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Richterman A, Saintilien E, St-Cyr M, Claudia Gracia L, Sauer S, Pierre I, Compere M, Elnaiem A, Dumerjuste D, Ivers LC. Food Insecurity at Tuberculosis Treatment Initiation Is Associated With Clinical Outcomes in Rural Haiti: A Prospective Cohort Study. Clin Infect Dis 2024; 79:534-541. [PMID: 38888419 DOI: 10.1093/cid/ciae252] [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: 02/12/2024] [Indexed: 06/20/2024] Open
Abstract
BACKGROUND Tuberculosis is a leading cause of death worldwide, and food insecurity is known to negatively influence health outcomes through multiple pathways. Few studies have interrogated the relationship between food insecurity and tuberculosis outcomes, particularly independent of nutrition. METHODS We conducted a prospective cohort study of adults initiating first-line treatment for clinically suspected or microbiologically confirmed drug-sensitive tuberculosis at a rural referral center in Haiti. We administered a baseline questionnaire, collected clinical data, and analyzed laboratory samples. We used logistic regression models to estimate the relationship between household food insecurity (Household Hunger Scale) and treatment failure or death. We accounted for exclusion of patients lost to follow-up using inverse probability of censoring weighting and adjusted for measured confounders and nutritional status using inverse probability of treatment weighting. RESULTS We enrolled 257 participants (37% female) between May 2020 and March 2023 with a median age (interquartile range) of 35 (25-45) years. Of these, 105 (41%) had no hunger in the household, 104 (40%) had moderate hunger in the household, and 48 (19%) had severe hunger in the household. Eleven participants (4%) died, and 6 (3%) had treatment failure. After adjustment, food insecurity was significantly associated with subsequent treatment failure or death (odds ratio 5.78 [95% confidence interval, 1.20-27.8]; P = .03). CONCLUSIONS Household food insecurity at tuberculosis treatment initiation was significantly associated with death or treatment failure after accounting for loss to follow-up, measured confounders, and nutritional status. In addition to the known importance of undernutrition, our findings indicate that food insecurity independently affects tuberculosis treatment outcomes in Haiti.
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Affiliation(s)
- Aaron Richterman
- Department of Medicine (Infectious Diseases), University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Elie Saintilien
- Tuberculosis Program, Health Equity International/St Boniface Hospital, Fond-des-Blancs, Haiti
| | - Medgine St-Cyr
- Tuberculosis Program, Health Equity International/St Boniface Hospital, Fond-des-Blancs, Haiti
| | - Louise Claudia Gracia
- Tuberculosis Program, Health Equity International/St Boniface Hospital, Fond-des-Blancs, Haiti
| | - Sara Sauer
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Inobert Pierre
- Tuberculosis Program, Health Equity International/St Boniface Hospital, Fond-des-Blancs, Haiti
| | - Moise Compere
- Tuberculosis Program, Health Equity International/St Boniface Hospital, Fond-des-Blancs, Haiti
| | - Ahmed Elnaiem
- Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Dyemy Dumerjuste
- Tuberculosis Program, Health Equity International/St Boniface Hospital, Fond-des-Blancs, Haiti
| | - Louise C Ivers
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
- Center for Global Health, Massachusetts General Hospital, Boston, Massachusetts, USA
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Richterman A, Sinha P, Ivers LC, Gross R, Rantleru T, Tamuhla N, Bisson GP. Food Insecurity and Undernutrition Are Associated With Distinct Immunologic Profiles in People With Tuberculosis and Advanced HIV Starting Antiretroviral Therapy. J Acquir Immune Defic Syndr 2024; 95:494-504. [PMID: 38346410 PMCID: PMC10947883 DOI: 10.1097/qai.0000000000003386] [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] [Received: 09/25/2023] [Accepted: 12/20/2023] [Indexed: 03/17/2024]
Abstract
BACKGROUND Food insecurity and undernutrition are related but distinct concepts contributing to poor HIV and tuberculosis outcomes. Pathways linking them with immunologic profile, which may relate to clinical outcomes, remain understudied. METHODS We analyzed data from a cohort study of 165 antiretroviral therapy (ART)-naïve adults with advanced HIV and newly diagnosed tuberculosis in Botswana from 2009 to 2013. Twenty-nine plasma biomarkers were measured pre-ART and 4 weeks post-ART initiation. We used principal components analysis (PCA) and multivariable linear regression models to assess relationships between immunological profiles and food insecurity (based on the Household Food Insecurity Access Scale), undernutrition (body mass index <18.5 kg/m 2 ), and clinical outcomes. RESULTS PCA identified 5 principal components with eigenvalues >1. After adjustment, food insecurity was associated with PC3 pre-ART (0.19 per increased category of severity, 95% CI: 0.02 to 0.36) and post-ART (0.24, 95% CI: 0.07 to 0.41). PC3 was driven by higher levels of IFN-α, IFN-γ, interleukin (IL)-12p40, vascular endothelial growth factor, IL-1α, and IL-8 and decreased concentrations of IL-3. Undernutrition was associated with PC5 post-ART (0.49, 95% CI: 0.16 to 0.82). PC5 was driven by higher levels of IL-8, MIP-1α, IL-6, and IL-10 and decreased concentrations in IP-10 and IFN-α. Post-ART PC3 (4.3 percentage point increased risk per increased score of 1, 95% CI: 0.3 to 8.9) and post-ART PC5 (4.8, 95% CI: 0.6 to 8.9) were associated with death in adjusted models. DISCUSSION We identified 2 distinct immunologic profiles associated with food insecurity, undernutrition, and clinical outcomes in patients with advanced HIV and tuberculosis. Different pathophysiologic processes may link food insecurity and undernutrition with poor outcomes in this vulnerable patient population. Future studies should assess the impact of improving food access and intake on immune function and clinical outcomes.
