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SCHNURE MC, KASAIE P, DOWDY DW, GENBERG BL, KENDALL EA, FOJO AT. Forecasting the effect of HIV-targeted interventions on the age distribution of people with HIV in Kenya. AIDS 2024; 38:1375-1385. [PMID: 38537051 PMCID: PMC11211060 DOI: 10.1097/qad.0000000000003895] [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: 04/10/2024]
Abstract
OBJECTIVES To provide accurate forecasts of the age distribution of people with HIV (PWH) in Kenya from 2025 to 2040. DESIGN Development of a compartmental model of HIV in Kenya, calibrated to historical estimates of HIV epidemiology. METHODS We forecasted changes in population size and age distribution of new HIV infections and PWH under the status quo and under scale-up of HIV services. RESULTS Without scale-up, new HIV infections were forecasted to fall from 34 000 (28 000-41 000) in 2,025 to 29 000 (15 000-57 000) in 2,040; the percentage of new infections occurring among persons over 30 increased from 33% (20-50%) to 40% (24-62%). The median age of PWH increased from 39 years (38-40) in 2025 to 43 years (39-46) in 2040, and the percentage of PWH over age 50 increased from 26% (23-29%) to 34% (26-43%). Under the full intervention scenario, new infections were forecasted to fall to 6,000 (3,000-12 000) in 2,040. The percentage of new infections occurring in people over age 30 increased to 52% (34-71%) in 2,040, and there was an additional shift in the age structure of PWH [forecasted median age of 46 (43-48) and 40% (33-47%) over age 50]. CONCLUSION PWH in Kenya are forecasted to age over the next 15 years; improvements to the HIV care continuum are expected to contribute to the growing proportion of older PWH.
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Affiliation(s)
| | - Parastu KASAIE
- The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD USA
| | - David W. DOWDY
- The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD USA
| | - Becky L. GENBERG
- The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD USA
| | - Emily A. KENDALL
- The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Anthony T. FOJO
- The Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Shishani K, Kaduka L, Olale J, Mbuka S, Mutai J, Ochieng R, Muniu E, Sivarajan Froelicher E. Prevalence of Cardiovascular Risk Factors in Rural Kenya-2023: Vihiga II. West J Nurs Res 2024:1939459241256580. [PMID: 38824396 DOI: 10.1177/01939459241256580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2024]
Abstract
BACKGROUND The aim of this study was to estimate the prevalence of cardiovascular disease (CVD) risk factors among adults in Vihiga County, Western Kenya. METHODS A cross-sectional population-based study was completed. Participants (n = 575) were selected at the household level using a systematic random sample, and sociodemographic, anthropometrical, clinical, and biochemical data were collected. RESULTS The sample consisted of 71.8% women and 28.2% men. The prevalence of high blood pressure (BP) was 56.4%. A greater proportion of women (62.8%) had low levels of high-density lipoprotein (HDL) compared with men (44.7%) (odds ratio [OR], 2.99; 95% CI, 1.59-5.64). High triglyceride levels were more prevalent in men (16.4%) compared with women (15.4%) (OR, 0.37; 95% CI, 0.19-0.71). Based on average waist to hip ratio, abdominal obesity was significantly higher in women (55.4%) compared with men (27.6%) (OR, 2.62; 95% CI, 1.52-4.49). Low levels of physical inactivity were prevalent in women (36.3%) at significantly higher proportions compared with men (22.7%) (OR, 1.73; 95% CI, 1.02-2.92). Women used tobacco at significantly lower proportions (0.5%) compared with men (27.2%) (OR, 0.01; 95% CI, 0.00-0.06). A higher proportion of women (47.9%) rated their general health as poor compared with men (37.1%), a statistically significant difference (OR, 2.0; 95% CI, 1.23-3.28). CONCLUSION The prevalence of CVD risk factors, such as hypertension, obesity, dyslipidemia, low physical activity, and tobacco use indicates the urgent need for comprehensive health promotion programs to improve public health in rural areas of Kenya.
