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Turin TC, Kazi M, Rumana N, Lasker MAA, Chowdhury N. Employing diffusion of innovation theory for 'not missing the mass' in community-engaged research. BMJ Open 2023; 13:e069680. [PMID: 37612113 PMCID: PMC10450088 DOI: 10.1136/bmjopen-2022-069680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Accepted: 07/31/2023] [Indexed: 08/25/2023] Open
Abstract
INTRODUCTION Engaging with minority communities, such as immigrants and ethnic minorities, often involves adopting top-down approaches, wherein researchers and policymakers provide solutions based on their perspective. However, these approaches may not adequately address the needs and preferences of the community members, who have valuable insights and experiences to share. Therefore, community-engaged approaches, which involve collaborative partnerships between community members and researchers to identify issues, co-create solutions, and recommend policy changes, are becoming more recognized for their effectiveness and relevance. Yet, prevailing community engagement efforts often focus on easily reachable and already engaged segments of the community, sometimes overlooking the broader population. METHODS When working with immigrant and racialized communities, we encountered difficulties in engaging the wider community through traditional researcher-led approaches. We realized that overcoming these challenges required innovative strategies rooted in community-based participatory research principles and the diffusion of innovation theory. We recognized that a nuanced understanding of the community's dynamics and preferences was crucial in shaping our approach and building trust and rapport with the community members. RESULTS The need to bridge the gap between researcher-led initiatives and community-driven involvement has never been more pronounced. Our experience, chronicled in this article, highlights the journey of our research program with an immigrant/racialized community. This reflection enhances our comprehension of community engagement that deliberately strives to reach a larger cross-section of the community. By providing practical methods for reaching the broader community and navigating the intricacies of engagement, we aim to assist fellow researchers in conducting effective community-engaged research across various minority communities. CONCLUSION In sharing our insights and successful strategies for community engagement, we hope to contribute to the field's knowledge. Our commitment to fostering meaningful collaboration underscores the importance of co-creating solutions that resonate with the diverse voices within these communities. Through these efforts, we envision a more inclusive and impactful approach to addressing the complex challenges faced by minority populations.
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Affiliation(s)
- Tanvir C Turin
- Department of Family Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Mashrur Kazi
- Department of Family Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Nahid Rumana
- Community Scholar and Citizen Researcher, Calgary, Alberta, Canada
- Foothills Medical Centre, Calgary, Alberta, Canada
| | | | - Nashit Chowdhury
- Department of Family Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
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Bhagavathula AS, Bansil S, Nishimura Y. Google Trends in Breast and Cervical Cancer Searches From 2008 to 2021: An Infodemiology Study. Cureus 2023; 15:e39035. [PMID: 37323300 PMCID: PMC10266303 DOI: 10.7759/cureus.39035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/15/2023] [Indexed: 06/17/2023] Open
Abstract
INTRODUCTION Breast and cervical cancer are the leading causes of cancer death among women worldwide. Given the growing concern, cervical cancer awareness month (CCAM) in January and Breast cancer awareness month (BCAM) in October occur annually as global health observances to raise public awareness. This infodemiology study aimed to assess trends in public online searches for breast cancer and cervical cancer following the annual BCAM and CCAM from 2008 to 2021. METHODS Google Trends (GT) was used to investigate online searches for "breast cancer" and "cervical cancer" from January 1, 2008, to December 31, 2021. (168 months). A joinpoint regression analysis was used to identify statistically significant weekly percentage changes (WPCs) and monthly percentage changes (MPCs) trends over time. RESULTS Breast cancer searches increased in October (BCAM) every year, while cervical cancer searches increased in January (CCAM) in 2013, 2019, and 2020. Joinpoint regression analysis revealed a significant negative trend in "breast cancer" searches from 2008 to 2021 (MPC: -0.2%, 95% CI: -0.3 to -0.1) and an upward trend in "cervical cancer" searches from May 2017 to December 2021 (MPC: 0.5%, 95% CI: 0.2 to 0.7). CONCLUSION Online searches on "breast cancer" remain consistently high only during BCAM, and "cervical cancer" has increased by 0.5% MPC since May 2017. Our findings can inform online interventions like event-based opportunities (BCAM and CCAM) and Google Ads to raise public awareness of breast and cervical cancer.
