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Bielick C, Canan C, Ingersoll K, Waldman AL, Schwendinger J, Dillingham R. Three-Year Follow-up of PositiveLinks: Higher Use of mHealth Platform Associated with Sustained HIV Suppression. AIDS Behav 2024; 28:2708-2718. [PMID: 38869759 PMCID: PMC11286697 DOI: 10.1007/s10461-024-04405-z] [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] [Accepted: 05/30/2024] [Indexed: 06/14/2024]
Abstract
PositiveLinks (PL) is a mHealth platform to support care engagement by people with HIV (PWH). Daily reminders prompt the user to report medication adherence, mood, and daily stress. Higher response rate to PL check-ins has been associated with better suppression of viral load over 6-18 months. We conducted a retrospective chart review for a three-year period collecting demographic information, average mood and stress scores, and all viral loads obtained in usual patient care. We performed multivariable logistic regression modeling to identify factors associated with loss of viral load suppression and a time-to-event survival analysis until first unsuppressed viral load stratified by PL usage. Of the 513 PWH included, 103 had at least one episode of viral non-suppression. Low users of PL were more likely to have an unsuppressed viral load with an adjusted Odds Ratio (aOR) of 5.8 (95% CI 3.0-11.5, p < 0.001). Protective factors included older age (aOR 0.96; 95% CI 0.93-0.98, p = 0.003) and income above the federal poverty level (FPL) (aOR 0.996; 95% CI 0.995-0.998, p < 0.001). High PL use was also associated with better viral load suppression (VLS) over time (p < 0.0001 ((aHR) of 0.437 (95% CI 0.290-0.658, p < 0.001)) after adjusting for age and FPL. High stress scores were related to subsequent loss of viral suppression in an exploratory analysis. High check-in response rate on the PL app, older age, and higher income are associated with sustained VLS over time. Conversely, lack of response to check-ins or increased reported stress may signal a need for additional support.
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Affiliation(s)
- Catherine Bielick
- Division of Infectious Diseases and International Health, University of Virginia, Charlottesville, VA, USA.
| | - Chelsea Canan
- Division of Disease Prevention, Virginia Department of Health, Richmond, VA, USA
| | - Karen Ingersoll
- Department of Psychiatry and Neurobehavioral Sciences, University of Virginia, Charlottesville, VA, USA
| | - Ava Lena Waldman
- Department of Psychiatry and Neurobehavioral Sciences, University of Virginia, Charlottesville, VA, USA
| | - Jason Schwendinger
- Department of Psychiatry and Neurobehavioral Sciences, University of Virginia, Charlottesville, VA, USA
| | - Rebecca Dillingham
- Division of Infectious Diseases and International Health, University of Virginia, Charlottesville, VA, USA
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Barth SK, Saulters KJ, Balba GP, Monroe AK, Horberg MA, Kumar PN, Greenberg AE, Castel AD. Mixed Methods Analysis of Telehealth Experience, Satisfaction, and Quality of Care During the COVID Pandemic Among Persons with HIV in Washington, DC. AIDS Behav 2024; 28:912-923. [PMID: 37872460 PMCID: PMC10923106 DOI: 10.1007/s10461-023-04198-7] [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] [Accepted: 09/21/2023] [Indexed: 10/25/2023]
Abstract
The purpose of this study is to describe telehealth experiences and quality of HIV care provided to an urban population of people with HIV (PWH) in Washington, DC. We used self-reported survey data from a cohort of PWH in the DC Cohort longitudinal study linked to medical records (October 26, 2020-December 31, 2021). Analyses followed a mixed-methods approach, including prevalence estimates and multivariable logistic regression of telehealth use by demographic and HIV characteristics. We measured primary motivation, modes of engagement, and telehealth satisfaction. Qualitative responses to open-ended questions were coded using collaborative coding. A framework developed by the National Quality Forum (NQF) was applied to the results. Among 978 participants, 69% reported using telehealth for HIV care during the pandemic. High school graduates were less likely to use telehealth compared to those with college education (aOR 0.69, 95% CI 0.48, 0.98). PWH with > 1 co-morbid condition were more likely to use telehealth compared to those without (aOR 1.42, 95% CI 1.02, 1.95). The majority reported satisfaction with telehealth (81%). Qualitative analysis of telehealth satisfaction found that most responses were related to access to care and technology, effectiveness, and patient experience. PWH using telehealth during the pandemic were satisfied with their experience though use differed demographically. Telehealth was used effectively to overcome barriers to care engagement, including transportation, costs, and time. As we transition away from the emergency pandemic responses, it will be important to determine how this technology can be used in the future in an equitable manner to further strengthen HIV care engagement.