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Affiliation(s)
- Kawkab Shishani
- College of Nursing, Washington State University, Spokane, WA, USA
| | - Lydia Kaduka
- Centre for Public Health Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Joanna Olale
- Centre for Clinical Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Schiller Mbuka
- Centre for Public Health Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Joseph Mutai
- Centre for Public Health Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Rodgers Ochieng
- Centre for Public Health Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Erastus Muniu
- Centre for Public Health Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Erika Sivarajan Froelicher
- Department of Physiological Nursing, School of Nursing, University of California, San Francisco, San Francisco, CA, USA
- Department of Epidemiology and Biostatistics, School of Medicine, University of California, San Francisco, San Francisco, CA, USA
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3
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Sawe SJ, Mugo R, Wilson-Barthes M, Osetinsky B, Chrysanthopoulou SA, Yego F, Mwangi A, Galárraga O. Gaussian process emulation to improve efficiency of computationally intensive multidisease models: a practical tutorial with adaptable R code. BMC Med Res Methodol 2024; 24:26. [PMID: 38281017 PMCID: PMC10821551 DOI: 10.1186/s12874-024-02149-x] [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: 01/27/2023] [Accepted: 01/11/2024] [Indexed: 01/29/2024] Open
Abstract
BACKGROUND The rapidly growing burden of non-communicable diseases (NCDs) among people living with HIV in sub-Saharan Africa (SSA) has expanded the number of multidisease models predicting future care needs and health system priorities. Usefulness of these models depends on their ability to replicate real-life data and be readily understood and applied by public health decision-makers; yet existing simulation models of HIV comorbidities are computationally expensive and require large numbers of parameters and long run times, which hinders their utility in resource-constrained settings. METHODS We present a novel, user-friendly emulator that can efficiently approximate complex simulators of long-term HIV and NCD outcomes in Africa. We describe how to implement the emulator via a tutorial based on publicly available data from Kenya. Emulator parameters relating to incidence and prevalence of HIV, hypertension and depression were derived from our own agent-based simulation model and other published literature. Gaussian processes were used to fit the emulator to simulator estimates, assuming presence of noise for design points. Bayesian posterior predictive checks and leave-one-out cross validation confirmed the emulator's descriptive accuracy. RESULTS In this example, our emulator resulted in a 13-fold (95% Confidence Interval (CI): 8-22) improvement in computing time compared to that of more complex chronic disease simulation models. One emulator run took 3.00 seconds (95% CI: 1.65-5.28) on a 64-bit operating system laptop with 8.00 gigabytes (GB) of Random Access Memory (RAM), compared to > 11 hours for 1000 simulator runs on a high-performance computing cluster with 1500 GBs of RAM. Pareto k estimates were < 0.70 for all emulations, which demonstrates sufficient predictive accuracy of the emulator. CONCLUSIONS The emulator presented in this tutorial offers a practical and flexible modelling tool that can help inform health policy-making in countries with a generalized HIV epidemic and growing NCD burden. Future emulator applications could be used to forecast the changing burden of HIV, hypertension and depression over an extended (> 10 year) period, estimate longer-term prevalence of other co-occurring conditions (e.g., postpartum depression among women living with HIV), and project the impact of nationally-prioritized interventions such as national health insurance schemes and differentiated care models.
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Affiliation(s)
- Sharon Jepkorir Sawe
- African Center of Excellence in Data Science, University of Rwanda, Kigali, Rwanda
| | - Richard Mugo
- Academic Model Providing Access to Healthcare, Eldoret, Kenya
| | - Marta Wilson-Barthes
- Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA
| | - Brianna Osetinsky
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland
| | | | - Faith Yego
- Department of Health Policy Management & Human Nutrition, Moi University School Public Health, Eldoret, Kenya
| | - Ann Mwangi
- Academic Model Providing Access to Healthcare, Eldoret, Kenya
- Department of Mathematics, Physics & Computing, School of Science and Aerospace Studies, Moi University, Eldoret, Kenya
| | - Omar Galárraga
- Academic Model Providing Access to Healthcare, Eldoret, Kenya.
- Department of Health Services, Policy and Practice, and International Health Institute, Brown University School of Public Health, Providence, RI, USA.
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Kumar M, Njuguna S, Amin N, Kanana S, Tele A, Karanja M, Omar N, Yator O, Wambugu C, Bukusi D, Weaver MR. Burden and risk factors of mental and substance use disorders among adolescents and young adults in Kenya: results from the Global Burden of Disease Study 2019. EClinicalMedicine 2024; 67:102328. [PMID: 38204491 PMCID: PMC10776414 DOI: 10.1016/j.eclinm.2023.102328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Revised: 11/05/2023] [Accepted: 11/07/2023] [Indexed: 01/12/2024] Open
Abstract
Background Mental and substance use disorders are a major public health concern globally, with high rates of disability, morbidity, and mortality associated with these. In low- and middle-income countries, such as Kenya, mental health is often given low priority, and resources for the prevention and treatment of mental and substance use disorders are limited. Adolescence and young adulthood are critical periods for the development of mental and substance use disorders, with many disorders emerging during this time. In Kenya, the burden and risk factors of mental and substance use disorders among adolescents and young adults is not well understood. Methods The data used in this study were obtained from the Global Burden of Disease (GBD) Study 2019. We selected the data on the number of mental and substance use disorders among adolescents and young adults in Kenya from the GBD results tool. The data were extracted by mental health (MH) condition, by age group and by sex. We used descriptive statistical methods to summarise and present the data. Specifically, we calculated the disability-adjusted life-years (DALYs) rates, risk factors of mental and substance use disorders by age group and sex. Findings In 2019, among 10-24-year-olds in Kenya, mental disorders ranked as the second leading cause of disability, following unintentional injuries, and accounted for 248,936 [95% uncertainty interval 175,033; 341,680] DALYs or 9.4% of 2,656,546 total DALYs. Substance use disorders accounted 15,022 [9948; 20,710] DALYs. Depressive, anxiety, and conduct disorders accounted for the most DALYs of mental disorders accounting for 3.1%, 2.3% and 1.7% of the total DALYs, respectively. The main risk factors for incident DALYs in 10-24-year-olds were bullying and victimization (66.5%). Childhood sexual abuse accounted for 13.7% of the DALYs, lead exposure accounted for 8.5% of the DALYs, intimate partner violence accounted for 11.3% of the DALYs (2%) with all victims being females, and illicit drug use accounted for (52.7%) of DALYs. Interpretation Improved surveillance of mental health and substance use burden at national and county levels is needed. Focus on timely screening and intervention for idiopathic developmental intellectual disability, conduct disorder, and substance use disorder in young boys and depression, anxiety, and eating disorders in young girls and women is critically needed. Funding MK is funded by FIC/NIMH K43 TW 010716 and R33MH124149-03. The publication was made possible by funding from the Gates Foundation.