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Affiliation(s)
- Akshaya S Bhagavathula
- Center for Public Health and Technology, Health, Human Performance and Recreation, University of Arkansas, Fayetteville, USA
| | - Surbhi Bansil
- Department of Medicine, University of Hawaii John A. Burns School of Medicine, Honolulu, USA
| | - Yoshito Nishimura
- Department of Medicine, University of Hawaii John A. Burns School of Medicine, Honolulu, USA
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Washington A, Chabaan J, Fakih A, Ford S, Rutledge L, Lilly J, Herrera MY, Kim Y, Thompson HS. "Why is it so necessary?": African American Parents' Perspectives on Delaying and Refusing HPV Vaccination. J Pediatr Health Care 2023:S0891-5245(23)00002-0. [PMID: 36764888 DOI: 10.1016/j.pedhc.2023.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 01/07/2023] [Accepted: 01/09/2023] [Indexed: 02/11/2023]
Abstract
INTRODUCTION This study aimed to describe the perspectives of parents who had delayed and refused human papillomavirus (HPV) vaccination for their children, even when it was discussed or recommended by a health care provider, and to identify the factors related to vaccine hesitancy. METHOD Twenty predominantly African American parents of children aged 11-17 years were recruited from various community clinics and organizations to participate in focus groups about their decision-making regarding HPV vaccination. Using deductive content analysis and the Vaccine Hesitancy Determinants Matrix, we describe their perspectives and influences on vaccination decision-making. RESULTS Multiple reasons emerged, which included concerns about the age of children, perceived discrimination and mistrust based on race and socioeconomic status, and vaccine safety. DISCUSSION Findings support the development of targeted interventions that address vaccine safety concerns, mistrust, patient-provider communication, and parent education about the benefits of HPV vaccination.
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Affiliation(s)
- Ariel Washington
- Ariel Washington, Postdoctoral Research Fellow, School of Nursing, University of Michigan, Ann Arbor, MI.
| | - Jasmine Chabaan
- Jasmine Chabaan, Research Assistant, Karmanos Cancer Institute, School of Medicine, Wayne State University, Detroit, MI
| | - Ali Fakih
- Ali Fakih, Research Assistant, Karmanos Cancer Institute, School of Medicine, Wayne State University, Detroit, MI
| | - Sabrina Ford
- Sabrina Ford, Associate Professor, Department of Obstetrics, Gynecology and Reproductive Biology, College of Human Medicine, Michigan State University, East Lansing, MI
| | - Lisa Rutledge
- Lisa Rutledge, Special Projects Manager, Western Wayne Family Health Centers, Inkster, MI
| | - Jametta Lilly
- Jametta Lilly, CEO, Detroit Parent Network, Detroit, MI
| | - Maida Y Herrera
- Maida Y. Herrera, Research Support Manager, Karmanos Cancer Institute, School of Medicine, Wayne State University, Detroit, MI
| | - Yang Kim
- Yang Kim, Research Assistant, Karmanos Cancer Institute, School of Medicine, Wayne State University, Detroit, MI
| | - Hayley S Thompson
- Hayley S. Thompson, Professor, Karmanos Cancer Institute, School of Medicine, Wayne State University, Detroit, MI
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Skinner NA, Sanders K, Lopez E, Sotz Mux MS, Abascal Miguel L, Vosburg KB, Johnston J, Diamond-Smith N, Kraemer Diaz A. Barriers to COVID-19 vaccine acceptance to improve messages for vaccine uptake in indigenous populations in the central highlands of Guatemala: a participatory qualitative study. BMJ Open 2023; 13:e067210. [PMID: 36707110 PMCID: PMC9884572 DOI: 10.1136/bmjopen-2022-067210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
INTRODUCTION As of July 2022, a little over one-third of Guatemalans were fully vaccinated. While COVID-19 vaccination rates are not officially reported nationally by racial/ethnic groups, non-governmental organisations and reporters have observed that COVID-19 vaccination rates are especially low among high-risk Indigenous populations. We conducted one of the first studies on COVID-19 vaccine acceptance in Indigenous populations in the Central Highlands of Guatemala, which aimed to better understand the barriers to COVID-19 vaccine uptake and how to improve vaccine promotional campaigns. METHODS In November 2021, we conducted eight focus group discussions (FGDs) with 42 Indigenous men and women and 16 in-depth interviews (IDIs) with community health workers, nurses and physicians in Chimaltenango and Sololá. Using a participatory design approach, our qualitative analysis used constant comparative methods to understand the inductive and deductive themes from the FGD and IDI transcripts. RESULTS We found three major overarching barriers to vaccination within the sampled population: (1) a lack of available easily understandable, linguistically appropriate and culturally sensitive COVID-19 vaccine information; (2) vaccine access and supply issues that prevented people from being vaccinated efficiently and quickly; and (3) widespread misinformation and disinformation that prey on people's fears of the unknown and mistrust of the medical establishment and government. CONCLUSION When developing COVID-19 vaccine messages, content should be culturally relevant, appropriate for low-literacy populations and in the languages that people prefer to speak. Promotional materials should be in multiple modalities (print, radio and social media) and also have specific Maya cultural references (dress, food and concepts of disease) to ensure messaging connects with intended targets. This study supports the need for more robust research into best practices for communicating about COVID-19 vaccines to marginalised communities globally and suggests that policy makers should invest in targeted local solutions to increase vaccine uptake.
