884) prior to a sexual reproductive health (SRH) visit. Participants self-reported data at baseline and 3 months post-baseline. Within an intent-to-treat framework, we estimated the average causal effect of assignment to Plan A on three confirmatory and five exploratory outcomes. We found that individuals assigned to Plan A had higher contraceptive knowledge, may be more likely to get sexually transmitted infection (STI) testing, and may have elevated HIV/STI risk perceptions 3 months post-video. Although we found no difference in long-acting reversible contraception (LARC) use nor frequency of condomless sex in the full sample, we did observe that first-time SRH visitors assigned to Plan A had a higher probability of using LARC than those in the control group. This study demonstrates that Plan A is a low-burden, inexpensive, and highly scalable video intervention for black and Hispanic adolescent females that has significant and borderline significant effects on protective sexual health behaviors and important antecedents. It adds to the evidence base of effective teen pregnancy prevention programs and the limited set of rigorous and causal studies investigating the effectiveness of entertainment-education interventions on sexual risk reduction. Registered in ClinicalTrials.gov (NCT03238313) on August 3, 2017.
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Affiliation(s)
- Eric Jenner
- The Policy & Research Group, 8434 Oak Street, 70118, New Orleans, LA, USA
| | - Sarah Walsh
- The Policy & Research Group, 8434 Oak Street, 70118, New Orleans, LA, USA
| | - Catherine Henley
- The Policy & Research Group, 8434 Oak Street, 70118, New Orleans, LA, USA.
| | - Hilary Demby
- The Policy & Research Group, 8434 Oak Street, 70118, New Orleans, LA, USA
| | - Rebekah Leger
- The Policy & Research Group, 8434 Oak Street, 70118, New Orleans, LA, USA
| | - Gretchen Falk
- The Policy & Research Group, 8434 Oak Street, 70118, New Orleans, LA, USA
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Davies A, Mullin S, Chapman S, Barnard K, Bakhbakhi D, Ion R, Neuberger F, Standing J, Merriel A, Fraser A, Burden C. Interventions to enhance medication adherence in pregnancy- a systematic review. BMC Pregnancy Childbirth 2023; 23:135. [PMID: 36864375 PMCID: PMC9979410 DOI: 10.1186/s12884-022-05218-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Accepted: 11/15/2022] [Indexed: 03/04/2023] Open
Abstract
BACKGROUND Sub-optimal medication adherence in pregnant women with chronic disease and pregnancy-related indications has the potential to adversely affect maternal and perinatal outcomes. Adherence to appropriate medications is advocated during and when planning pregnancy to reduce risk of adverse perinatal outcomes relating to chronic disease and pregnancy-related indications. We aimed to systematically identify effective interventions to promote medication adherence in women who are pregnant or planning to conceive and impact on perinatal, maternal disease-related and adherence outcomes. METHODS Six bibliographic databases and two trial registries were searched from inception to 28th April 2022. We included quantitative studies evaluating medication adherence interventions in pregnant women and women planning pregnancy. Two reviewers selected studies and extracted data on study characteristics, outcomes, effectiveness, intervention description (TIDieR) and risk of bias (EPOC). Narrative synthesis was performed due to study population, intervention and outcome heterogeneity. RESULTS Of 5614 citations, 13 were included. Five were RCTs, and eight non-randomised comparative studies. Participants had asthma (n = 2), HIV (n = 6), inflammatory bowel disease (IBD; n = 2), diabetes (n = 2) and risk of pre-eclampsia (n = 1). Interventions included education +/- counselling, financial incentives, text messaging, action plans, structured discussion and psychosocial support. One RCT found an effect of the tested intervention on self-reported antiretroviral adherence but not objective adherence. Clinical outcomes were not evaluated. Seven non-randomised comparative studies found an association between the tested intervention and at least one outcome of interest: four found an association between receiving the intervention and both improved clinical or perinatal outcomes and adherence in women with IBD, gestational diabetes mellitus (GDM), and asthma. One study in women with IBD reported an association between receiving the intervention and maternal outcomes but not for self-reported adherence. Two studies measured only adherence outcomes and reported an association between receiving the intervention and self-reported and/or objective adherence in women with HIV and risk of pre-eclampsia. All studies had high or unclear risk of bias. Intervention reporting was adequate for replication in two studies according to the TIDieR checklist. CONCLUSIONS There is a need for high-quality RCTs reporting replicable interventions to evaluate medication adherence interventions in pregnant women and those planning pregnancy. These should assess both clinical and adherence outcomes.