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Amutuhaire W, Mulindwa F, Castelnuovo B, Brusselaers N, Schwarz JM, Edrisa M, Dujanga S, Salata RA, Yendewa GA. Prevalence of Cardiometabolic Disease Risk Factors in People With HIV Initiating Antiretroviral Therapy at a High-Volume HIV Clinic in Kampala, Uganda. Open Forum Infect Dis 2023; 10:ofad241. [PMID: 37351455 PMCID: PMC10284103 DOI: 10.1093/ofid/ofad241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 04/27/2023] [Indexed: 06/24/2023] Open
Abstract
Background Cardiometabolic diseases are a leading cause of HIV-related morbidity and mortality, yet routine screening is not undertaken in high-burden countries. We aimed to assess the prevalence and risk factors of the metabolic syndrome (MetS) and its components in adult Ugandan people with HIV (PWH) initiating dolutegravir-based antiretroviral therapy (ART). Methods We conducted a cross-sectional study using baseline sociodemographic and clinical data of PWH aged ≥18 years enrolled in the Glucose metabolism changes in Ugandan HIV patients on Dolutegravir (GLUMED) study from January to October 2021. MetS was defined as having ≥3 of the following: abdominal obesity, hypertension (HTN), hyperglycemia, elevated triglycerides, and low high-density lipoprotein cholesterol. Multiple logistic regression was used to assess associations between potential risk factors and MetS and its components. Results Three hundred nine PWH were analyzed (100% ART-naïve, 59.2% female, median age 31 years, and median CD4 count 318 cells/mm3). The prevalence of MetS was 13.9%. The most common cardiometabolic condition was dyslipidemia (93.6%), followed by abdominal obesity (34.0%), hyperglycemia (18.4%), and HTN (8.1%). In adjusted analysis, MetS was associated with age >40 years (adjusted odds ratio [aOR], 3.33; 95% CI, 1.45-7.67) and CD4 count >200 cells/mm3 (aOR, 3.79; 95% CI, 1.23-11.63). HTN was associated with age >40 years (aOR, 2.96; 95% CI, 1.32-6.64), and dyslipidemia was associated with urban residence (aOR, 4.99; 95% CI, 1.35-18.53). Conclusions Cardiometabolic risk factors were common in this young Ugandan cohort of PWH initiating dolutegravir-based ART, underscoring the need for programmatic implementation of surveillance and management of comorbidities in Uganda and similar settings.
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Affiliation(s)
- Willington Amutuhaire
- Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Frank Mulindwa
- Makerere University Infectious Diseases Institute, Kampala, Uganda
- Global Health Institute, Antwerp University, Antwerp, Belgium
| | | | - Nele Brusselaers
- Global Health Institute, Antwerp University, Antwerp, Belgium
- Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden
| | - Jean-Marc Schwarz
- School of Medicine, University of California San Francisco, San Francisco, California, USA
| | - Mutebi Edrisa
- Department of Internal Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | | | - Robert A Salata
- Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
- Division of Infectious Diseases and HIV Medicine, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - George A Yendewa
- Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
- Division of Infectious Diseases and HIV Medicine, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
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6
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Collini P, Mawson RL. A new era of HIV care for age-associated multimorbidity. Curr Opin Infect Dis 2023; 36:9-14. [PMID: 36484174 DOI: 10.1097/qco.0000000000000890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
PURPOSE OF REVIEW The management of people with HIV has shifted focus from acute AIDS-defining illness towards improving detection of chronic disease and reducing impact of multimorbidity. In this review, we explore this shifting paradigm of HIV care and the evidence for alternative models proposed to provide integrated holistic services for people with HIV (PWH) with multimorbidity. RECENT FINDINGS Despite 25 years of the antiretroviral treatment (ART) era an increased incidence of noncommunicable disease (NCD) and multimorbidity in PWH persists. As the world moves closer to universal ART coverage this phenomenon is now reported in low- and middle-income settings. Multimorbidity affects PWH disproportionately compared to the general population and results in reduced health related quality of life (HRQoL), greater hospitalization and higher mortality. There is evidence that NCD care provision and outcomes may be inferior for PWH than their HIV negative counterparts. Various models of integrated multimorbidity care have developed and are grouped into four categories; HIV specialist clinics incorporating NCD care, primary care services incorporating HIV care, community NCD clinics offering integrated HIV care, and multidisciplinary care integrated with HIV in secondary care. Evidence is limited as to the best way to provide multimorbidity care for PWH. SUMMARY A new era of HIV care for an ageing population with multimorbidity brings challenges for health providers who need to develop holistic patient focused services which span a range of coexisting conditions.