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Affiliation(s)
- Shannon K Barth
- Department of Epidemiology, The George Washington University Milken Institute School of Public Health, 950 New Hampshire Avenue NW, Suite 500, Washington, DC, 20052, USA.
| | - Kacie J Saulters
- Department of Internal Medicine, University of Maryland Capital Region Health, Largo, MD, USA
| | - Gayle P Balba
- Division of Infectious Diseases, Georgetown University Medical Center, Washington, DC, USA
| | - Anne K Monroe
- Department of Epidemiology, The George Washington University Milken Institute School of Public Health, 950 New Hampshire Avenue NW, Suite 500, Washington, DC, 20052, USA
| | - Michael A Horberg
- Kaiser Permanente Mid-Atlantic Permanente Research Institute, Rockville, MD, USA
| | - Princy N Kumar
- Georgetown University School of Medicine, Washington, DC, USA
| | - Alan E Greenberg
- Department of Epidemiology, The George Washington University Milken Institute School of Public Health, 950 New Hampshire Avenue NW, Suite 500, Washington, DC, 20052, USA
| | - Amanda D Castel
- Department of Epidemiology, The George Washington University Milken Institute School of Public Health, 950 New Hampshire Avenue NW, Suite 500, Washington, DC, 20052, USA
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Amiri P, Nadri H, Bahaadinbeigy K. Facilitators and barriers of mHealth interventions during the Covid-19 pandemic: systematic review. BMC Health Serv Res 2023; 23:1176. [PMID: 37898755 PMCID: PMC10613392 DOI: 10.1186/s12913-023-10171-w] [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: 03/03/2023] [Accepted: 10/18/2023] [Indexed: 10/30/2023] Open
Abstract
BACKGROUND With the spread of Covid-19 disease, health interventions related to the control, prevention, and treatment of this disease and other diseases were given real attention. The purpose of this systematic review is to express facilitators and barriers of using mobile health (mHealth) interventions during the Covid-19 pandemic. METHODS In this systematic review, original studies were searched using keywords in the electronic database of PubMed until August 2022. The objectives and outcomes of these studies were extracted. Finally, to identify the facilitators and barriers of mHealth interventions, a qualitative content analysis was conducted based on the strengths, weaknesses, opportunities, and threats (SWOT) analysis method with Atlas.ti 8 software. We evaluated the studies using the Mixed Methods Appraisal Tool (MMAT). RESULTS In total, 1598 articles were identified and 55 articles were included in this study. Most of the studies used mobile applications to provide and receive health services during the Covid-19 pandemic (96.4%). The purpose of the applications was to help prevention (17), follow-up (15), treatment (12), and diagnosis (8). Using SWOT analysis, 13 facilitators and 18 barriers to patients' use of mHealth services were identified. CONCLUSION Mobile applications are very flexible technologies that can be customized for each person, patient, and population. During the Covid-19 pandemic, the applications designed due to lack of interaction, lack of time, lack of attention to privacy, and non-academic nature have not met their expectations of them.
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Affiliation(s)
- Parastoo Amiri
- Department of Health Information Technology, School of Allied Medical Sciences, Lorestan University of Medical Sciences, Khorramabad, Iran
| | - Hamed Nadri
- Department of Health Information Technology, , School of Allied Medical Sciences, Urmia University of Medical Sciences, Urmia, Iran
| | - Kambiz Bahaadinbeigy
- Medical Informatics Research Center, Institute of Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran.