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Affiliation(s)
- Nadine Ann Skinner
- Stanford Center for Health Education, Stanford University School of Medicine, Stanford, California, USA
| | - Kelly Sanders
- Institute for Global Health Sciences, University of California San Francisco, San Francisco, California, USA
| | - Emily Lopez
- Maya Health Alliance Wuqu' Kawoq, Tecpan, Guatemala
| | | | - Lucía Abascal Miguel
- Institute for Global Health Sciences, University of California San Francisco, San Francisco, California, USA
| | - Kathryn B Vosburg
- Institute for Global Health Sciences, University of California San Francisco, San Francisco, California, USA
| | - Jamie Johnston
- Stanford Center for Health Education, Stanford University School of Medicine, Stanford, California, USA
| | - Nadia Diamond-Smith
- Institute for Global Health Sciences, University of California San Francisco, San Francisco, California, USA
- Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California, USA
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Abascal Miguel L, Lopez E, Sanders K, Skinner NA, Johnston J, Vosburg KB, Kraemer Diaz A, Diamond-Smith N. Evaluating the impact of a linguistically and culturally tailored social media ad campaign on COVID-19 vaccine uptake among indigenous populations in Guatemala: a pre/post design intervention study. BMJ Open 2022; 12:e066365. [PMID: 36523220 PMCID: PMC9748511 DOI: 10.1136/bmjopen-2022-066365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVES To evaluate the impact of culturally and linguistically tailored informational videos delivered via social media campaigns on COVID-19 vaccine uptake in Indigenous Maya communities in Guatemala. METHODS Our team designed a series of videos utilising community input and evaluated the impact using a pre-post intervention design. In-person preintervention surveys were collected from a sample of respondents in four rural municipalities in Guatemala in March 2022. Facebook, Instagram and browser ads were flooded with COVID-19 vaccine informational videos in Spanish, Kaqchikel and Kiche for 3 weeks. Postintervention surveys were conducted by telephone among the same participants in April 2022. Logistic regression models were used to estimate the OR of COVID-19 vaccine uptake following exposure to the intervention videos. RESULTS Preintervention and postintervention surveys were collected from 1572 participants. The median age was 28 years; 63% (N=998) identified as women, and 36% spoke an Indigenous Mayan language. Twenty-one per cent of participants (N=327) reported watching the intervention content on social media. At baseline, 89% (N=1402) of participants reported having at least one COVID-19 vaccine, compared with 97% (N=1507) in the follow-up. Those who reported watching the videos had 1.78 times the odds (95% CI 1.14 to 2.77) of getting vaccinated after watching the videos compared with those who did not see the videos when adjusted by age, community, sex and language. CONCLUSION Our findings suggest that culturally and linguistically tailored videos addressing COVID-19 vaccine misinformation deployed over social media can increase vaccinations in a rural, indigenous population in Guatemala, implying that social media content can influence vaccination uptake. Providing accurate, culturally sensitive information in local languages from trusted sources may help increase vaccine uptake in historically marginalised populations.