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Affiliation(s)
- Paul Collini
- Department of Infection, Immunity and Cardiovascular Disease, The University of Sheffield
| | - Rebecca L Mawson
- Academic Unit of Primary Medical Care, The University of Sheffield, Samuel Fox House, Sheffield, UK
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Han X, Hou H, Xu J, Ren J, Li S, Wang Y, Yang H, Wang Y. Significant association between HIV infection and increased risk of COVID-19 mortality: a meta-analysis based on adjusted effect estimates. Clin Exp Med 2022:10.1007/s10238-022-00840-1. [PMID: 35695974 PMCID: PMC9189270 DOI: 10.1007/s10238-022-00840-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 05/09/2022] [Indexed: 12/13/2022]
Abstract
To investigate the relationship between human immunodeficiency virus (HIV) infection and the risk of mortality among coronavirus disease 2019 (COVID-19) patients based on adjusted effect estimate by a quantitative meta-analysis. A random-effects model was used to estimate the pooled effect size (ES) with corresponding 95% confidence interval (CI). I2 statistic, sensitivity analysis, Begg’s test, meta-regression and subgroup analyses were also conducted. This meta-analysis presented that HIV infection was associated with a significantly higher risk of COVID-19 mortality based on 40 studies reporting risk factors-adjusted effects with 131,907,981 cases (pooled ES 1.43, 95% CI 1.25–1.63). Subgroup analyses by male proportion and setting yielded consistent results on the significant association between HIV infection and the increased risk of COVID-19 mortality. Allowing for the existence of heterogeneity, further meta-regression and subgroup analyses were conducted to seek the possible source of heterogeneity. None of factors might be possible reasons for heterogeneity in the further analyses. Sensitivity analysis indicated the robustness of this meta-analysis. The Begg’s test manifested that there was no publication bias (P = 0.2734). Our findings demonstrated that HIV infection was independently associated with a significantly increased risk of mortality in COVID-19 patients. Further well-designed studies based on prospective study estimates are warranted to confirm our findings.
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Affiliation(s)
- Xueya Han
- Department of Epidemiology, School of Public Health, Zhengzhou University, No. 100 of Science Avenue, Zhengzhou, 450001, Henan Province, China
| | - Hongjie Hou
- Department of Epidemiology, School of Public Health, Zhengzhou University, No. 100 of Science Avenue, Zhengzhou, 450001, Henan Province, China
| | - Jie Xu
- Department of Epidemiology, School of Public Health, Zhengzhou University, No. 100 of Science Avenue, Zhengzhou, 450001, Henan Province, China
| | - Jiahao Ren
- Department of Epidemiology, School of Public Health, Zhengzhou University, No. 100 of Science Avenue, Zhengzhou, 450001, Henan Province, China
| | - Shuwen Li
- Department of Epidemiology, School of Public Health, Zhengzhou University, No. 100 of Science Avenue, Zhengzhou, 450001, Henan Province, China
| | - Ying Wang
- Department of Epidemiology, School of Public Health, Zhengzhou University, No. 100 of Science Avenue, Zhengzhou, 450001, Henan Province, China
| | - Haiyan Yang
- Department of Epidemiology, School of Public Health, Zhengzhou University, No. 100 of Science Avenue, Zhengzhou, 450001, Henan Province, China.
| | - Yadong Wang
- Department of Toxicology, Henan Center for Disease Control and Prevention, Zhengzhou, 450016, Henan Province, China
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Peng L, He Y, Zhang J, Hong D, Li G. Erythropoietin and iron for anemia in HIV-infected patients undergoing maintenance hemodialysis in China: a cross-sectional study. BMC Nephrol 2022; 23:60. [PMID: 35135490 PMCID: PMC8827246 DOI: 10.1186/s12882-022-02693-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 01/31/2022] [Indexed: 11/14/2022] Open
Abstract
Background Anemia is a common complication of chronic kidney disease (CKD) and HIV infection. The number of people living with HIV on hemodialysis (HD) is increasing. However, there is no data about anemia and related therapies in this kind of patients in China. We aim to assess the difference in hemoglobin (Hgb) and treatments like erythropoietin and iron between HIV-HD patients and HD patients in Chengdu, China. Methods This cross-sectional study was conducted with data collection from January 2020 to June 2020. Thirty-four HIV-infected HD patients and thirty-five non-HIV-infected HD patients were included. Age, gender, dialysis vintage, single-pool (sp) Kt/V, Hgb, the dose of erythropoietin, ferritin, use of iron preparations, and serum albumin were collected in all patients. Time since HIV diagnosis, counts of CD4 + T cells, HIV RNA, and antiretroviral therapy for HIV infection were collected in HIV-infected patients. T-test, Mann–Whitney U test, and chi-square statistics were applied in SPSS. Results The Hgb of HIV-HD and HD groups were 105.70 (95.93–112.08) g/L and 112.00 (93.00–126.00) g/L respectively (P = 0.064). There was a statistically significant higher erythropoietin dosage used in the HIV-HD population (222.55 ± 115.47 U/kg/week) compared to the HIV-negative HD group (161.86 ± 110.31 U/kg/week) (P = 0.029). 16/34 (47.06%) HIV-HD patients and 5/35 (14.29%) HD patients were treated with iron preparations (P = 0.003). The ferritin levels were 316.50 (117.38–589.75) ng/ml and 272.70 (205.00–434.00) ng/ml in HIV-HD and HD groups respectively. Conclusions A higher erythropoietin dosage and a higher probability of iron preparations may be required to maintain Hgb in HIV-HD patients compared with HD patients. Supplementary Information The online version contains supplementary material available at 10.1186/s12882-022-02693-y.