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Affiliation(s)
- Anna Davies
- Academic Women's Health Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, BS8 1QU, UK.
| | - Sadie Mullin
- grid.5337.20000 0004 1936 7603Academic Women’s Health Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, BS8 1QU UK
| | - Sarah Chapman
- grid.7340.00000 0001 2162 1699Department of Pharmacy and Pharmacology, University of Bath, Bath, BA2 7AY UK
| | - Katie Barnard
- grid.416201.00000 0004 0417 1173North Bristol NHS Trust, Southmead Hospital, Southmead Road, Bristol, BS10 5NB UK
| | - Danya Bakhbakhi
- grid.5337.20000 0004 1936 7603Academic Women’s Health Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, BS8 1QU UK
| | - Rachel Ion
- grid.416201.00000 0004 0417 1173North Bristol NHS Trust, Southmead Hospital, Southmead Road, Bristol, BS10 5NB UK
| | - Francesca Neuberger
- grid.416201.00000 0004 0417 1173North Bristol NHS Trust, Southmead Hospital, Southmead Road, Bristol, BS10 5NB UK
| | - Judith Standing
- grid.416201.00000 0004 0417 1173North Bristol NHS Trust, Southmead Hospital, Southmead Road, Bristol, BS10 5NB UK
| | - Abi Merriel
- grid.5337.20000 0004 1936 7603Academic Women’s Health Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, BS8 1QU UK ,grid.5337.20000 0004 1936 7603Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, BS8 1QU UK
| | - Abigail Fraser
- grid.5337.20000 0004 1936 7603Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, BS8 1QU UK ,grid.410421.20000 0004 0380 7336National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol and Weston NHS Foundation Trust and University of Bristol, Oakfield House, Oakfield Grove, Bristol, BS8 2BN UK
| | - Christy Burden
- grid.5337.20000 0004 1936 7603Academic Women’s Health Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, BS8 1QU UK
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Zhou J, Yun J, Ye X, Liu W, Xiao W, Song P, Wang H. Interventions to improve antiretroviral adherence in HIV-infected pregnant women: A systematic review and meta-analysis. Front Public Health 2022; 10:1056915. [PMID: 36568785 PMCID: PMC9773995 DOI: 10.3389/fpubh.2022.1056915] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 11/22/2022] [Indexed: 12/13/2022] Open
Abstract
Background Medication adherence in HIV-infected pregnant women remains suboptimal. This systematic review and meta-analysis aimed to evaluate the effectiveness of interventions on improving antiretroviral adherence targeting among HIV-infected pregnant women. Methods Five databases were screened to identify quasi-experimental studies and randomized controlled trials. The risk ratios (RR) and confidential intervals (CI) were extracted to estimate the improvement in antiretroviral adherence after interventions compared with control conditions. This study was registered with PROSPERO, number CRD42021256317. Results Nine studies were included in the review, totaling 2,900 participants. Three interventions had significance: enhanced standard of care (eSOC, RR 1.14, 95%CI 1.07-1.22, Z = 3.79, P < 0.01), eSOC with supporter (RR 1.12, 95%CI 1.04-1.20, Z = 2.97, P < 0.01) and device reminder (RR 1.33, 95%CI 1.04-1.72, Z = 2.23, P = 0.03). Discussion The study supported the eSOC and the device reminder as effective intervention strategies for improving HIV medication adherence. Based on the current findings, the study called for more efforts to improve antiretroviral care for pregnant women through involving multicenter, large-sample, and high-quality research and combining the device reminder with other intervention methods. Systematic review registration https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021256317, identifier CRD42021256317.