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Kim JYH, Barth SK, Monroe AK, Ahsan S, Kovacic J, Senn S, Castel AD. The impact of COVID-19 on the HIV continuum of care: challenges, innovations, and opportunities. Expert Rev Anti Infect Ther 2023; 21:831-846. [PMID: 37470436 DOI: 10.1080/14787210.2023.2239503] [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: 04/05/2023] [Revised: 06/23/2023] [Accepted: 07/18/2023] [Indexed: 07/21/2023]
Abstract
INTRODUCTION In February 2019, the United States (US) launched the Ending the HIV Epidemic (EHE) initiative with emphasis on improving the various steps of the Human Immunodeficiency Virus (HIV) prevention and care continuum. However, in March 2020, the Coronavirus Disease 2019 (COVID-19) pandemic was declared, curtailing efforts to end the epidemic in the US. AREAS COVERED To describe the impact of the pandemic on EHE in the US, the authors performed a comprehensive literature review focusing on outcomes at each step of the HIV care continuum. Simultaneously, they identified examples of pandemic-era innovations that may help EHE. EXPERT OPINION Numerous studies demonstrated pandemic-related disruptions across the care continuum as well as the impact on preexisting barriers to care among People with HIV (PWH) at higher risk for poor outcomes. As the pandemic progressed, innovative approaches to delivering healthcare and providing essential services emerged, including widespread use of telemedicine, expansion of home-based care, self-collected sexually transmitted infection (STI) and HIV testing, and co-located testing for COVID-19 and HIV/STIs. While the COVID-19 pandemic initially hindered achieving EHE in the US, the ability to be agile, flexible, and creative led to innovation in HIV care delivery that may ultimately assist in meeting EHE goals as we transition into the post-pandemic era.
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Affiliation(s)
- Jenny Yeon Hee Kim
- Department of Global Health, The George Washington University Milken School of Public Health, 950 New Hampshire Ave NW, 4th Floor, Washington, DC, 20052, USA
| | - Shannon K Barth
- Department of Epidemiology, The George Washington University Milken School of Public Health, 950 New Hampshire Ave NW, 5th Floor, Washington DC, 20052, USA
| | - Anne K Monroe
- Department of Epidemiology, The George Washington University Milken School of Public Health, 950 New Hampshire Ave NW, 5th Floor, Washington DC, 20052, USA
| | - Sarah Ahsan
- Department of Epidemiology, The George Washington University Milken School of Public Health, 950 New Hampshire Ave NW, 5th Floor, Washington DC, 20052, USA
| | - Janja Kovacic
- Department of Epidemiology, The George Washington University Milken School of Public Health, 950 New Hampshire Ave NW, 5th Floor, Washington DC, 20052, USA
| | - Siena Senn
- Department of Epidemiology, The George Washington University Milken School of Public Health, 950 New Hampshire Ave NW, 5th Floor, Washington DC, 20052, USA
| | - Amanda D Castel
- Department of Epidemiology, The George Washington University Milken School of Public Health, 950 New Hampshire Ave NW, 5th Floor, Washington DC, 20052, USA
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Clement ME, Lovett A, Caldwell S, Beckford J, Hilgart M, Corneli A, Flickinger T, Dillingham R, Ingersoll K. Development of an mHealth App to Support the Prevention of Sexually Transmitted Infections Among Black Men Who Have Sex With Men Engaged in Pre-exposure Prophylaxis Care in New Orleans, Louisiana: Qualitative User-Centered Design Study. JMIR Form Res 2023; 7:e43019. [PMID: 36848209 PMCID: PMC10011974 DOI: 10.2196/43019] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 01/11/2023] [Accepted: 01/12/2023] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Sexual health disparities exist for Black men who have sex with men (BMSM) in New Orleans, Louisiana. Rates of sexually transmitted infections (STIs) are high for both BMSM and those taking HIV pre-exposure prophylaxis (PrEP). OBJECTIVE In this study, we introduced an existing PrEP adherence app to new potential users-BMSM engaged in PrEP care in New Orleans-to guide app adaptation with STI prevention features and tailoring for the local context. METHODS Using a user-centered design, we conducted 4 focus group discussions (FGDs), with interim app adaptations from December 2020 to March 2021. During the FGDs, a video of the app, app website, and mock-ups were shown to participants. We asked about facilitators of and barriers to STI prevention in general, current app use, impressions of the existing app, new app features to potentially facilitate STI prevention, and how the app should be tailored for BMSM. We used applied qualitative thematic analysis to identify themes and needs of the population. RESULTS Overall, 4 FGDs were conducted with 24 BMSM taking PrEP. We grouped themes into 4 categories: STI prevention, current app use and preferences, preexisting features and impressions of the prep'd app, and new features and modifications for BMSM. Participants noted concern about STIs and shared that anxiety about some STIs was higher than that for others; some participants shared that since the emergence of PrEP, little thought is given to STIs. However, participants desired STI prevention strategies and suggested prevention methods to implement through the app, including access to resources, educational content, and sex diaries to follow their sexual activity. When discussing app preferences, they emphasized the need for an app to offer relevant features and be easy to use and expressed that some notifications were important to keep users engaged but that they should be limited to avoid notification fatigue. Participants thought that the current app was useful and generally liked the existing features, including the ability to communicate with providers, staff, and each other through the community forum. They had suggestions for modifications for STI prevention, such as the ability to comment on sexual encounters, and for tailoring to the local context, such as depictions of iconic sights from the area. Mental health emerged as an important need to be addressed through the app during discussion of almost all features. Participants also stressed the importance of ensuring privacy and reducing stigma through the app. CONCLUSIONS A PrEP adherence app was iteratively adapted with feedback from BMSM, resulting in a new app modified for the New Orleans context and with STI prevention features. Participants gave the app a new name, PCheck, to be more discreet. Next steps will assess PCheck use and STI prevention outcomes.