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Affiliation(s)
- Lei Peng
- Department of Nephrology, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, 611731, China.,School of Automation Engineering, University of Electronic Science and Technology of China, Chengdu, 611731, China
| | - Yanan He
- Public Health Clinical Center of Chengdu, Chengdu, China
| | - Jiong Zhang
- Department of Nephrology, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, 611731, China
| | - Daqing Hong
- Department of Nephrology, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, 611731, China.
| | - Guisen Li
- Department of Nephrology, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, 611731, China
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Liu A, Wei Q, Lin H, Ding Y, Sun YV, Zhao D, He J, Ma Z, Li F, Zhou S, Chen X, Shen W, Gao M, He N. Baseline Characteristics of Mitochondrial DNA and Mutations Associated With Short-Term Posttreatment CD4+T-Cell Recovery in Chinese People With HIV. Front Immunol 2022; 12:793375. [PMID: 34970271 PMCID: PMC8712318 DOI: 10.3389/fimmu.2021.793375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Accepted: 11/16/2021] [Indexed: 11/25/2022] Open
Abstract
Background Mitochondrial DNA (mtDNA) profiles and contributions of mtDNA variants to CD4+T-cell recovery in Euramerican people living with HIV (PLWH) may not be transferred to East-Asian PLWH, highlighting the need to consider more regional studies. We aimed to identify mtDNA characteristics and mutations that explain the variability of short-term CD4+T-cell recovery in East-Asian PLWH. Method Eight hundred fifty-six newly reported antiretroviral therapy (ART)-naïve Chinese PLWH from the Comparative HIV and Aging Research in Taizhou (CHART) cohort (Zhejiang Province, Eastern China) were enrolled. MtDNA was extracted from peripheral whole blood of those PLWH at HIV diagnosis, amplified, and sequenced using polymerase chain reaction and gene array. Characterization metrics such as mutational diversity and momentum were developed to delineate baseline mtDNA mutational patterns in ART-naïve PLWH. The associations between mtDNA genome-wide single nucleotide variants and CD4+T-cell recovery after short-term (within ~48 weeks) ART in 724 PLWH were examined using bootstrapping median regressions. Results Of 856 participants, 74.18% and 25.82% were male and female, respectively. The median age was 37 years; 94.51% were of the major Han ethnicity, and 69.04% and 28.62% were of the heterosexual and homosexual transmission, respectively. We identified 2,352 types of mtDNA mutations and mtDNA regions D-loop, ND5, CYB, or RNR1 with highest mutational diversity or volume. Female PLWH rather than male PLWH at the baseline showed remarkable age-related uptrends of momentum and mutational diversity as well as correlations between CD4+T <200 (cells/μl) and age-related uptrends of mutational diversity in many mtDNA regions. After adjustments of important sociodemographic and clinical variables, m.1005T>C, m.1824T>C, m.3394T>C, m.4491G>A, m.7828A>G, m.9814T>C, m.10586G>A, m.12338T>C, m.13708G>A, and m.14308T>C (at the Bonferroni-corrected significance) were negatively associated with short-term CD4+T-cell recovery whereas m.93A>G, m.15218A>G, and m.16399A>G were positively associated with short-term CD4+T-cell recovery. Conclusion Our baseline mtDNA characterization stresses the attention to East-Asian female PLWH at risk of CD4+T-cell loss-related aging and noncommunicable chronic diseases. Furthermore, mtDNA variants identified in regression analyses account for heterogeneity in short-term CD4+T-cell recovery of East-Asian PLWH. These results may help individualize the East-Asian immune recovery strategies under complicated HIV management caused by CD4+T-cell loss.
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Affiliation(s)
- Anni Liu
- Department of Epidemiology, School of Public Health, Fudan University, Shanghai, China.,Key Laboratory of Public Health Safety of Ministry of Education, Fudan University, Shanghai, China.,Weill Cornell Graduate School of Medical Sciences, Cornell University, New York, NY, United States
| | - Qian Wei
- Department of Epidemiology, School of Public Health, Fudan University, Shanghai, China.,Key Laboratory of Public Health Safety of Ministry of Education, Fudan University, Shanghai, China
| | - Haijiang Lin
- Department of Epidemiology, School of Public Health, Fudan University, Shanghai, China.,Key Laboratory of Public Health Safety of Ministry of Education, Fudan University, Shanghai, China.,Department of AIDS/STD Control and Prevention, Taizhou City Center for Disease Control and Prevention, Taizhou, China
| | - Yingying Ding
- Department of Epidemiology, School of Public Health, Fudan University, Shanghai, China.,Key Laboratory of Public Health Safety of Ministry of Education, Fudan University, Shanghai, China
| | - Yan V Sun
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, United States.,Department of Biomedical Informatics, School of Medicine, Emory University, Atlanta, GA, United States
| | - Dan Zhao
- Department of Epidemiology, School of Public Health, Fudan University, Shanghai, China.,Key Laboratory of Public Health Safety of Ministry of Education, Fudan University, Shanghai, China
| | - Jiayu He
- Department of Epidemiology, School of Public Health, Fudan University, Shanghai, China.,Key Laboratory of Public Health Safety of Ministry of Education, Fudan University, Shanghai, China
| | - Zhonghui Ma
- Department of Epidemiology, School of Public Health, Fudan University, Shanghai, China.,Key Laboratory of Public Health Safety of Ministry of Education, Fudan University, Shanghai, China
| | - Feihu Li
- School of Mathematical Sciences, Fudan University, Shanghai, China
| | - Sujuan Zhou
- Department of Epidemiology, School of Public Health, Fudan University, Shanghai, China.,Key Laboratory of Public Health Safety of Ministry of Education, Fudan University, Shanghai, China
| | - Xiaoxiao Chen
- Department of AIDS/STD Control and Prevention, Taizhou City Center for Disease Control and Prevention, Taizhou, China
| | - Weiwei Shen
- Department of AIDS/STD Control and Prevention, Taizhou City Center for Disease Control and Prevention, Taizhou, China