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Affiliation(s)
- Jie Zhou
- Department of Social Medicine of School of Public Health and Department of Pharmacy of the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Jingyi Yun
- Department of Social Medicine of School of Public Health and Department of Pharmacy of the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Xinxin Ye
- Department of Social Medicine of School of Public Health and Women's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Wen Liu
- Department of Social Medicine of School of Public Health and Women's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Wenhan Xiao
- Department of Social Medicine of School of Public Health and Women's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Peige Song
- Department of Social Medicine of School of Public Health and Women's Hospital, Zhejiang University School of Medicine, Hangzhou, China,Peige Song
| | - Hongmei Wang
- Department of Social Medicine of School of Public Health and Department of Pharmacy of the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China,*Correspondence: Hongmei Wang
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Osingada CP, McMorris B, Piehler TF, Tracy MF, Porta CM. Acceptability, Feasibility, and Efficacy of Telehealth Interventions for HIV Testing and Treatment in Adult Populations. Telemed J E Health 2022. [DOI: 10.1089/tmj.2022.0424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Affiliation(s)
- Charles Peter Osingada
- Adult and Gerontological Health Cooperative, School of Nursing, University of Minnesota, Minneapolis, Minnesota, USA
| | - Barbara McMorris
- Population Health and Systems Cooperative, School of Nursing, University of Minnesota, Minneapolis, Minnesota, USA
| | - Timothy F. Piehler
- Department of Family Social Science, College of Education and Human Development, University of Minnesota, Minneapolis, Minnesota, USA
| | - Mary Fran Tracy
- Adult and Gerontological Health Cooperative, School of Nursing, University of Minnesota, Minneapolis, Minnesota, USA
| | - Carolyn M. Porta
- Population Health and Systems Cooperative, School of Nursing, University of Minnesota, Minneapolis, Minnesota, USA
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Ren J, Li M, Luo Y, Zheng Y, Tang J, Wang Y, Chen Y. Sunset Without AIDS: protocol for a randomized controlled trial of a brief video-based intervention to improve the ability of AIDS prevention in elderly men. Trials 2022; 23:146. [PMID: 35164846 PMCID: PMC8843026 DOI: 10.1186/s13063-022-06069-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Accepted: 01/30/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Although progress has been made in the prevention and treatment of HIV in China, there are still a considerable number of new infections annually, especially in older men. HIV health education for older men is urgently needed. Evidence-based, acceptable, and scalable interventions are urgently needed to increase their capacity to prevent HIV. We describe a trial protocol to evaluate the effectiveness of a brief video-based intervention targeting older men's knowledge of HIV prevention.
Design
This study is a randomized controlled trial. The trial will be held in the residents’ activity centers of three communities.
Methods
A total of 450 older men will be randomly divided into three groups (Sunset Without AIDS intervention group and two control groups) for 2 weeks. We will assess the feasibility and acceptability of intervention through interviews. The primary outcome includes changes in participants’ knowledge related to AIDS after 2 weeks intervention and 1, 3, and 6 months of follow-up. The secondary outcomes, e.g., changes in participants’ stigma attitude, risk behaviors attitude, and risk behaviors related to AIDS, will be respectively assessed 2 weeks, 1 month, 3 months, and 6 months after the second intervention.
Discussion
Sunset Without AIDS may be an innovative way to help older men improve HIV prevention knowledge, fill the gap in video-based HIV prevention education for the older men in China, and gain experience of HIV education. This project will innovate the HIV education ideas of older men and enrich the theoretical research content of AIDS-related education of older men. The findings may also provide the basis for the research and formulation of more reasonable AIDS education strategies, prevention, and control policies for the elderly.