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Affiliation(s)
- Meredith Edwards Clement
- Division of Infectious Diseases, Louisiana State University Health Sciences Center- New Orleans, New Orleans, LA, United States
| | - Aish Lovett
- Division of Infectious Diseases, Louisiana State University Health Sciences Center- New Orleans, New Orleans, LA, United States
| | - Sylvia Caldwell
- Department of Psychiatry and Neurobehavioral Sciences, University of Virginia Health, Charlottesville, VA, United States
| | - Jeremy Beckford
- Department of Epidemiology, University of Washington, Seattle, WA, United States
| | - Michelle Hilgart
- Department of Psychiatry and Neurobehavioral Sciences, University of Virginia Health, Charlottesville, VA, United States
| | - Amy Corneli
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, United States
- Duke Clinical Research Institute, Durham, NC, United States
| | - Tabor Flickinger
- Division of General, Geriatric, Palliative, and Hospital Medicine, University of Virginia, Charlottesville, VA, United States
| | - Rebecca Dillingham
- Division of Infectious Disease and International Health, University of Virginia, Charlottesville, VA, United States
| | - Karen Ingersoll
- Department of Psychiatry and Neurobehavioral Sciences, University of Virginia Health, Charlottesville, VA, United States
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Meyer D, Slone SE, Ogungbe O, Duroseau B, Farley JE. Impact of the COVID-19 Pandemic on HIV Healthcare Service Engagement, Treatment Adherence, and Viral Suppression in the United States: A Systematic Literature Review. AIDS Behav 2023; 27:344-357. [PMID: 35916951 PMCID: PMC9344234 DOI: 10.1007/s10461-022-03771-w] [Citation(s) in RCA: 22] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/25/2022] [Indexed: 01/24/2023]
Abstract
The COVID-19 pandemic has necessitated adaptations in how healthcare services are rendered. However, it is unclear how these adaptations have impacted HIV healthcare services across the United States. We conducted a systematic review to assess the impacts of the pandemic on service engagement, treatment adherence, and viral suppression. We identified 26 total studies spanning the beginning of the pandemic (March 11, 2020) up until November 5, 2021. Studies were conducted at the national, state, and city levels and included representation from all four CDC HIV surveillance regions. Studies revealed varying impacts of the pandemic on HIV healthcare retention/engagement, medication adherence, and viral suppression rates, including decreases in HIV healthcare visits, provider cancellations, and inability to get prescription refills. Telehealth was critical to ensuring continued access to care and contributed to improved retention and engagement in some studies. Disparities existed in who had access to the resources needed for telehealth, as well as among populations living with HIV whose care was impacted by the pandemic.