| | - Meiyang Gao
- Department of Epidemiology, School of Public Health, Fudan University, Shanghai, China.,Key Laboratory of Public Health Safety of Ministry of Education, Fudan University, Shanghai, China
| | - Na He
- Department of Epidemiology, School of Public Health, Fudan University, Shanghai, China.,Key Laboratory of Public Health Safety of Ministry of Education, Fudan University, Shanghai, China.,Key Laboratory of Health Technology Assessment, National Commission of Health, Fudan University, Shanghai, China
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10
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Liu J, Hou Y, Sun L, Wang L, He Y, Zhou Y, Xu L, Liu X, Zhao F, Zhang L, Wang H, Wang FS. High population-attributable fractions of traditional risk factors for non-AIDS-defining diseases among people living with HIV in China: a cohort study. Emerg Microbes Infect 2021; 10:416-423. [PMID: 33620297 PMCID: PMC7971336 DOI: 10.1080/22221751.2021.1894904] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Morbidity and mortality of non-AIDS-defining diseases (NADs) have become the increasing burden of people living with HIV (PLWH) with long-term antiretroviral therapy (ART). We aimed to quantify the contribution of modifiable risk factors to NADs. We included PLWHs starting ART at the Third People’s Hospital of Shenzhen (China) from Jan 1, 2010 to Dec 31, 2017. We defined NAD outcomes of interest as cardiovascular disease (CVD), end-stage liver disease (ESLD), advanced renal disease (ARD), and non-AIDS-defining cancers (NADCs). We estimated incidence of outcomes and population-attributable fractions (PAFs) of modifiable traditional and HIV-related risk factors for each outcome. Overall, 8,301 participants (median age at study entry, 31 years) contributed 33,146 person-years of follow-up (PYFU). Incidence of CVD (362/100,000 PYFU) was the highest among outcomes, followed by that of ARD (270/100,000 PYFU), ESLD (213/100,000 PYFU), and NADC (152/100,000 PYFU). Totally, 34.14% of CVD was attributable to smoking, 7.98% to hypertension, and 6.44% to diabetes. For ESLD, 24.57% and 25.04% of it could be avoided if chronic hepatitis B and C virus infection, respectively, did not present. The leading PAFs for ARD were declined estimated glomerular filtration rate (eGFR) (39.68%) and low CD4 count (39.61%), followed by diabetes (10.19%). PAFs of hypertension, diabetes, and smoking for CVD, and declined eGFR and diabetes for ARD increased with age. The contribution of traditional risk factors for these NADs far outweighed the HIV-related risk factors. Individual-level interventions and population-level policy-making is needed to focus on these factors to prevent NADs in long-term management of HIV infection.
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Affiliation(s)
- Jiaye Liu
- National Clinical Research Centre for Infectious Diseases, The Third People's Hospital of Shenzhen and The Second Affiliated Hospital of Southern University of Science and Technology, Shenzhen, People's Republic of China.,Medical School of Chinese PLA, Beijing, People's Republic of China.,Treatment and Research Centre for Infectious Diseases, The Fifth Medical Centre of PLA General Hospital, Beijing, People's Republic of China
| | - Yuying Hou
- Medical School of Chinese PLA, Beijing, People's Republic of China.,Treatment and Research Centre for Infectious Diseases, The Fifth Medical Centre of PLA General Hospital, Beijing, People's Republic of China
| | - Liqin Sun
- National Clinical Research Centre for Infectious Diseases, The Third People's Hospital of Shenzhen and The Second Affiliated Hospital of Southern University of Science and Technology, Shenzhen, People's Republic of China
| | - Lifeng Wang
- Treatment and Research Centre for Infectious Diseases, The Fifth Medical Centre of PLA General Hospital, Beijing, People's Republic of China
| | - Yun He
- National Clinical Research Centre for Infectious Diseases, The Third People's Hospital of Shenzhen and The Second Affiliated Hospital of Southern University of Science and Technology, Shenzhen, People's Republic of China
| | - Yang Zhou
- National Clinical Research Centre for Infectious Diseases, The Third People's Hospital of Shenzhen and The Second Affiliated Hospital of Southern University of Science and Technology, Shenzhen, People's Republic of China
| | - Liumei Xu
- National Clinical Research Centre for Infectious Diseases, The Third People's Hospital of Shenzhen and The Second Affiliated Hospital of Southern University of Science and Technology, Shenzhen, People's Republic of China
| | - Xiaoning Liu
- National Clinical Research Centre for Infectious Diseases, The Third People's Hospital of Shenzhen and The Second Affiliated Hospital of Southern University of Science and Technology, Shenzhen, People's Republic of China
| | - Fang Zhao
- National Clinical Research Centre for Infectious Diseases, The Third People's Hospital of Shenzhen and The Second Affiliated Hospital of Southern University of Science and Technology, Shenzhen, People's Republic of China
| | - Lukun Zhang
- National Clinical Research Centre for Infectious Diseases, The Third People's Hospital of Shenzhen and The Second Affiliated Hospital of Southern University of Science and Technology, Shenzhen, People's Republic of China
| | - Hui Wang
- National Clinical Research Centre for Infectious Diseases, The Third People's Hospital of Shenzhen and The Second Affiliated Hospital of Southern University of Science and Technology, Shenzhen, People's Republic of China
| | - Fu-Sheng Wang
- Medical School of Chinese PLA, Beijing, People's Republic of China.,Treatment and Research Centre for Infectious Diseases, The Fifth Medical Centre of PLA General Hospital, Beijing, People's Republic of China
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11
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Abstract
