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Zapata JP, Zamantakis A, Queiroz A, Merle JL, Benbow N, Mustanski B. Pre-exposure Prophylaxis (PrEP) implementation among latino MSM: a qualitative scoping review of implementation determinants and change methods. Implement Sci Commun 2024; 5:107. [PMID: 39350221 PMCID: PMC11441171 DOI: 10.1186/s43058-024-00645-1] [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: 11/07/2023] [Accepted: 09/16/2024] [Indexed: 10/04/2024] Open
Abstract
INTRODUCTION The increasing rates of HIV among Latino men who have sex with men (MSM) necessitate innovative and rigorous studies to evaluate prevention and treatment strategies. Pre-exposure prophylaxis (PrEP) is a highly effective tool in preventing HIV acquisition and plays a crucial role in the Ending the HIV Epidemic in the U.S. initiative. However, there is a scarcity of PrEP research specifically focused on Latino MSM, and the factors influencing its implementation remain largely unknown. METHODS To address this gap, we conducted a comprehensive review exploring the determinants (barriers and facilitators) of PrEP implementation among Latino MSM, as well as the change methods (implementation strategies and adjunctive interventions) that have been evaluated to promote its adoption. Our review encompassed 43 peer-reviewed articles examining determinants and four articles assessing change methods. Determinants were coded using the updated Consolidated Framework for Implementation Research (CFIR 2.0) to understand the multilevel barriers and facilitators associated with implementation. RESULTS The majority of research has focused on PrEP recipients (i.e., patients), primarily examining their awareness and willingness to use PrEP. Fewer studies have explored the factors influencing clinicians and service delivery systems. Additionally, the evaluation of change methods to enhance clinician adoption and adherence to PrEP and recipient adherence to PrEP has been limited. CONCLUSION It is evident that there is a need for culturally adapted strategies tailored specifically for Latino MSM, as the current literature remains largely unexplored in this regard. By incorporating principles from implementation science, we can gain a clearer understanding of the knowledge, skills, and roles necessary for effective cultural adaptations. Future research should emphasize factors influencing implementation from a clinician standpoint and focus on innovative change methods to increase PrEP awareness, reach, adoption, and sustained adherence among Latino MSM.
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Affiliation(s)
- Juan Pablo Zapata
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, Chicago, IL, USA.
- Medical Social Sciences Department, Northwestern University, Chicago, IL, USA.
| | - Alithia Zamantakis
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, Chicago, IL, USA
- Medical Social Sciences Department, Northwestern University, Chicago, IL, USA
| | - Artur Queiroz
- Center of Population Sciences for Health Equity, College of Nursing, Florida State University, Tallahassee, FL, USA
| | - James L Merle
- Department of Population Health Sciences, Spencer Fox Eccles School of Medicine, University of Utah, Salt Lake City, UT, USA
| | - Nanette Benbow
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, Chicago, IL, USA
- Medical Social Sciences Department, Northwestern University, Chicago, IL, USA
| | - Brian Mustanski
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, Chicago, IL, USA
- Medical Social Sciences Department, Northwestern University, Chicago, IL, USA
- Department of Psychiatry and Behavioral Sciences, Northwestern University, Chicago, IL, USA
- Department of Infectious Diseases, Northwestern University, Chicago, IL, USA
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McKay VR, Zamantakis A, Pachicano AM, Merle JL, Purrier MR, Swan M, Li DH, Mustanski B, Smith JD, Hirschhorn LR, Benbow N. Establishing evidence criteria for implementation strategies in the US: a Delphi study for HIV services. Implement Sci 2024; 19:50. [PMID: 39010153 PMCID: PMC11251241 DOI: 10.1186/s13012-024-01379-3] [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: 02/21/2024] [Accepted: 06/28/2024] [Indexed: 07/17/2024] Open
Abstract
BACKGROUND There are no criteria specifically for evaluating the quality of implementation research and recommending implementation strategies likely to have impact to practitioners. We describe the development and application of the Best Practices Tool, a set of criteria to evaluate the evidence supporting HIV-specific implementation strategies. METHODS We developed the Best Practices Tool from 2022-2023 in three phases. (1) We developed a draft tool and criteria based on a literature review and key informant interviews. We purposively selected and recruited by email interview participants representing a mix of expertise in HIV service delivery, quality improvement, and implementation science. (2) The tool was then informed and revised through two e-Delphi rounds using a survey delivered online through Qualtrics. The first and second round Delphi surveys consisted of 71 and 52 open and close-ended questions, respectively, asking participants to evaluate, confirm, and make suggestions on different aspects of the rubric. After each survey round, data were analyzed and synthesized as appropriate; and the tool and criteria were revised. (3) We then applied the tool to a set of research studies assessing implementation strategies designed to promote the adoption and uptake of