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Affiliation(s)
- Aaron Richterman
- Department of Medicine (Infectious Diseases), University of Pennsylvania, Philadelphia, PA
| | - Pranay Sinha
- Department of Medicine (Infectious Diseases), Boston University Chobanian and Avedisian School of Medicine, Boston, MA
| | - Louise C Ivers
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA
- Center for Global Health, Massachusetts General Hospital, Boston, MA
| | - Robert Gross
- Department of Medicine (Infectious Diseases), University of Pennsylvania, Philadelphia, PA
- Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA; and
| | | | - Neo Tamuhla
- Botswana-UPenn Partnership, Gaborone, Botswana
| | - Gregory P Bisson
- Department of Medicine (Infectious Diseases), University of Pennsylvania, Philadelphia, PA
- Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA; and
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Whitehouse CR, Akyirem S, Petoskey C, Huang S, Lendvai D, Batten J, Whittemore R. A Systematic Review of Interventions That Address Food Insecurity for Persons With Prediabetes or Diabetes Using the RE-AIM Framework. Sci Diabetes Self Manag Care 2024; 50:141-166. [PMID: 38545669 DOI: 10.1177/26350106241232649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/16/2024]
Abstract
PURPOSE The purpose of this study is to systematically review interventions that address food insecurity for persons with prediabetes or type 2 diabetes using the RE-AIM (Reach, Effectiveness, Adoption, Implementation, Maintenance) framework. METHODS Six databases (OVIDMEDLINE, OVIDEMBASE, OVID APA PsycINFO, Web of Science, Cochrane Central Registry of Controlled Trials, and EBSCO CINAHL Complete) were searched through January 2023. Research team members independently performed screening of abstracts and full texts, data abstraction, and risk assessment. RESULTS In all, 3,139 unique citations were identified, and 20 studies met inclusion criteria. Interventions included medically tailored meals/groceries (n = 10) or produce prescriptions/vouchers (n = 10). Reach and effectiveness were the highest reported RE-AIM elements. Interventions reached a high-risk population via food banks, community-based outreach, and federally qualified health centers. A majority of participants identified as female, Black, or Hispanic/Latinx and were living below the federal poverty level. Most studies reported at least 1 diabetes outcome (ie, A1C, hypoglycemia, diabetes distress, diabetes self-management). Seventeen studies reported impact on A1C, with the majority reporting a decrease in A1C and 53% (9/17) of studies demonstrating a decrease over time. Self-management improved in 50% (3/6) of studies that evaluated this outcome. Self-efficacy improved in 40% (2/5) of studies, and improvements were seen in depressive symptoms/diabetes distress (4/7 studies) and quality of life (5/5 studies). Seven studies reported statistically significant improvements in food insecurity. CONCLUSION Food insecurity has been associated with higher risks and adverse clinical outcomes in adults with diabetes. Implementing interventions that address food insecurity among adults with or at risk for diabetes can enhance food security and clinically important diabetes-related outcomes. Additional research dedicated to the sustainability of interventions is needed.
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Affiliation(s)
| | | | | | - Shuyuan Huang
- NYU Rory Meyers College of Nursing, New York, New York
| | - Dora Lendvai
- VA Connecticut Healthcare System, West Haven, Connecticut
| | - Janene Batten
- Harvey Cushing/John Hay Whitney Medical Library, Yale University, Orange, Connecticut
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Franke MA, Emmrich JV, Ranjaharinony F, Ravololohanitra OG, Andriamasy HE, Knauss S, Muller N. A cross-sectional analysis of the effectiveness of a nutritional support programme for people with tuberculosis in Southern Madagascar using secondary data from a non-governmental organisation. Infect Dis Poverty 2024; 13:13. [PMID: 38303047 PMCID: PMC10835822 DOI: 10.1186/s40249-024-01182-8] [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] [Received: 11/04/2023] [Accepted: 01/25/2024] [Indexed: 02/03/2024] Open
Abstract
BACKGROUND There is a strong, bi-directional link between tuberculosis (TB) and undernutrition: TB often causes undernutrition, and undernourished people are more likely to contract TB and experience worse outcomes. Globally, several TB nutritional support programmes exist; however, evidence on their effectiveness is limited and contested. This study evaluates the effect of a nutritional support programme implemented for people with TB in the Atsimo-Andrefana region, Madagascar in 2022. Within this programme, undernourished people with TB [with a body mass index (BMI) of < 18.5 kg/m2] receive 0.6 L of vegetable oil and 6.0 kg of a soy-wheat blend per month throughout their TB treatment. METHODS We analysed secondary non-governmental organisation data collected between January and November 2022 in the Atsimo-Andrefana region, Southern Madagascar, including information on an individual's medical conditions (e.g., type of TB, treatment outcomes) and nutritional status measured prior to, during, and after completion of treatment (e.g., height, weight, mid-upper arm circumference). We conducted descriptive analyses of patient baseline characteristics and outcomes to assess the impact of the provided nutritional support on the BMI of people with TB. RESULTS A total of 1310 people with TB were included in the study [9.9% (130) children under the age of 5, 32.1% (420) children between 5 and 18 years, 58.0% (760) adults]. 55.4% of children under 5, 28.1% of children between ages 5 and 18, and 81.3% of adults were undernourished at treatment initiation. 42.3% (55/130) of children under 5 experienced severe acute malnutrition at treatment uptake. While the average BMI of adults with TB receiving food support increased over time, from 17.1 kg/m2 (interquartile range: 15.8-18.3, range: 10.3-22.5) to 17.9 kg/m2 (interquartile range: 16.6-19.1, range: 11.9-24.1), most adults remained undernourished even after completing TB treatment. CONCLUSIONS The current TB nutritional support programme falls short of sufficiently increasing the BMI of people with TB to overcome malnutrition. There is an urgent need to revise the nutritional support available for people with TB, particularly for children under 5.