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Affiliation(s)
| | - Emily Lopez
- Wuqu' Kawoq, Maya Health Alliance, Tecpan, Guatemala
| | - Kelly Sanders
- Institute for Global Health Sciences, UCSF, San Francisco, California, USA
| | - Nadine Ann Skinner
- Stanford Center for Health Education, Stanford University School of Medicine, Stanford, California, USA
| | - Jamie Johnston
- Stanford Center for Health Education, Stanford University School of Medicine, Stanford, California, USA
| | - Kathryn B Vosburg
- Institute for Global Health Sciences, UCSF, San Francisco, California, USA
| | | | - Nadia Diamond-Smith
- Institute for Global Health Sciences, UCSF, San Francisco, California, USA
- Department of Epidemiology and Biostatistics, UCSF, San Francisco, California, USA
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Bautista-Valarezo E, Vega Crespo B, Maldonado-Rengel R, Espinosa ME, Neira VA, Verhoeven V. Knowledge and Perceptions about Cervical Cancer and HPV Screening in Women in Rural Areas of Ecuador: A Qualitative Research Study. Int J Environ Res Public Health 2022; 19:11053. [PMID: 36078764 PMCID: PMC9517721 DOI: 10.3390/ijerph191711053] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 08/30/2022] [Accepted: 09/01/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Cervical cancer continues to be a major health problem in developing countries. Educational programs, as well as Pap and HPV screening and vaccination, are important tools to reduce the morbidity and mortality rates associated with this disease. The objective of this study is to explore the diverse knowledge and perceptions about cervical cancer and the different diagnostic tests for HPV of populations living in the rural parish "El Valle". METHOD A qualitative study was conducted through eight focus groups, which included 46 participants from mixed ethnic groups. A phenomenological analysis was performed. RESULTS Four topics and seven sub-topics were identified. By analyzing all the narratives, it was possible to identify that the perception of cervical cancer was focused on its severity, secondary to its infectious process and screening periodicity. However, despite the diverse knowledge, indigenous people do not relate it to the human papilloma virus; in addition, there is also certain resistance to undergo the Pap smear test, for reasons such as inaccessibility and its sampling process. CONCLUSIONS It is necessary to develop educational programs for the prevention of cervical cancer and to implement diagnostic alternatives to reach populations with precarious accessibility, as well as women who refuse to undergo the Pap smear test.
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Affiliation(s)
- Estefanía Bautista-Valarezo
- Facultad de Ciencias de la Salud, Universidad Técnica Particular de Loja, Loja 1101608, Ecuador; (R.M.-R.); (M.E.E.)
| | - Bernardo Vega Crespo
- Facultad de Ciencias Médicas, Universidad de Cuenca, Cuenca 010203, Ecuador; (B.V.C.); (V.A.N.)
| | - Ruth Maldonado-Rengel
- Facultad de Ciencias de la Salud, Universidad Técnica Particular de Loja, Loja 1101608, Ecuador; (R.M.-R.); (M.E.E.)
- Programa de Doctorado en Ciencias Morfológicas, Universidad de la Frontera, Temuco 4811230, Chile
| | - María Elena Espinosa
- Facultad de Ciencias de la Salud, Universidad Técnica Particular de Loja, Loja 1101608, Ecuador; (R.M.-R.); (M.E.E.)
- Programa de Doctorado en Ciencias Médicas, Universidad de la Frontera, Temucho 4811230, Chile
| | - Vivian Alejandra Neira
- Facultad de Ciencias Médicas, Universidad de Cuenca, Cuenca 010203, Ecuador; (B.V.C.); (V.A.N.)