evidence-based HIV interventions to assess reliable application of the tool and criteria. RESULTS Our initial literature review yielded existing tools for evaluating intervention-level evidence. For a strategy-level tool, additions emerged from interviews, for example, a need to consider the context and specification of strategies. Revisions were made after both Delphi rounds resulting in the confirmation of five evaluation domains - research design, implementation outcomes, limitations and rigor, strategy specification, and equity - and four evidence levels - best, promising, more evidence needed, and harmful. For most domains, criteria were specified at each evidence level. After an initial pilot round to develop an application process and provide training, we achieved 98% reliability when applying the criteria to 18 implementation strategies. CONCLUSIONS We developed a tool to evaluate the evidence supporting implementation strategies for HIV services. Although specific to HIV in the US, this tool is adaptable for evaluating strategies in other health areas.
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Affiliation(s)
- Virginia R McKay
- Center for Public Health Systems Science, Brown School, Washington University in St. Louis, St. Louis, MO, USA.
| | - Alithia Zamantakis
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, Chicago, IL, USA
| | - Ana Michaela Pachicano
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, Chicago, IL, USA
| | - James L Merle
- Department of Population Health Sciences, Division of Health System Innovation and Research, Spencer Fox Eccles School of Medicine, The University of Utah, Salt Lake City, UT, USA
| | - Morgan R Purrier
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, Chicago, IL, USA
| | - McKenzie Swan
- Center for Public Health Systems Science, Brown School, Washington University in St. Louis, St. Louis, MO, USA
| | - Dennis H Li
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, Chicago, IL, USA
- Center for Prevention Implementation Methodology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
- Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
- Center for Dissemination and Implementation Science, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Brian Mustanski
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, Chicago, IL, USA
- Center for Prevention Implementation Methodology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
- Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Justin D Smith
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, Chicago, IL, USA
| | - Lisa R Hirschhorn
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Nanette Benbow
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, Chicago, IL, USA
- Center for Prevention Implementation Methodology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
- Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
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Harkness A, Giusto A, Hamilton AB, Hernandez‐Ramirez RU, Spiegelman D, Weiner BJ, Beidas RS, Larson ME, Lippman SA, Wainberg ML, Smith JD. Navigating grey areas in HIV and mental health implementation science. J Int AIDS Soc 2024; 27:e26271. [PMID: 38923301 PMCID: PMC11197965 DOI: 10.1002/jia2.26271] [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: 08/16/2023] [Accepted: 04/29/2024] [Indexed: 06/28/2024] Open
Abstract
INTRODUCTION Implementation science (IS) offers methods to systematically achieve the Ending the HIV Epidemic goals in the United States, as well as the global UNAIDS targets. Federal funders such as the National Institutes of Mental Health (NIMH) have invested in implementation research to achieve these goals, including supporting the AIDS Research Centres (ARCs), which focus on high-impact science in HIV and mental health (MH). To facilitate capacity building for the HIV/MH research workforce in IS, "grey areas," or areas of IS that are confusing, particularly for new investigators, should be addressed in the context of HIV/MH research. DISCUSSION A group of IS experts affiliated with NIMH-funded ARCs convened to identify common and challenging grey areas. The group generated a preliminary list of 19 grey areas in HIV/MH-related IS. From the list, the authors developed a survey which was distributed to all ARCs to prioritize grey areas to address in this paper. ARC members across the United States (N = 60) identified priority grey areas requiring clarification. This commentary discusses topics with 40% or more endorsement. The top grey areas that ARC members identified were: (1) Differentiating implementation strategies from interventions; (2) Determining when an intervention has sufficient evidence for adaptation; (3) Integrating recipient perspectives into HIV/MH implementation research; (4) Evaluating whether an implementation strategy is evidence-based; (5) Identifying rigorous approaches for evaluating the impact of implementation strategies in the absence of a control group or randomization; and (6) Addressing innovation in HIV/MH IS grants. The commentary addresses each grey area by drawing from the existing literature (when available), providing expert guidance on addressing each in the context of HIV/MH research, and providing domestic and global HIV and HIV/MH case examples that address these grey areas. CONCLUSIONS HIV/MH IS is key to achieving domestic and international goals for ending HIV transmission and mitigating its impact. Guidance offered in this paper can help to overcome challenges to rigorous and high-impact HIV/MH implementation research.