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Affiliation(s)
- Mara Anna Franke
- Global Digital Health Lab at Charité Center for Global Health, Charité - Universitätsmedizin Berlin, Berlin, Germany.
- London School of Hygiene and Tropical Medicine, London, UK.
- Ärzte Für Madagaskar E.V., Leipzig, Germany.
| | - Julius Valentin Emmrich
- Global Digital Health Lab at Charité Center for Global Health, Charité - Universitätsmedizin Berlin, Berlin, Germany
- Ärzte Für Madagaskar E.V., Leipzig, Germany
- Heidelberg Institute of Global Health, Heidelberg University, Heidelberg, Germany
- Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Berlin, Germany
| | | | | | - Harizaka Emmanuel Andriamasy
- Global Digital Health Lab at Charité Center for Global Health, Charité - Universitätsmedizin Berlin, Berlin, Germany
- Doctors for Madagascar, Antananarivo, Madagascar
| | - Samuel Knauss
- Global Digital Health Lab at Charité Center for Global Health, Charité - Universitätsmedizin Berlin, Berlin, Germany
- Ärzte Für Madagaskar E.V., Leipzig, Germany
- Heidelberg Institute of Global Health, Heidelberg University, Heidelberg, Germany
- Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Nadine Muller
- Global Digital Health Lab at Charité Center for Global Health, Charité - Universitätsmedizin Berlin, Berlin, Germany
- Ärzte Für Madagaskar E.V., Leipzig, Germany
- Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Berlin, Germany
- Speciality Network: Infectious Diseases and Respiratory Medicine, Charité - Universitätsmedizin Berlin, Berlin, Germany
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Hamill MM, Hu F, Adebajo S, Kokogho A, Tiamiyu AB, Parker ZF, Charurat ME, Ake JA, Baral SD, Nowak RG, Crowell TA. Food and Water Insecurity in Sexual and Gender Minority Groups Living With HIV in Lagos, Nigeria. J Acquir Immune Defic Syndr 2023; 93:171-180. [PMID: 36881816 PMCID: PMC10293107 DOI: 10.1097/qai.0000000000003183] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Accepted: 02/22/2023] [Indexed: 03/09/2023]
Abstract
BACKGROUND Food and water insecurity are associated with poor health outcomes that may be exacerbated by social marginalization and barriers to health care experienced by sexual and gender minorities (SGM) in resource-limited settings. We explored factors associated with food and water insecurity in SGM with HIV. SETTING A longitudinal study of 357 men who have sex with men, transgender women, and other gender-identifying people in Lagos, Nigeria. METHODS Laboratory testing, interviews, food and water assessments, and anthropometry were performed quarterly. Robust Poisson regression with generalized estimating equations was used to evaluate factors potentially associated with food and water insecurity. RESULTS From 2014 to 2018, 357 SGM with HIV completed either the food or water assessments. At baseline, participants identified as cisgender men who have sex with men 265 (74.2%), transgender women 63 (17.7%), or as nonbinary/other gender 29 (8.1%). Food insecurity and water insecurity were reported by 63/344(18.3%) and 113/357(31.7%), respectively, at any visit. Food and water insecurity each decreased with ongoing study participation. Food insecurity was associated with nonpartnered relationship status, CD4 count <500 cells/mm 3 , and lack of access to piped water. Water insecurity was associated with age 25 years or older, living with a man, transactional sex, and food insecurity. CONCLUSIONS Food and water insecurity were common among SGM in Nigeria and decreased with continued study participation, suggesting amenability to intervention when SGM are successfully engaged in care. Targeted interventions to support food and water security may improve HIV-related outcomes, such as CD4 count.