Trial registration
Chinese Clinical Trial Registry ChiCTR2100045708. Registered on 23 April 2021
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Wetzel EC, Tembo T, Abrams EJ, Mazenga A, Chitani MJ, Ahmed S, Yu X, Kim MH. The relationship between intimate partner violence and HIV outcomes among pregnant women living with HIV in Malawi. Malawi Med J 2021; 33:242-252. [PMID: 35291385 PMCID: PMC8892998 DOI: 10.4314/mmj.v33i4.4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Background Intimate partner violence (IPV) is a global public health concern particularly in pregnancy where IPV can have negative health implications for the mother and child. Data suggest IPV disproportionately affects pregnant women living with HIV (PWLWH) compared to those without HIV. HIV-related outcomes are worse among women experiencing IPV. Despite this knowledge, there is paucity of data concerning PWLWH and IPV in Malawi, where there is a high HIV prevalence (10.6%). Objectives We aim to characterize IPV amongst PWLWH in Malawi and describe its relationship to demographic characteristics, psychosocial factors, and HIV-related outcomes. Methods This analysis used data from the VITAL Start pilot study, which is a video-based intervention targeting retention and ART adherence amongst PWLWH in Malawi. PWLWH not on ART were recruited at antenatal clinic and given study questionnaires to assess demographics, IPV, and psychosocial factors. Questionnaires were also administered at one-month follow-up to assess outcomes related to HIV. Descriptive statistics and logistic regression models were used to explore the risk factors associated with IPV. Results Thirty-nine percent of participants reported ever experiencing IPV from their current partner. The majority (53%) reporting IPV experienced more than one type of violence. IPV was associated with being married (p=0.04) and depression (p<0.0001) in the univariable analysis. For women retained at one-month, IPV was associated with reporting a missed ART dose in the past month but not with adherence measured by pill count. Conclusions A large proportion of PWLWH experienced IPV from their current partner and IPV was associated with worse self-reported ART adherence at one-month follow-up. Further evidence is needed to understand how IPV impacts PWLWH throughout postpartum and beyond. Given the detrimental impact on health outcomes among PWLWH in Malawi, additional focus on IPV is essential to identify mechanisms to prevent, screen, and manage IPV among this population.
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Affiliation(s)
- Elizabeth C Wetzel
- Baylor College of Medicine International Pediatric AIDS Initiative, Texas Children's Hospital, Houston, United States of America (USA)
- Baylor College of Medicine - Children's Foundation Malawi, Lilongwe, Malawi
| | - Tapiwa Tembo
- Baylor College of Medicine - Children's Foundation Malawi, Lilongwe, Malawi
| | - Elaine J Abrams
- ICAP at Columbia University, Mailman School of Public Health and Department of Pediatrics, Vagelos College of Physicians & Surgeons, Columbia University, New York, USA
| | - Alick Mazenga
- Baylor College of Medicine - Children's Foundation Malawi, Lilongwe, Malawi
| | - Mike J Chitani
- Baylor College of Medicine - Children's Foundation Malawi, Lilongwe, Malawi
| | - Saeed Ahmed
- Baylor College of Medicine International Pediatric AIDS Initiative, Texas Children's Hospital, Houston, United States of America (USA)
- Baylor College of Medicine - Children's Foundation Malawi, Lilongwe, Malawi
| | - Xiaoying Yu
- University of Texas Medical Branch at Galveston, Galveston, USA
| | - Maria H Kim
- Baylor College of Medicine International Pediatric AIDS Initiative, Texas Children's Hospital, Houston, United States of America (USA)
- Baylor College of Medicine - Children's Foundation Malawi, Lilongwe, Malawi
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11
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Brittain K, Teasdale CA, Ngeno B, Odondi J, Ochanda B, Brown K, Langat A, Modi S, Abrams EJ. Improving retention in antenatal and postnatal care: a systematic review of evidence to inform strategies for adolescents and young women living with HIV. J Int AIDS Soc 2021; 24:e25770. [PMID: 34449121 PMCID: PMC8395389 DOI: 10.1002/jia2.25770] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 05/17/2021] [Accepted: 06/01/2021] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Young pregnant and postpartum women living with HIV (WLHIV) are at high risk of poor outcomes in prevention of mother-to-child transmission services. The aim of this systematic review was to collate evidence on strategies to improve retention in antenatal and/or postpartum care in this population. We also conducted a secondary review of strategies to increase attendance at antenatal care (ANC) and/or facility delivery among pregnant adolescents, regardless of HIV status, to identify approaches that could be adapted for adolescents and young WLHIV. METHODS Selected databases were searched on 1 December 2020, for studies published between January 2006 and November 2020, with screening and data abstraction by two independent reviewers. We identified papers that reported age-disaggregated results for adolescents and young WLHIV aged <25 years at the full-text review stage. For the secondary search, we included studies among female adolescents aged 10 to 19 years. RESULTS AND DISCUSSION Of 37 papers examining approaches to increase retention among pregnant and postpartum WLHIV, only two reported age-disaggregated results: one showed that integrated care during the postpartum period increased retention in HIV care among women aged 18 to 24 years; and another showed that a lay counsellor-led combination intervention did not reduce attrition among women aged 16 to 24 years; one further study noted that age did not modify the effectiveness of a combination intervention. Mobile health technologies, enhanced support, active follow-up and tracing and integrated services were commonly examined as standalone interventions or as part of combination approaches, with mixed evidence for each strategy. Of 10 papers identified in the secondary search, adolescent-focused services and continuity of care with the same provider appeared to be effective in improving attendance at ANC and/or facility delivery, while home visits and group ANC had mixed results. CONCLUSIONS This review highlights the lack of evidence regarding effective strategies to improve retention in antenatal and/or postpartum care among adolescents and young WLHIV specifically, as well as a distinct lack of age-disaggregated results in studies examining retention interventions for pregnant WLHIV of all ages. Identifying and prioritizing approaches to improve retention of adolescents and young WLHIV are critical for improving maternal and child health.