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Affiliation(s)
- Audrey Harkness
- School of Nursing and Health StudiesUniversity of MiamiCoral GablesFloridaUSA
| | - Ali Giusto
- Department of PsychiatryColumbia University Irving Medical CenterNew York State Psychiatric InstituteNew YorkNew YorkUSA
| | - Alison B. Hamilton
- Center for the Study of Healthcare InnovationImplementation & Policy, VA Greater Los Angeles Healthcare SystemLos AngelesCaliforniaUSA
- Department of Psychiatry & Biobehavioral SciencesUniversity of California Los AngelesLos AngelesCaliforniaUSA
| | - Raul U. Hernandez‐Ramirez
- Department of BiostatisticsCenter for Interdisciplinary Research on AIDSand Center for Methods in Implementation and Prevention ScienceYale School of Public HealthNew HavenConnecticutUSA
| | - Donna Spiegelman
- Department of BiostatisticsCenter for Interdisciplinary Research on AIDSand Center for Methods in Implementation and Prevention ScienceYale School of Public HealthNew HavenConnecticutUSA
| | - Bryan J. Weiner
- School of Public HealthUniversity of WashingtonSeattleWashingtonUSA
| | - Rinad S. Beidas
- Department of Medical Social SciencesFeinberg School of MedicineNorthwestern UniversityChicagoIllinoisUSA
| | - Michaela E. Larson
- School of Nursing and Health StudiesUniversity of MiamiCoral GablesFloridaUSA
- Division of Prevention ScienceUniversity of California San FranciscoSan FranciscoCaliforniaUSA
| | - Sheri A. Lippman
- Division of Prevention ScienceUniversity of California San FranciscoSan FranciscoCaliforniaUSA
| | - Milton L. Wainberg
- Department of PsychiatryColumbia University Irving Medical CenterNew York State Psychiatric InstituteNew YorkNew YorkUSA
| | - Justin D. Smith
- Department of Population Health SciencesSpencer Fox Eccles School of Medicine at the University of UtahSalt Lake CityUtahUSA
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Mckay V, Zamantakis A, Pachicano AM, Merle J, Purrier M, Swan M, Li D, Mustanski B, Smith JD, Hirschhorn L, Benbow N. Establishing Evidence Criteria for Implementation Strategies: A Delphi Study for HIV Services. RESEARCH SQUARE 2024:rs.3.rs-3979631. [PMID: 38464091 PMCID: PMC10925451 DOI: 10.21203/rs.3.rs-3979631/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/12/2024]
Abstract
Background There are no criteria specifically for evaluating the quality of implementation research and recommend implementation strategies likely to have impact to practitioners. We describe the development and application of the Best Practices Rubric, a set of criteria to evaluate the evidence supporting implementation strategies, in the context of HIV. Methods We developed the Best Practices Rubric from 2022-2023 in three phases. (1) We purposively selected and recruited by email participants representing a mix of expertise in HIV service delivery, quality improvement, and implementation science. We developed a draft rubric and criteria based on a literature review and key informant interviews. (2) The rubric was then informed and revised through two e-Delphi rounds using a survey delivered online through Qualtrics. The first and second round Delphi surveys consisted of 71 and 52 open and close-ended questions, respectively, asking participants to evaluate, confirm, and make