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Affiliation(s)
- Matthew M. Hamill
- Division of Infectious Diseases, Johns Hopkins Medicine, Baltimore, USA
| | - Fengming Hu
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, USA
- Henry M Jackson Foundation for the Advancement of Military Medicine Inc, Bethesda, USA
| | - Sylvia Adebajo
- Maryland Global Initiatives Corporation, University of Maryland Baltimore, Baltimore, USA
| | - Afoke Kokogho
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, USA
- Henry M Jackson Foundation for the Advancement of Military Medicine Inc, Bethesda, USA
| | - Abdulwasiu B. Tiamiyu
- HJF Medical Research International, Abuja, Nigeria
- US Army Medical Research Directorate-Africa/Nigeria, Abuja, Nigeria
| | - Zahra F. Parker
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, USA
- Henry M Jackson Foundation for the Advancement of Military Medicine Inc, Bethesda, USA
- US Army Medical Research Directorate-Africa/Nigeria, Abuja, Nigeria
| | - Manhattan E. Charurat
- Institute of Human Virology, University of Maryland School of Medicine, Baltimore, USA
| | - Julie A. Ake
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, USA
| | - Stefan D. Baral
- Department of Epidemiology, Johns Hopkins University, Baltimore, USA
| | - Rebecca G. Nowak
- Institute of Human Virology, University of Maryland School of Medicine, Baltimore, USA
| | - Trevor A. Crowell
- Division of Infectious Diseases, Johns Hopkins Medicine, Baltimore, USA
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, USA
- Henry M Jackson Foundation for the Advancement of Military Medicine Inc, Bethesda, USA
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Elnaiem AD, Franke MF, Richterman A, Guillaume Y, Vissieres K, Augustin GC, Ternier R, Ivers LC. Food insecurity and risk of cholera: A cross-sectional study and exploratory analysis of potential mediators. PLoS Negl Trop Dis 2023; 17:e0010574. [PMID: 36745661 PMCID: PMC9934351 DOI: 10.1371/journal.pntd.0010574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 02/16/2023] [Accepted: 01/23/2023] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Food insecurity has been independently associated with developing cholera and there is an inverse relationship between national food security and annual cholera incidence. However, the factors that mediate the risk of cholera among food insecure households remain largely unexplored. METHODOLOGY AND PRINCIPAL FINDINGS In a cross-sectional survey of rural households in Haiti, we explored the role of food behaviors (i.e., dietary choices and food-handling practices) as mediators of cholera risk among food-insecure families. We generated a series of multivariable regression models to test hypothesized associations between the severity of food insecurity (measured by the Household Hunger Scale), hygiene and food behaviors, and history of severe, medically-attended cholera. Moderate household hunger (Adjusted Odds Ratio [AOR] 1.47, 95% Confidence Interval (CI) 1.05-2.04; p = 0.021) and severe hunger (AOR 2.45, 95% CI 1.45-4.15; p = 0.001) were positively associated with a history of severe, medically-attended cholera compared with little to no household hunger. Household hunger was positively associated with three behaviors: antacid use, consumption of leftover non-reheated food, and eating food and beverages prepared outside of the home (i.e., at a restaurant or from a vendor). Consumption of outside food items and antacid use were positively associated with a history of cholera. CONCLUSION Our findings suggest that food behaviors may mediate the association between food insecurity and cholera and contribute to an understanding of how interventions could be designed to target food insecurity as part of cholera prevention and control.
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Affiliation(s)
- Ahmed D. Elnaiem
- Department of Medicine, Division of Global Health Equity, Brigham and Women’s Hospital, Boston, Massachusetts, United States of America
| | - Molly F. Franke
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Aaron Richterman
- Division of Infectious Diseases, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
| | - Yodeline Guillaume
- Center for Global Health, Massachusetts General Hospital, Boston, Massachusetts, United States of America
| | | | | | | | - Louise C. Ivers
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, United States of America
- Center for Global Health, Massachusetts General Hospital, Boston, Massachusetts, United States of America
- * E-mail:
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Ghazy RM, Sallam M, Ashmawy R, Elzorkany AM, Reyad OA, Hamdy NA, Khedr H, Mosallam RA. Catastrophic Costs among Tuberculosis-Affected Households in Egypt: Magnitude, Cost Drivers, and Coping Strategies. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:ijerph20032640. [PMID: 36768005 PMCID: PMC9915462 DOI: 10.3390/ijerph20032640] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/01/2023] [Revised: 01/24/2023] [Accepted: 01/30/2023] [Indexed: 05/31/2023]
Abstract
Despite national programs covering the cost of treatment for tuberculosis (TB) in many countries, TB patients still face substantial costs. The end TB strategy, set by the World Health Organization (WHO), calls for "zero" TB households to be affected by catastrophic payments by 2025. This study aimed to measure the catastrophic healthcare payments among TB patients in Egypt, to determine its cost drivers and determinants and to describe the coping strategies. The study utilized an Arabic-validated version of the TB cost tool developed by the WHO for estimating catastrophic healthcare expenditure using the cluster-based sample survey with stratification in seven administrative regions in Alexandria. TB payments were considered catastrophic if the total cost exceeded 20% of the household's annual income. A total of 276 patients were interviewed: 76.4% were males, 50.0% were in the age group 18-35, and 8.3% had multidrug-resistant TB. Using the human capital approach, 17.0% of households encountered catastrophic costs compared to 59.1% when using the output approach. The cost calculation was carried out using the Egyptian pound converted to the United States dollars based on 2021 currency values. Total TB cost was United States dollars (USD) 280.28 ± 29.9 with a total direct cost of USD 103 ± 10.9 and a total indirect cost of USD 194.15 ± 25.5. The direct medical cost was the main cost driver in the pre-diagnosis period (USD 150.23 ± 26.89 pre diagnosis compared to USD 77.25 ± 9.91 post diagnosis, p = 0.013). The indirect costs (costs due to lost productivity) were the main cost driver in the post-diagnosis period (USD 4.68 ± 1.18 pre diagnosis compared to USD 192.84 ± 25.32 post diagnosis, p < 0.001). The households drew on multiple financial strategies to cope with TB costs where 66.7% borrowed and 25.4% sold household property. About two-thirds lost their jobs and another two-thirds lowered their food intake. Being female, delay in diagnosis and being in the intensive phase were significant predictors of catastrophic payment. Catastrophic costs were high among TB households in Alexandria and showed wide variation according to the method used for indirect cost estimation. The main cost driver before diagnosis was the direct medical costs, while it was the indirect costs, post diagnosis.