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Affiliation(s)
- Kirsty Brittain
- Division of Epidemiology & BiostatisticsSchool of Public Health & Family MedicineUniversity of Cape TownCape TownSouth Africa
- Centre for Infectious Disease Epidemiology & ResearchSchool of Public Health & Family MedicineUniversity of Cape TownCape TownSouth Africa
| | - Chloe A Teasdale
- Mailman School of Public HealthICAP‐Columbia UniversityNew YorkNYUSA
- Department of EpidemiologyMailman School of Public HealthNew YorkNYUSA
- Department of Epidemiology and BiostatisticsCUNY Graduate School of Public Health & Health PolicyNew YorkNYUSA
| | - Bernadette Ngeno
- Division of Global HIV and Tuberculosis (DGHT)US Centers for Disease Control and PreventionAtlantaGAUSA
| | - Judith Odondi
- Mailman School of Public HealthICAP‐Columbia UniversityNew YorkNYUSA
| | - Boniface Ochanda
- Division of Global HIV and Tuberculosis (DGHT)US Centers for Disease Control and PreventionNairobiKenya
| | - Karryn Brown
- Division of Epidemiology & BiostatisticsSchool of Public Health & Family MedicineUniversity of Cape TownCape TownSouth Africa
| | - Agnes Langat
- Division of Global HIV and Tuberculosis (DGHT)US Centers for Disease Control and PreventionNairobiKenya
| | - Surbhi Modi
- Division of Global HIV and Tuberculosis (DGHT)US Centers for Disease Control and PreventionAtlantaGAUSA
| | - Elaine J Abrams
- Mailman School of Public HealthICAP‐Columbia UniversityNew YorkNYUSA
- Department of EpidemiologyMailman School of Public HealthNew YorkNYUSA
- Department of PediatricsVagelos College of Physicians and SurgeonsColumbia UniversityNew YorkNYUSA
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12
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Masiano S, Machine E, Mphande M, Markham C, Tembo T, Chitani M, Mkandawire A, Mazenga A, Ahmed S, Kim M. Video-Based Intervention for Improving Maternal Retention and Adherence to HIV Treatment: Patient Perspectives and Experiences. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18041737. [PMID: 33579047 PMCID: PMC7916796 DOI: 10.3390/ijerph18041737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Revised: 01/24/2021] [Accepted: 01/30/2021] [Indexed: 11/24/2022]
Abstract
VITAL Start is a video-based intervention aimed to improve maternal retention in HIV care and adherence to antiretroviral therapy (ART) in Malawi. We explored the experiences of pregnant women living with HIV (PWLHIV) not yet on ART who received VITAL Start before ART initiation to assess the intervention’s acceptability, feasibility, fidelity of delivery, and perceived impact. Between February and September 2019, we conducted semi-structured interviews with a convenience sample of 34 PWLHIV within one month of receiving VITAL Start. The participants reported that VITAL Start was acceptable and feasible and had good fidelity of delivery. They also reported that the video had a positive impact on their lives, encouraging them to disclose their HIV status to their sexual partners who, in turn, supported them to adhere to ART. The participants suggested using a similar intervention to provide health-related education/counseling to people with long term conditions. Our findings suggest that video-based interventions may be an acceptable, feasible approach to optimizing ART retention and adherence amongst PWLHIV, and they can be delivered with high fidelity. Further exploration of the utility of low cost, scalable, video-based interventions to address health counseling gaps in sub-Saharan Africa is warranted.