| | - Veronique Verhoeven
- Department of Family Medicine and Population Health, Faculty of Medicine and Health Sciences, University of Antwerp, Universiteitsplein 1, 2610 Antwerp, Belgium;
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Elshami M, Abukmail H, Al-slaibi I, Alser M, Radaydeh A, Alfuqaha A, Thalji M, Khader S, Khatib L, Fannoun N, Ahmad B, Kassab L, Khrishi H, Houssaini D, Abed N, Nammari A, Abdallah T, Alqudwa Z, Idais S, Tanbouz G, Hajajreh M, Selmiyh HA, Abo-hajouj Z, Hebi H, Zamel M, Skaik RN, Hammoud L, Rjoub S, Ayesh H, Rjoub T, Zakout R, Alser A, Abu-el-noor N, Bottcher B. Awareness of human papillomavirus and acceptability of the vaccine among women in Palestine: is it time for policy adjustment? BMC Womens Health 2022; 22:352. [PMID: 35986304 PMCID: PMC9389825 DOI: 10.1186/s12905-022-01930-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Accepted: 08/11/2022] [Indexed: 11/28/2022] Open
Abstract
Background Progress has been made in the reduction of morbidity and mortality of cervical cancer by the implementation of human papillomavirus (HPV) vaccination programs. This study aimed to assess the awareness of Palestinian women about HPV as well as their knowledge and acceptability of the HPV vaccine and to examine the factors associated with good awareness. Methods This was a national cross-sectional study. Adult women were recruited from hospitals, primary healthcare centers, and public spaces in 11 Palestinian governorates using convenience sampling. A structured questionnaire was used for data collection. For each correctly answered question, one point was given. The total score was calculated and categorized into poor (0–10) and good awareness (11–21). Results The questionnaire was completed by 7223 women out of 8086 who were approached (response rate = 89.3%). A total of 7058 questionnaires were included in the final analysis; 4403 from the West Bank and Jerusalem (WBJ) and 2655 from the Gaza Strip. Women recruited from the Gaza Strip were younger, getting lower monthly incomes, and with fewer chronic diseases than women recruited from the WBJ. Only 33 women (0.5%) displayed good awareness of HPV and its vaccine with 0.7% of women from WBJ and only 0.2% of women from the Gaza Strip. Completing post-secondary education, being employed or a student, and having a higher monthly income were associated with an increase in the likelihood of having good awareness. Among women who had heard of HPV (n = 571, 8.1%), only 46 women (8.1%) reported familiarity with its vaccine. Women from the WBJ were more likely than women from the Gaza Strip to have heard about the HPV vaccine (0.9% vs. 0.2%). Most women agreed to receive the HPV vaccine themselves or for their daughters if it was given without cost or with a co-payment. No differences were found in the likelihood of agreeing to receive the HPV vaccine among women in the WBJ versus the Gaza Strip. Conclusion The overall awareness of HPV and its vaccine was extremely low. Inclusion of the HPV vaccine in the national immunization program could change this, especially as the HPV vaccine appeared to be acceptable.
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Ntuli L, Mtshali A, Mzobe G, Liebenberg LJP, Ngcapu S. Role of Immunity and Vaginal Microbiome in Clearance and Persistence of Human Papillomavirus Infection. Front Cell Infect Microbiol 2022; 12:927131. [PMID: 35873158 PMCID: PMC9301195 DOI: 10.3389/fcimb.2022.927131] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 06/14/2022] [Indexed: 12/02/2022] Open
Abstract
Cervical cancer disproportionately affects women of reproductive age, with 80% of cases occurring in low- and middle-income countries. Persistent infection with high-risk human papillomavirus (HPV) genotypes has been described as the most common non-systemic biological risk factor for the development of cervical cancer. The mucosal immune system plays a significant role in controlling HPV infection by acting as the first line of host defense at the mucosal surface. However, the virus can evade host immunity using various mechanisms, including inhibition of the antiviral immune response necessary for HPV clearance. Pro-inflammatory cytokines and the vaginal microbiome coordinate cell-mediated immune responses and play a pivotal role in modulating immunity. Recently, diverse vaginal microbiome (associated with bacterial vaginosis) and genital inflammation have emerged as potential drivers of high-risk HPV positivity and disease severity in women. The potential role of these risk factors on HPV recurrence and persistence remains unclear. This article reviews the role of cellular or cytokine response and vaginal microbiome dysbiosis in the clearance, persistence, and recurrence of HPV infection.
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Affiliation(s)
- Lungelo Ntuli
- Department of Medical Microbiology, School of Laboratory Medicine and Medical Science, University of KwaZulu-Natal, Durban, South Africa
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), Durban, South Africa
| | - Andile Mtshali
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), Durban, South Africa
| | - Gugulethu Mzobe
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), Durban, South Africa
| | - Lenine JP Liebenberg
- Department of Medical Microbiology, School of Laboratory Medicine and Medical Science, University of KwaZulu-Natal, Durban, South Africa
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), Durban, South Africa
| | - Sinaye Ngcapu
- Department of Medical Microbiology, School of Laboratory Medicine and Medical Science, University of KwaZulu-Natal, Durban, South Africa
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), Durban, South Africa
- *Correspondence: Sinaye Ngcapu,
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