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Affiliation(s)
- Ramy Mohamed Ghazy
- Tropical Health Department, High Institute of Public Health, Alexandria University, Alexandria 21561, Egypt
| | - Malik Sallam
- Department of Pathology, Microbiology and Forensic Medicine, School of Medicine, The University of Jordan, Amman 11942, Jordan
- Department of Clinical Laboratories and Forensic Medicine, Jordan University Hospital, Amman 11942, Jordan
| | - Rasha Ashmawy
- Department of Clinical Research, Maamora Chest Hospital, Alexandria 21923, Egypt
| | | | - Omar Ahmed Reyad
- Internal Medicine and Cardiology Clinical Pharmacy Department, Alexandria University Main Hospital, Alexandria 21526, Egypt
| | - Noha Alaa Hamdy
- Department of Clinical Pharmacy & Pharmacy Practice, Faculty of Pharmacy, Alexandria University, Alexandria 21521, Egypt
| | - Heba Khedr
- MDR-TB Center, Maamora Chest Hospital, Alexandria 21912, Egypt
| | - Rasha Ali Mosallam
- Department of Health Administration and Behavioral Science, High Institute of Public Health, Alexandria University, Alexandria 21561, Egypt
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Vanleeuw L, Zembe-Mkabile W, Atkins S. "I'm suffering for food": Food insecurity and access to social protection for TB patients and their households in Cape Town, South Africa. PLoS One 2022; 17:e0266356. [PMID: 35472210 PMCID: PMC9041827 DOI: 10.1371/journal.pone.0266356] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Accepted: 03/18/2022] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Tuberculosis (TB) is a major health concern and the number one cause of death in South Africa. Social protection programmes can strengthen the resilience of TB patients, their families and households. This study aimed to get a better understanding of the role of social protection and other forms of support in relation to the burden of TB on patients and their households in South Africa. METHODS This is a cross-sectional exploratory qualitative study using a phenomenological approach to focus on the lived experiences and perceptions of TB patients and healthcare workers. We interviewed 16 patients and six healthcare workers and analysed data thematically. RESULTS The challenges faced by participants were closely related to household challenges. Participants reported a heavy physical burden, aggravated by a lack of nutritious food and that households could not provide the food they needed. Some needed to resort to charity. At the same time, households were significantly affected by the burden of caring for the patient-and remained the main source of financial, emotional and physical support. Participants reported challenges and costs associated with the application process and high levels of discretion by the assessing doctor allowing doctors' opinions and beliefs to influence their assessment. CONCLUSION Access to adequate nutritious food was a key issue for many patients and this need strained already stretched households and budgets. Few participants reported obtaining state social protection support during their illness, but many reported challenges and high costs of trying to access it. Further research should be conducted on support mechanisms and interventions for TB patients, but also their households, including food support, social protection and contact tracing. In deciding eligibility for grants, the situation of the household should be considered in addition to the individual patient.
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Affiliation(s)
- Lieve Vanleeuw
- Health Systems Research unit, South African Medical Research Council, Tygerberg, South Africa
- New Social Research and Global Health and Development, Faculty of Social Sciences, Tampere University, Tampere, Finland
| | - Wanga Zembe-Mkabile
- Health Systems Research unit, South African Medical Research Council, Tygerberg, South Africa
- Archie Mafeje Social Policy Research Institute, School of Transdisciplinary Research and Graduate, Studies, University of South Africa, Pretoria, South Africa
| | - Salla Atkins
- New Social Research and Global Health and Development, Faculty of Social Sciences, Tampere University, Tampere, Finland
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
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Robbiati C, Armando A, da Conceição N, Putoto G, Cavallin F. Association between diabetes and food insecurity in an urban setting in Angola: a case–control study. Sci Rep 2022; 12:1084. [PMID: 35058483 PMCID: PMC8776869 DOI: 10.1038/s41598-022-04888-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Accepted: 12/28/2021] [Indexed: 11/17/2022] Open
Abstract
Diabetes is common in urban settings in Sub-Saharan Africa. Household food insecurity has been suggested to increase the chance of developing diabetes among adults. The relationship between diabetes and food insecurity has not been explored in Angolan urban settings so far. This case–control (1:2) study investigated the association between diabetes and food insecurity among adults attending six healthcare facilities in Luanda (Angola) between April 2019 and September 2019. All subjects with fasting blood glucose (FBG) levels ≥ 126 mg/dl were included as cases. For each case, the next two subjects with FBG levels < 110 mg/dl were included as controls, to warrant the achievement of the set 1:2 ratio. Food insecurity was assessed using the Food Insecurity Experience Scale (FIES). A total of 663 participants (221 cases and 442 controls) were enrolled in the study. Median FIES raw score was 7 (IQR 1–8) in cases and 5 (IQR 2–8) in controls (p = 0.09). The distribution of FIES levels (0–3; 4–6; 7–8) was different between cases and controls (p < 0.0001), with highest FIES scores (7–8) recorded in 53.0% of cases and 38.2% of controls. Our findings revealed an association between diabetes and severe food insecurity among adults attending healthcare facilities in the capital city of Angola.