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Affiliation(s)
- Steven Masiano
- Baylor College of Medicine Children’s Foundation Malawi, PBAG B397, Lilongwe, Malawi; (E.M.); (M.M.) (T.T.); (M.C.); (A.M.); (A.M.); (S.A.)
- Correspondence: (S.M.); (M.K.)
| | - Edwin Machine
- Baylor College of Medicine Children’s Foundation Malawi, PBAG B397, Lilongwe, Malawi; (E.M.); (M.M.) (T.T.); (M.C.); (A.M.); (A.M.); (S.A.)
| | - Mtisunge Mphande
- Baylor College of Medicine Children’s Foundation Malawi, PBAG B397, Lilongwe, Malawi; (E.M.); (M.M.) (T.T.); (M.C.); (A.M.); (A.M.); (S.A.)
| | - Christine Markham
- Center for Health Promotion and Preventive Research, Department of Health Promotion and Behavioral Sciences, The University of Texas, Houston, TX 77030, USA;
| | - Tapiwa Tembo
- Baylor College of Medicine Children’s Foundation Malawi, PBAG B397, Lilongwe, Malawi; (E.M.); (M.M.) (T.T.); (M.C.); (A.M.); (A.M.); (S.A.)
| | - Mike Chitani
- Baylor College of Medicine Children’s Foundation Malawi, PBAG B397, Lilongwe, Malawi; (E.M.); (M.M.) (T.T.); (M.C.); (A.M.); (A.M.); (S.A.)
| | - Angella Mkandawire
- Baylor College of Medicine Children’s Foundation Malawi, PBAG B397, Lilongwe, Malawi; (E.M.); (M.M.) (T.T.); (M.C.); (A.M.); (A.M.); (S.A.)
| | - Alick Mazenga
- Baylor College of Medicine Children’s Foundation Malawi, PBAG B397, Lilongwe, Malawi; (E.M.); (M.M.) (T.T.); (M.C.); (A.M.); (A.M.); (S.A.)
| | - Saeed Ahmed
- Baylor College of Medicine Children’s Foundation Malawi, PBAG B397, Lilongwe, Malawi; (E.M.); (M.M.) (T.T.); (M.C.); (A.M.); (A.M.); (S.A.)
- Section of Retrovirology and Global Health, Baylor College of Medicine, Houston, TX 77030, USA
| | - Maria Kim
- Baylor College of Medicine Children’s Foundation Malawi, PBAG B397, Lilongwe, Malawi; (E.M.); (M.M.) (T.T.); (M.C.); (A.M.); (A.M.); (S.A.)
- Section of Retrovirology and Global Health, Baylor College of Medicine, Houston, TX 77030, USA
- Correspondence: (S.M.); (M.K.)
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13
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Kim MH, Tembo TA, Mazenga A, Yu X, Myer L, Sabelli R, Flick R, Hartig M, Wetzel E, Simon K, Ahmed S, Nyirenda R, Kazembe PN, Mphande M, Mkandawire A, Chitani MJ, Markham C, Ciaranello A, Abrams EJ. The Video intervention to Inspire Treatment Adherence for Life (VITAL Start): protocol for a multisite randomized controlled trial of a brief video-based intervention to improve antiretroviral adherence and retention among HIV-infected pregnant women in Malawi. Trials 2020; 21:207. [PMID: 32075677 PMCID: PMC7031891 DOI: 10.1186/s13063-020-4131-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Accepted: 02/01/2020] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND Improving maternal antiretroviral therapy (ART) retention and adherence is a critical challenge facing prevention of mother-to-child transmission (PMTCT) of HIV programs. There is an urgent need for evidence-based, cost-effective, and scalable interventions to improve maternal adherence and retention that can be feasibly implemented in overburdened health systems. Brief video-based interventions are a promising but underutilized approach to this crisis. We describe a trial protocol to evaluate the effectiveness and implementation of a standardized educational video-based intervention targeting HIV-infected pregnant women that seeks to optimize their ART retention and adherence by providing a VITAL Start (Video intervention to Inspire Treatment Adherence for Life) before committing to lifelong ART. METHODS This study is a multisite parallel group, randomized controlled trial assessing the effectiveness of a brief facility-based video intervention to optimize retention and adherence to ART among pregnant women living with HIV in Malawi. A total of 892 pregnant women living with HIV and not yet on ART will be randomized to standard-of-care pre-ART counseling or VITAL Start. The primary outcome is a composite of retention and adherence (viral load < 1000 copies/ml) 12 months after starting ART. Secondary outcomes include assessments of behavioral adherence (self-reported adherence, pharmacy refill, and tenofovir diphosphate concentration), psychosocial impact, and resource utilization. We will also examine the implementation of VITAL Start via surveys and qualitative interviews with patients, partners, and health care workers and conduct cost-effectiveness analyses. DISCUSSION This is a robust evaluation of an innovative facility-based video intervention for pregnant women living with HIV, with the potential to improve maternal and infant outcomes. TRIAL REGISTRATION ClinicalTrials.gov, NCT03654898. Registered on 31 August 2018.