PURPOSE OF REVIEW Biological and societal influences are different for men and women leading to different HIV outcomes and related infectious and non-infectious complications. This review evaluates sex differences in the epidemiology and immunological response to HIV and looks at major complications and coinfections, as well as care delivery systems focusing on low- and middle-income countries (LMICs) where most people with HIV live. RECENT FINDINGS More women than men access testing and treatment services in LMIC; women are more likely to be virologically suppressed in that environment. There is a growing recognition that the enhanced immunological response to several pathogens including HIV may result in improved outcomes for infectious comorbidities but may result in a greater burden of non-communicable diseases. Men and women have different requirements for HIV care. Attention to these differences may improve outcomes for all.
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12
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Agan BK, Marconi VC. Noncommunicable Diseases: Yet Another Challenge for Human Immunodeficiency Virus Treatment and Care in Sub-Saharan Africa. Clin Infect Dis 2020; 71:1874-1876. [PMID: 31734704 PMCID: PMC7643728 DOI: 10.1093/cid/ciz1104] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Accepted: 11/14/2019] [Indexed: 11/14/2022] Open
Affiliation(s)
- Brian K Agan
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc, Bethesda, Maryland, USA
| | - Vincent C Marconi
- Emory Vaccine Center, Rollins School of Public Health, Emory University School of Medicine, Atlanta, Georgia, USA
- Atlanta Veterans Affairs Medical Center, Atlanta, Georgia, USA
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13
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Deniz Şafak E. The Family Physician of the Future in Management of Chronic Diseases. EURASIAN JOURNAL OF FAMILY MEDICINE 2020. [DOI: 10.33880/ejfm.2020090301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Since the existence of the first human, humankind has tried to find immortality. In line with these efforts, the field of medicine has developed and has received its share from the developing technology. Digital technologies aim to improve human health through data management and analysis, mobile technologies, social networks, wearable or high-level applications and tools, they can be placed on the body. These technologies and practices provide the physician or healthcare worker with simultaneous information about the individual's health status, thereby keeping the individual's health status under constant control.
With these technologies, while monitoring the health status of the individual in terms of environmental, behavioral, psychological and physical aspects, a more controllable and effective health system can be pioneered. Telemedicine and virtual care, while keeping the physicians’ safe work during this period, where the COVID-19 pandemic negatively affected the world, has become an important tool in the care of patients.
This review aims to determine the digital health technologies and applications, their advantages, disadvantages and the current situation in future chronic diseases used in future health services and healthcare user.
Keywords: Family Physician, COVID-19, mobile health, pandemic, chronic disease
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14
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Kibachio J, Mwenda V, Ombiro O, Kamano JH, Perez‐Guzman PN, Mutai KK, Guessous I, Beran D, Kasaie P, Weir B, Beecroft B, Kilonzo N, Kupfer L, Smit M. Recommendations for the use of mathematical modelling to support decision-making on integration of non-communicable diseases into HIV care. J Int AIDS Soc 2020; 23 Suppl 1:e25505. [PMID: 32562338 PMCID: PMC7305412 DOI: 10.1002/jia2.25505] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Revised: 03/03/2020] [Accepted: 03/31/2020] [Indexed: 12/20/2022] Open
Abstract
INTRODUCTION Integrating services for non-communicable diseases (NCDs) into existing primary care platforms such as HIV programmes has been recommended as a way of strengthening health systems, reducing redundancies and leveraging existing systems to rapidly scale-up underdeveloped programmes. Mathematical modelling provides a powerful tool to address questions around priorities, optimization and implementation of such programmes. In this study, we examine the case for NCD-HIV integration, use Kenya as a case-study to highlight how modelling has supported wider policy formulation and decision-making in healthcare and to collate stakeholders' recommendations on use of models for NCD-HIV integration decision-making. DISCUSSION Across Africa, NCDs are increasingly posing challenges for health systems, which historically focused on the care of acute and infectious conditions. Pilot programmes using integrated care services have generated advantages for both provider and user, been cost-effective, practical and achieve rapid coverage scale-up. The shared chronic nature of NCDs and HIV means that many operational approaches and infrastructure developed for HIV programmes apply to NCDs, suggesting this to be a cost-effective and sustainable policy option for countries with large HIV programmes and small, un-resourced NCD programmes. However, the vertical nature of current disease programmes, policy financing and operations operate as barriers to NCD-HIV integration. Modelling has successfully been used to inform health decision-making across a number of disease areas and in a number of ways. Examples from Kenya include (i) estimating current and future disease burden to set priorities for public health interventions, (ii) forecasting the requisite investments by government, (iii) comparing the impact of different integration approaches, (iv) performing cost-benefit analysis for integration and (v) evaluating health system capacity needs. CONCLUSIONS Modelling can and should play an integral part in the decision-making processes for health in general and NCD-HIV integration specifically. It is especially useful where little data is available. The successful use of modelling to inform decision-making will depend on several factors including policy makers' comfort with and understanding of models and their uncertainties, modellers understanding of national priorities, funding opportunities and building local modelling capacity to ensure sustainability.