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Thomas S, Abraham A, Callaghan PJ, Rappuoli R. Challenges for Vaccinologists in the First Half of the Twenty-First Century. Methods Mol Biol 2022; 2410:3-25. [PMID: 34914040 DOI: 10.1007/978-1-0716-1884-4_1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
The COVID-19 pandemic of 2020-2021 has highlighted the importance of vaccines and vaccination in human health. The pandemic has resulted in social distancing, travel restrictions, decreased trade, high unemployment, commodity price decline, and financial stress that has impacted the global economy. Since December 2020, a massive vaccination campaign is undergoing in every country on the planet to protect against SARS-CoV-2. Vaccination is the cheapest health-care interventions that can save more lives than any other drugs or therapies. Some of the common diseases of the twentieth century including smallpox and polio are seldom reported due to intense vaccination programs that eradicated it. Smallpox is completely eradicated globally; whereas, polio is confined to only a couple of countries. Vaccination has not only improved the health of man but also improved food security by preventing diseases in farm animals and aquacultured fish. Awareness of the principles of immunology and novel vaccines has led to effective vaccination strategies. Climate change could lead to generation of new strains of infectious microorganisms that would require development of novel vaccines. Recent years have seen the increase in incidence of brain-eating amoeba and flesh-eating bacteria (necrotizing fasciitis). There are no vaccines for these diseases. Though vaccination programs have eradicated several diseases and increased the quality of life, there are several diseases that have no effective vaccines. Currently there are no vaccines for cancer, neurodegenerative diseases, autoimmune diseases, as well as infectious diseases like tuberculosis, AIDS, and parasitic diseases including malaria. Spontaneous evolution of pathogenic microorganisms may lead to pandemics that impact the health of not only humanity but also other animals. Hence, the challenge to vaccinologists is the development of novel vaccines and vaccination strategies within limited time period and using minimum resources. In addition, the vaccine developed should be administered globally within a short duration so as to prevent generation of pathogenic variants more lethal than the parent strain.
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Affiliation(s)
- Sunil Thomas
- Lankenau Institute for Medical Research, Wynnewood, USA.
| | - Ann Abraham
- Lankenau Institute for Medical Research, Wynnewood, USA
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Soboka M, Tesfaye M, Adorjan K, Krahl W, Tesfaye E, Yitayih Y, Strobl R, Grill E. Effect of food insecurity on mental health of patients with tuberculosis in Southwest Ethiopia: a prospective cohort study. BMJ Open 2021; 11:e045434. [PMID: 34588229 PMCID: PMC8479992 DOI: 10.1136/bmjopen-2020-045434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE The objective of this study is to investigate the effect of food insecurity on the mental health of patients with tuberculosis (TB) in Ethiopia. DESIGN A prospective cohort study. SETTING Health centres and hospitals located in Jimma zone, Southwest Ethiopia. PARTICIPANTS Patients with TB who had recently been diagnosed with TB and started directly observed treatment in the selected 26 health institutions from October 2017 to October 2018. A total of 268 patients were followed for 6 months and data were collected at recruitment and two follow-up visits (at 2 and 6 months). Patients with multidrug-resistant TB were not included in the study. MAIN OUTCOME MEASURES Mental distress was measured by the Self-Reporting Questionnaire-20 while food insecurity was assessed by using the Household Food Insecurity Access Scale. RESULTS A total of 268 patients were recruited and there was no lost to follow-up. The prevalence of food insecurity at baseline, first and second follow-up was 49.3%, 45.9% and 39.6%, respectively. Of these, 28.0% of them reported severe food insecurity at baseline which declined to 23.5% at the end of the sixth month. Likewise, the prevalence of mental distress at baseline was 61.2% but declined to 22.0% at the second follow-up. At baseline, 77.3% of patients with mental distress reported severe food insecurity but declined to 46.0% at second follow-up. In the final model, severe food insecurity (OR 4.7, 95% CI 2.4 to 9.4) and being a government employee (adjusted odds ratio (aOR) 0.3, 95% CI 0.1 to 0.9) were associated with mental distress. CONCLUSION In this study, food insecurity was associated with mental distress over the course of follow-up. Likewise, there is a high prevalence of food insecurity and mental distress among patients with TB on treatment. Therefore, early assessment and interventions for food insecurity may improve the mental health of patients with TB on treatment.