suggestions on different aspects of the rubric. After each survey round, data were analyzed and synthesized as appropriate, and the rubric and criteria were revised. (3) We then applied the rubric to a set of research studies assessing 18 implementation strategies designed to promote the adoption and uptake of pre-exposure prophylaxis, an HIV prevention medication, to assess reliable application of the rubric and criteria. Results Our initial literature review yielded existing rubrics and criteria for evaluating intervention-level evidence. For a strategy-level rubric, additions emerged from interviews, for example, a need to consider the context and specification of strategies. Revisions were made after both Delphi rounds resulting in the confirmation of five evaluation domains - research design, implementation outcomes, limitations and rigor, strategy specification, and equity - and four evidence levels - best practice, promising practice, more evidence needed, and harmful practices. For most domains, criteria were specified at each evidence level. After an initial pilot round to develop an application process and provide training, we achieved 98% reliability when applying the criteria to 18 implementation strategies. Conclusions We developed a rubric to evaluate the evidence supporting implementation strategies for HIV services. Although the rubric is specific to HIV, this tool is adaptable for evaluating strategies in other health areas.
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Mustanski B, Queiroz A, Merle JL, Zamantakis A, Zapata JP, Li DH, Benbow N, Pyra M, Smith JD. A Systematic Review of Implementation Research on Determinants and Strategies of Effective HIV Interventions for Men Who Have Sex with Men in the United States. Annu Rev Psychol 2024; 75:55-85. [PMID: 37722749 PMCID: PMC10872355 DOI: 10.1146/annurev-psych-032620-035725] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/20/2023]
Abstract
Men who have sex with men (MSM) are disproportionately affected by HIV, accounting for two-thirds of HIV cases in the United States despite representing ∼5% of the adult population. Delivery and use of existing and highly effective HIV prevention and treatment strategies remain suboptimal among MSM. To summarize the state of the science, we systematically review implementation determinants and strategies of HIV-related health interventions using implementation science frameworks. Research on implementation barriers has focused predominantly on characteristics of individual recipients (e.g., ethnicity, age, drug use) and less so on deliverers (e.g., nurses, physicians), with little focus on system-level factors. Similarly, most strategies target recipients to influence their uptake and adherence, rather than improving and supporting implementation systems. HIV implementation research is burgeoning; future research is needed to broaden the examination of barriers at the provider and system levels, as well as expand knowledge on how to match strategies to barriers-particularly to address stigma. Collaboration and coordination among federal, state, and local public health agencies; community-based organizations; health care providers; and scientists are important for successful implementation of HIV-related health innovations.