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Affiliation(s)
- Diane Meyer
- Center for Health Security, Department of Environmental Health and Engineering, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD USA 621 East Pratt Street, Suite 210, 21202 ,Center for Infectious Disease and Nursing Innovation, Johns Hopkins University School of Nursing, 525 North Wolfe Street, Suite 511, 21205 Baltimore, MD USA
| | - Sarah E. Slone
- Center for Infectious Disease and Nursing Innovation, Johns Hopkins University School of Nursing, 525 North Wolfe Street, Suite 511, 21205 Baltimore, MD USA
| | - Oluwabunmi Ogungbe
- Center for Infectious Disease and Nursing Innovation, Johns Hopkins University School of Nursing, 525 North Wolfe Street, Suite 511, 21205 Baltimore, MD USA
| | - Brenice Duroseau
- Center for Infectious Disease and Nursing Innovation, Johns Hopkins University School of Nursing, 525 North Wolfe Street, Suite 511, 21205 Baltimore, MD USA
| | - Jason E. Farley
- Center for Infectious Disease and Nursing Innovation, Johns Hopkins University School of Nursing, 525 North Wolfe Street, Suite 511, 21205 Baltimore, MD USA
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Intersecting epidemics: the impact of coronavirus disease 2019 on the HIV prevention and care continua in the United States. AIDS 2022; 36:1749-1759. [PMID: 35730392 DOI: 10.1097/qad.0000000000003305] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To summarize the broad impact of the coronavirus disease 2019 (COVID-19) pandemic on HIV prevention and care in the United States with a focus on the status-neutral HIV care continuum. DESIGN We conducted an editorial review of peer-reviewed literature on the topics of HIV-risk behaviors, sexually transmitted illness (STI) and HIV prevalence, HIV prevention and treatment trends, and evolving practices during the COVID-19 pandemic. METHODS For relevant literature, we reviewed, summarized, and categorized into themes that span the HIV prevention and care continua, including sexual risk behaviors, mental health, and substance use. RESULTS We identified important changes within each component of the HIV care continuum across the United States during the COVID-19 pandemic. Shifts in prevention practices, engagement with care, care provision, medication adherence, testing, and prevalence rates were observed during the pandemic. CONCLUSION Although heightened disparities for people at risk for, and living with, HIV were seen during the COVID-19 pandemic, many health systems and clinics have achieved and maintained engagement in HIV prevention and care. This review highlights barriers and innovative solutions that can support durable and accessible health systems through future public health crises.
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Flickinger TE, Waselewski M, Tabackman A, Huynh J, Hodges J, Otero K, Schorling K, Ingersoll K, Tiouririne NAD, Dillingham R. Communication between patients, peers, and care providers through a mobile health intervention supporting medication-assisted treatment for opioid use disorder. PATIENT EDUCATION AND COUNSELING 2022; 105:2110-2115. [PMID: 35260260 PMCID: PMC10112280 DOI: 10.1016/j.pec.2022.02.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Revised: 02/08/2022] [Accepted: 02/21/2022] [Indexed: 05/02/2023]
Abstract
INTRODUCTION Our team developed the HOPE app as a clinic-based platform to support patients receiving medication assisted treatment (MAT) for opioid use disorder. We investigated the app's two communication features: an anonymous community message board (CMB) and secure messaging between patients and their clinic team. METHODS The HOPE (Heal Overcome Persist Endure) app was piloted with patients and MAT providers. Text from the CMB and messaging were downloaded and de-identified. Content analysis was performed using iteratively developed codebooks with team consensus. RESULTS The pilot study enrolled 28 participants; 25 were "members" (patients) and 3 were providers (physician, nurse, social worker). Of member-generated CMB posts, 45% described the poster's state of mind, including positive and negative emotions, 47% conveyed support and 8% asked for support. Members' secure messages to the team included 52% medical, 45% app-related, and 8% social topics. Provider's messages contained information exchange (90%) and relationship-building (36%). DISCUSSION Through the CMB, members shared emotions and social support with their peers. Through secure messaging, members addressed medical and social needs with their care team, used primarily for information exchange but also relationship-building. PRACTICE IMPLICATIONS The HOPE app addresses communication needs for patients in MAT and can support them in recovery.
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Affiliation(s)
- Tabor E Flickinger
- Department of Medicine, University of Virginia School of Medicine, Charlottesville, VA, USA.
| | - Marika Waselewski
- Department of Family Medicine, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Alexa Tabackman
- University of Virginia School of Medicine, Charlottesville, VA, USA
| | | | - Jacqueline Hodges
- Department of Medicine, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Kori Otero
- Department of Medicine, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Kelly Schorling
- Department of Psychiatry and Neurobehavioral Sciences, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Karen Ingersoll
- Department of Psychiatry and Neurobehavioral Sciences, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Nassima Ait-Daoud Tiouririne
- Department of Psychiatry and Neurobehavioral Sciences, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Rebecca Dillingham
- Department of Medicine, University of Virginia School of Medicine, Charlottesville, VA, USA
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