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Affiliation(s)
- Matiwos Soboka
- Center for International Health, Ludwig Maximilian University, Munich, Germany
- Department of Psychiatry, Medical Faculty, Jimma University, Jimma, Ethiopia
| | - Markos Tesfaye
- Center for International Health, Ludwig Maximilian University, Munich, Germany
- Department of Psychiatry, St. Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Kristina Adorjan
- Center for International Health, Ludwig Maximilian University, Munich, Germany
- Institute of Psychiatric Phenomics and Genomics (IPPG), University Hospital, LMU, Munich, Germany
- Department of Psychiatry and Psychotherapy, LMU Munich, Munich, Germany
| | - Wolfgang Krahl
- Center for International Health, Ludwig Maximilian University, Munich, Germany
- Department of Forensic Psychiatry, Isar Amper Klinikum, Munich, Germany
| | - Elias Tesfaye
- Department of Psychiatry, Medical Faculty, Jimma University, Jimma, Ethiopia
| | - Yimenu Yitayih
- Department of Psychiatry, Medical Faculty, Jimma University, Jimma, Ethiopia
| | - Ralf Strobl
- German Center for Vertigo and Balance Disorders, University Hospital LMU Muenchen, Munich, Germany
- Institute for Medical Information Processing, Biometry and Epidemiology, Ludwig Maximilians University Muenchen, Munich, Germany
| | - Eva Grill
- Center for International Health, Ludwig Maximilian University, Munich, Germany
- German Center for Vertigo and Balance Disorders, University Hospital LMU Muenchen, Munich, Germany
- Institute for Medical Information Processing, Biometry and Epidemiology, Ludwig Maximilians University Muenchen, Munich, Germany
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Uppal A, Oxlade O, Nsengiyumva NP, N'Diaye DS, Alvarez GG, Schwartzman K. Social and behavioral risk reduction strategies for tuberculosis prevention in Canadian Inuit communities: a cost-effectiveness analysis. BMC Public Health 2021; 21:280. [PMID: 33536003 PMCID: PMC7860224 DOI: 10.1186/s12889-021-10187-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Accepted: 01/06/2021] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Tuberculosis (TB) is an important public health problem in Inuit communities across Canada, with an annual incidence rate in 2017 that was nearly 300 times higher than in Canadian-born non-Indigenous individuals. Social and behavioral factors that are prevalent in the North, such as commercial tobacco use, excessive alcohol use, food insecurity and overcrowded housing put individuals at higher risk for TB morbidity and mortality. We examined the potential impact of mitigation strategies for these risk factors, in reducing TB burden in this setting. METHODS We created a transmission model to simulate the epidemiology of TB in Nunavut, Canada. We then used a decision analysis model to assess the potential impact of several evidence-based strategies targeting tobacco use, excessive alcohol use, food insecurity and overcrowded housing. We predicted TB incidence, TB-related deaths, quality adjusted life years (QALYs), and associated costs and cost-effectiveness over 20 years. All costs were expressed in 2018 Canadian dollars. RESULTS Compared to a status quo scenario with no new interventions for these risk factors, the reduction strategy for tobacco use was most effective and cost-effective, reducing TB incidence by 5.5% (95% uncertainty range: 2.7-11%) over 20 years, with an estimated cost of $95,835 per TB case prevented and $49,671 per QALY gained. The addition of the food insecurity reduction strategy reduced incidence by a further 2% (0.5-3%) compared to the tobacco cessation strategy alone, but at significant cost. CONCLUSIONS Strategies that aim to reduce commercial tobacco use and improve food security will likely lead to modest reductions in TB morbidity and mortality. Although important for the communities, strategies that address excess alcohol use and overcrowding will likely have a more limited impact on TB-related outcomes at current scale, and are associated with much higher cost. Their benefits will be more substantial with scale up, which will also likely have important downstream impacts such as improved mental health, educational attainment and food security.
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Affiliation(s)
- Aashna Uppal
- Montreal Chest Institute, Montreal, Quebec, Canada
- Respiratory Epidemiology and Clinical Research Unit, Centre for Outcomes Research and Evaluation, Research Institute of McGill University Health Centre, Montreal, Quebec, Canada
- McGill International Tuberculosis Centre, 1001 boulevard Décarie, Room D05.2511, Montréal, Québec, H4A 3J1, Canada
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada
| | - Olivia Oxlade
- Respiratory Epidemiology and Clinical Research Unit, Centre for Outcomes Research and Evaluation, Research Institute of McGill University Health Centre, Montreal, Quebec, Canada
- McGill International Tuberculosis Centre, 1001 boulevard Décarie, Room D05.2511, Montréal, Québec, H4A 3J1, Canada
| | - Ntwali Placide Nsengiyumva
- Respiratory Epidemiology and Clinical Research Unit, Centre for Outcomes Research and Evaluation, Research Institute of McGill University Health Centre, Montreal, Quebec, Canada
- McGill International Tuberculosis Centre, 1001 boulevard Décarie, Room D05.2511, Montréal, Québec, H4A 3J1, Canada
| | - Dieynaba S N'Diaye
- Montreal Chest Institute, Montreal, Quebec, Canada
- Respiratory Epidemiology and Clinical Research Unit, Centre for Outcomes Research and Evaluation, Research Institute of McGill University Health Centre, Montreal, Quebec, Canada
- McGill International Tuberculosis Centre, 1001 boulevard Décarie, Room D05.2511, Montréal, Québec, H4A 3J1, Canada
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada
| | - Gonzalo G Alvarez
- The Ottawa Hospital Research Institute, Department of Medicine, Division of Respirology, The Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada
| | - Kevin Schwartzman
- Montreal Chest Institute, Montreal, Quebec, Canada.