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Affiliation(s)
- Brian Mustanski
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, Chicago, Illinois, USA;
- Third Coast Center for AIDS Research, Chicago, Illinois, USA
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Artur Queiroz
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, Chicago, Illinois, USA;
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - James L Merle
- Department of Population Health Sciences, Spencer Fox Eccles School of Medicine, University of Utah, Salt Lake City, Utah, USA
| | - Alithia Zamantakis
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, Chicago, Illinois, USA;
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Juan Pablo Zapata
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, Chicago, Illinois, USA;
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Dennis H Li
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, Chicago, Illinois, USA;
- Third Coast Center for AIDS Research, Chicago, Illinois, USA
- Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Nanette Benbow
- Third Coast Center for AIDS Research, Chicago, Illinois, USA
- Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Maria Pyra
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, Chicago, Illinois, USA;
| | - Justin D Smith
- Department of Population Health Sciences, Spencer Fox Eccles School of Medicine, University of Utah, Salt Lake City, Utah, USA
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Bayan MH, Smalls T, Boudreau A, Mirza AW, Pasco C, Demko ZO, Rothman RE, Hsieh YH, Eshleman SH, Mostafa HH, Gonzalez-Jimenez N, Chavez PR, Emerson B, Delaney KP, Daugherty D, MacGowan RJ, Manabe YC, Hamill MM. Evaluating the impact of point-of-care HIV viral load assessment on linkage to care in Baltimore, MD: a randomized controlled trial. BMC Infect Dis 2023; 23:570. [PMID: 37658305 PMCID: PMC10474693 DOI: 10.1186/s12879-023-08459-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 07/13/2023] [Indexed: 09/03/2023] Open
Abstract
BACKGROUND Integration of a sensitive point-of-care (POC) HIV viral load (VL) test into screening algorithms may help detect acute HIV infection earlier, identify people with HIV (PWH) who are not virally suppressed, and facilitate earlier referral to antiretroviral therapy (ART), or evaluation for pre-exposure prophylaxis (PrEP). This report describes a randomized clinical trial sponsored by the Centers for Disease Control and Prevention (CDC): "Ending the HIV Epidemic Through Point-of-Care Technologies" (EHPOC). The study's primary aim is to evaluate the use of a POC HIV VL test as part of a testing approach and assess the impact on time to linkage to ART or PrEP. The study will recruit people in Baltimore, Maryland, including patients attending a hospital emergency department, patients attending an infectious disease clinic, and people recruited via community outreach. The secondary aim is to evaluate the performance characteristics of two rapid HIV antibody tests approved by the United States Food and Drug Administration (FDA). METHODS The study will recruit people 18 years or older who have risk factors for HIV acquisition and are not on PrEP, or PWH who are not taking ART. Participants will be randomly assigned to either the control arm or the intervention arm. Participants randomized to the control arm will only receive the standard-of-care (SOC) HIV screening tests. Intervention arm participants will receive a POC HIV VL test in addition to the SOC HIV diagnostic screening tests. Follow up will consist of an interim phone survey conducted at week-4 and an in-person week-12 visit. Demographic and behavioral information, and oral fluid and blood specimens will be collected at enrollment and at week-12. Survey data will be captured in a Research Electronic Data Capture (REDCap) database. Participants in both arms will be referred for either ART or PrEP based on their HIV test results. DISCUSSION The EHPOC trial will explore a novel HIV diagnostic technology that can be performed at the POC and provide viral assessment. The study may help inform HIV testing algorithms and contribute to the evidence to support same day ART and PrEP recommendations. TRIAL REGISTRATION NIH ClinicalTrials.gov NCT04793750. Date: 11 March 2021.
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Affiliation(s)
| | - Travis Smalls
- Division of Infectious Diseases, Johns Hopkins University, Baltimore, MD, USA
| | - Alec Boudreau
- Division of Infectious Diseases, Johns Hopkins University, Baltimore, MD, USA
| | - Agha W Mirza
- Division of Infectious Diseases, Johns Hopkins University, Baltimore, MD, USA
| | - Courtney Pasco
- Division of Infectious Diseases, Johns Hopkins University, Baltimore, MD, USA
| | - Zoe O Demko
- Division of Infectious Diseases, Johns Hopkins University, Baltimore, MD, USA
| | - Richard E Rothman
- Division of Infectious Diseases, Johns Hopkins University, Baltimore, MD, USA
- Department of Emergency Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Yu-Hsiang Hsieh
- Department of Emergency Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Susan H Eshleman
- Department of Pathology, Johns Hopkins University, Baltimore, MD, USA
| | - Heba H Mostafa
- Department of Pathology, Johns Hopkins University, Baltimore, MD, USA
| | | | | | - Brian Emerson
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Kevin P Delaney
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | | | - Yukari C Manabe
- Division of Infectious Diseases, Johns Hopkins University, Baltimore, MD, USA
| | - Matthew M Hamill
- Division of Infectious Diseases, Johns Hopkins University, Baltimore, MD, USA.
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