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Affiliation(s)
- Maria H Kim
- Baylor College of Medicine International Pediatric AIDS Initiative, Texas Children's Hospital, Houston, TX, USA. .,Baylor College of Medicine Children's Foundation Malawi, Lilongwe, Malawi.
| | - Tapiwa A Tembo
- Baylor College of Medicine Children's Foundation Malawi, Lilongwe, Malawi
| | - Alick Mazenga
- Baylor College of Medicine Children's Foundation Malawi, Lilongwe, Malawi
| | - Xiaoying Yu
- University of Texas Medical Branch at Galveston, Galveston, TX, USA
| | - Landon Myer
- Division of Epidemiology and Biostatistics, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Rachael Sabelli
- Baylor College of Medicine Children's Foundation Malawi, Lilongwe, Malawi
| | - Robert Flick
- Baylor College of Medicine International Pediatric AIDS Initiative, Texas Children's Hospital, Houston, TX, USA.,Baylor College of Medicine Children's Foundation Malawi, Lilongwe, Malawi
| | - Miriam Hartig
- Baylor College of Medicine International Pediatric AIDS Initiative, Texas Children's Hospital, Houston, TX, USA.,Baylor College of Medicine Children's Foundation Malawi, Lilongwe, Malawi
| | - Elizabeth Wetzel
- Baylor College of Medicine International Pediatric AIDS Initiative, Texas Children's Hospital, Houston, TX, USA.,Baylor College of Medicine Children's Foundation Malawi, Lilongwe, Malawi
| | - Katie Simon
- Baylor College of Medicine International Pediatric AIDS Initiative, Texas Children's Hospital, Houston, TX, USA.,Baylor College of Medicine Children's Foundation Malawi, Lilongwe, Malawi
| | - Saeed Ahmed
- Baylor College of Medicine International Pediatric AIDS Initiative, Texas Children's Hospital, Houston, TX, USA.,Baylor College of Medicine Children's Foundation Malawi, Lilongwe, Malawi
| | - Rose Nyirenda
- HIV Unit, Malawi Ministry of Health, Lilongwe, Malawi
| | - Peter N Kazembe
- Baylor College of Medicine International Pediatric AIDS Initiative, Texas Children's Hospital, Houston, TX, USA.,Baylor College of Medicine Children's Foundation Malawi, Lilongwe, Malawi
| | - Mtisunge Mphande
- Baylor College of Medicine Children's Foundation Malawi, Lilongwe, Malawi
| | - Angella Mkandawire
- Baylor College of Medicine Children's Foundation Malawi, Lilongwe, Malawi
| | - Mike J Chitani
- Baylor College of Medicine Children's Foundation Malawi, Lilongwe, Malawi
| | - Christine Markham
- Health Promotion & Behavioral Sciences, The University of Texas School of Public Health, Houston, TX, USA
| | - Andrea Ciaranello
- Division of Infectious Diseases, Department of Medicine; Medical Practice Evaluation Center; both at Massachusetts General Hospital, Boston, MA, USA
| | - Elaine J Abrams
- ICAP at Columbia, Mailman School of Public Health and Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA
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