- Respiratory Epidemiology and Clinical Research Unit, Centre for Outcomes Research and Evaluation, Research Institute of McGill University Health Centre, Montreal, Quebec, Canada.
- McGill International Tuberculosis Centre, 1001 boulevard Décarie, Room D05.2511, Montréal, Québec, H4A 3J1, Canada.
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada.
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Mwamba C, Kerkhoff AD, Kagujje M, Lungu P, Muyoyeta M, Sharma A. Diagnosed with TB in the era of COVID-19: patient perspectives in Zambia. Public Health Action 2020; 10:141-146. [PMID: 33437679 DOI: 10.5588/pha.20.0053] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Accepted: 10/23/2020] [Indexed: 11/10/2022] Open
Abstract
Introduction Delayed TB diagnosis and treatment perpetuate the high burden of TB-related morbidity and mortality in resource-constrained settings. We explored the potential of COVID-19 to further compromise TB care engagement in Zambia. Methods From April to May 2020, we purposefully selected 17 adults newly diagnosed with TB from three public health facilities in Lusaka, Zambia, for in-depth phone interviews. We conducted thematic analyses using a hybrid approach. Results The majority of participants were highly concerned about the impact of lockdowns on their financial security. Most were not worried about being diagnosed with COVID-19 when seeking care for their illness because they felt unwell prior to the outbreak; however, they were very worried about contracting COVID-19 during clinic visits. COVID-19 was perceived as a greater threat than TB as it is highly transmittable and there is no treatment for it, which provoked fear of social isolation and of death among participants in case they contracted it. Nonetheless, participants reported willingness to continue with TB medication and the clinic visits required to improve their health. Conclusion The COVID-19 pandemic did not appear to deter care-seeking for TB by patients. However, messaging on TB in the era of COVID-19 must encourage timely care-seeking by informing people of infection control measures taken at health facilities.
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Affiliation(s)
- C Mwamba
- Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
| | - A D Kerkhoff
- Division of HIV, Infectious Diseases and Global Medicine, Zuckerberg San Francisco General Hospital and Trauma Center, University of California, San Francisco, San Francisco, CA, USA
| | - M Kagujje
- Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
| | - P Lungu
- National Tuberculosis and Leprosy Control Programme, Lusaka.,Department of Internal Medicine, University Teaching Hospital, Lusaka, Zambia
| | - M Muyoyeta
- Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
| | - A Sharma
- Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
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Lee G, Scuffell J, Galea JT, Shin SS, Magill E, Jaramillo E, Sweetland AC. Impact of mental disorders on active TB treatment outcomes: a systematic review and meta-analysis. Int J Tuberc Lung Dis 2020; 24:1279-1284. [PMID: 33317672 PMCID: PMC7740071 DOI: 10.5588/ijtld.20.0458] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND: Comorbid mental disorders in patients with TB may exacerbate TB treatment outcomes. We systematically reviewed current evidence on the association between mental disorders and TB outcomes.METHODS: We searched eight databases for studies published from 1990 to 2018 that compared TB treatment outcomes among patients with and without mental disorders. We excluded studies that did not systematically assess mental disorders and studies limited to substance use. We extracted study and patient characteristics and effect measures and performed a meta-analysis using random-effects models to calculate summary odds ratios (ORs) with 95% confidence intervals (CIs).RESULTS: Of 7687 studies identified, 10 were included in the systematic review and nine in the meta-analysis. Measurement of mental disorders and TB outcomes were heterogeneous across studies. The pooled association between mental disorders and any poor outcome, loss to follow-up, and non-adherence were OR 2.13 (95%CI 0.85-5.37), 1.90 (95%CI 0.33-10.91), and 1.60 (95%CI 0.81-3.02), respectively. High statistical heterogeneity was present.CONCLUSION: Our review suggests that mental disorders in TB patients increase the risk of poor TB outcomes, but pooled estimates were imprecise due to small number of eligible studies. Integration of psychological and TB services might improve TB outcomes and progress towards TB elimination.
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Affiliation(s)
- G Lee
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, QC, Canada
| | - J Scuffell
- School of Population Health and Environmental Sciences, King´s College London, London, UK
| | - J T Galea
- School of Social Work, College of Behavioral and Community Sciences, University of South Florida, Tampa, FL, College of Public Health, University of South Florida, Tampa, FL
| | - S S Shin
- Sue & Bill Gross School of Nursing, University of California at Irvine, Irvine, CA
| | - E Magill
- Department of Psychiatry, Columbia Vagelos College of Physicians and Surgeons, New York State Psychiatric Institute, New York, NY, USA
| | - E Jaramillo
- Global Tuberculosis Programme, World Health Organization, Geneva, Switzerland
| | - A C Sweetland
- Department of Psychiatry, Columbia Vagelos College of Physicians and Surgeons, New York State Psychiatric Institute, New York, NY, USA
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