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Affiliation(s)
- Joseph Kibachio
- Division of Non‐communicable DiseasesMinistry of HealthKenya
- Faculty of MedicineUniversity of GenevaSwitzerlandGeneva
| | - Valerian Mwenda
- Division of Non‐communicable DiseasesMinistry of HealthKenya
| | - Oren Ombiro
- Division of Non‐communicable DiseasesMinistry of HealthKenya
| | - Jamima H Kamano
- Department of MedicineMoi University School of MedicineKenyaEldoret
- AMPATHKenyaLondon
| | - Pablo N Perez‐Guzman
- MRC Centre for Global Infectious Disease AnalysisDepartment of Infectious Disease EpidemiologyImperial College LondonLondonUnited Kingdom
| | | | - Idris Guessous
- Division of Primary Care MedicineGeneva University Hospital and University of GenevaGenevaSwitzerland
| | - David Beran
- Division of Tropical and Humanitarian MedicineUniversity of Geneva and Geneva University HospitalsGenevaSwitzerland
| | - Paratsu Kasaie
- John Hopkins Bloomberg School of Public HealthBaltimoreMDUSA
| | - Brian Weir
- John Hopkins Bloomberg School of Public HealthBaltimoreMDUSA
| | - Blythe Beecroft
- Fogarty International CenterNational Institutes of HealthBethesdaMDUSA
| | | | - Linda Kupfer
- Fogarty International CenterNational Institutes of HealthBethesdaMDUSA
| | - Mikaela Smit
- MRC Centre for Global Infectious Disease AnalysisDepartment of Infectious Disease EpidemiologyImperial College LondonLondonUnited Kingdom
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15
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Perez-Guzman PN, Chung MH, De Vuyst H, Dalal S, Mutai KK, Muthoni K, Kigen B, Kilonzo N, Hallett TB, Smit M. The impact of scaling up cervical cancer screening and treatment services among women living with HIV in Kenya: a modelling study. BMJ Glob Health 2020; 5:e001886. [PMID: 32337077 PMCID: PMC7170464 DOI: 10.1136/bmjgh-2019-001886] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Revised: 02/18/2020] [Accepted: 03/08/2020] [Indexed: 12/18/2022] Open
Abstract
Introduction We aimed to quantify health outcomes and programmatic implications of scaling up cervical cancer (CC) screening and treatment options for women living with HIV in care aged 18–65 in Kenya. Methods Mathematical model comparing from 2020 to 2040: (1) visual inspection with acetic acid (VIA) and cryotherapy (Cryo); (2) VIA and Cryo or loop excision electrical procedure (LEEP), as indicated; (3) human papillomavirus (HPV)-DNA testing and Cryo or LEEP; and (4) enhanced screening technologies (either same-day HPV-DNA testing or digitally enhanced VIA) and Cryo or LEEP. Outcomes measured were annual number of CC cases, deaths, screening and treatment interventions, and engaged in care (numbers screened, treated and cured) and five yearly age-standardised incidence. Results All options will reduce CC cases and deaths compared with no scale-up. Options 1–3 will perform similarly, averting approximately 28 000 (33%) CC cases and 7700 (27%) deaths. That is, VIA screening would yield minimal losses to follow-up (LTFU). Conversely, LTFU associated with HPV-DNA testing will yield a lower care engagement, despite better diagnostic performance. In contrast, option 4 would maximise health outcomes, averting 43 200 (50%) CC cases and 11 800 (40%) deaths, given greater care engagement. Yearly rescreening with either option will impose a substantial burden on the health system, which could be reduced by spacing out frequency to three yearly without undermining health gains. Conclusions Beyond the specific choice of technologies to scale up, efficiently using available options will drive programmatic success. Addressing practical constraints around diagnostics’ performance and LTFU will be key to effectively avert CC cases and deaths.
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Affiliation(s)
| | - Michael Hoonbae Chung
- Department of Medicine, Aga Khan University, Nairobi, Kenya.,Global Health, University of Washington, Seattle, Washington, USA
| | - Hugo De Vuyst
- Infections and Cancer Epidemiology Group, International Agency for Research on Cancer, Lyon, France
| | - Shona Dalal
- Department of HIV/AIDS, World Health Organization, Geneva, Switzerland
| | | | | | | | | | - Timothy B Hallett
- Department of Infectious Disease Epidemiology, Imperial College London, London, UK
| | - Mikaela Smit
- Department of Infectious Disease Epidemiology, Imperial College London, London, UK.,Division of Infectious Diseases, University Hospitals Geneva, Geneva, Switzerland
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