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Ising A, Waller A, Frerichs L. Evaluation of an Emergency Department Visit Data Mental Health Dashboard. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2023; 29:369-376. [PMID: 36867507 DOI: 10.1097/phh.0000000000001727] [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: 03/04/2023]
Abstract
CONTEXT Local health departments (LHDs) need timely county-level and subcounty-level data to monitor health-related trends, identify health disparities, and inform areas of highest need for interventions as part of their ongoing assessment responsibilities; yet, many health departments rely on secondary data that are not timely and cannot provide subcounty insights. OBJECTIVE We developed and evaluated a mental health dashboard in Tableau for an LHD audience featuring statewide syndromic surveillance emergency department (ED) data in North Carolina from the North Carolina Disease Event Tracking and Epidemiologic Collection Tool (NC DETECT). DESIGN We developed a dashboard that provides counts, crude rates, and ED visit percentages at statewide and county levels, as well as breakdowns by zip code, sex, age group, race, ethnicity, and insurance coverage for 5 mental health conditions. We evaluated the dashboards through semistructured interviews and a Web-based survey that included the standardized usability questions from the System Usability Scale. PARTICIPANTS Convenience sample of LHD public health epidemiologists, health educators, evaluators, and public health informaticians. RESULTS Six semistructured interview participants successfully navigated the dashboard but identified usability issues when asked to compare county-level trends displayed in different outputs (eg, tables vs graphs). Thirty respondents answered all questions on the System Usability Scale for the dashboard, which received an above average score of 86. CONCLUSIONS The dashboards scored well on the System Usability Scale, but more research is needed to identify best practices in disseminating multiyear syndromic surveillance ED visit data on mental health conditions to LHDs.
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Affiliation(s)
- Amy Ising
- Department of Emergency Medicine, School of Medicine (Drs Ising and Waller), and Department of Health Policy and Management, Gillings School of Global Public Health (Dr Frerichs), University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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Guralnik E. Utilization of Electronic Health Records for Chronic Disease Surveillance: A Systematic Literature Review. Cureus 2023; 15:e37975. [PMID: 37223147 PMCID: PMC10202040 DOI: 10.7759/cureus.37975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/22/2023] [Indexed: 05/25/2023] Open
Abstract
This study reviews the current utilization of electronic health records (EHRs) for chronic disease surveillance, discusses approaches that are used in obtaining EHR-derived disease prevalence estimates, and identifies health indicators that have been studied using EHR-based surveillance methods. PubMed was searched for relevant keywords: (electronic health records [Title/Abstract] AND surveillance [Title/Abstract]) OR (electronic medical records [Title/Abstract] AND surveillance [Title/Abstract]). Articles were assessed based on detailed inclusion and exclusion criteria and organized by common themes, as per the PRISMA review protocol. The study period was limited to 2015-2021 due to the wider adoption of EHR in the U.S. only since 2015. The review included only US studies and only those that focused on chronic disease surveillance. 17 studies were included in the review. The most common approaches the review identified focused on validating EHR-derived estimates against those from traditional national surveys. The most studied conditions were diabetes, obesity, and hypertension. The majority of reviewed studies demonstrated comparable prevalence estimates with traditional population health surveillance surveys. The most common approach for the estimation of chronic disease conditions was to use small-area estimation by geographic patterns, neighborhoods, or census tracts. The use of EHR-based surveillance systems for public health purposes is feasible, and the population health estimates appear comparable to those obtained through traditional surveillance surveys. The application of EHRs for public health surveillance appears promising and could offer a real-time alternative to traditional surveillance methods. A timely assessment of population health at local and regional levels would ensure a more targeted allocation of public health and healthcare resources as well as more effective intervention and prevention initiatives.
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Affiliation(s)
- Elina Guralnik
- Health Administration and Policy, Health Informatics, George Mason University, Fairfax, USA
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Melles RB, Jorge AM, Marmor MF, Zhou B, Conell C, Niu J, McCormick N, Zhang Y, Choi HK. Hydroxychloroquine Dose and Risk for Incident Retinopathy : A Cohort Study. Ann Intern Med 2023; 176:166-173. [PMID: 36645889 DOI: 10.7326/m22-2453] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Hydroxychloroquine is recommended for all patients with systemic lupus erythematosus and is often used for other inflammatory conditions, but a critical long-term adverse effect is vision-threatening retinopathy. OBJECTIVE To characterize the long-term risk for incident hydroxychloroquine retinopathy and examine the degree to which average hydroxychloroquine dose within the first 5 years of treatment predicts this risk. DESIGN Cohort study. SETTING U.S. integrated health network. PARTICIPANTS All patients aged 18 years or older who received hydroxychloroquine for 5 or more years between 2004 and 2020 and had guideline-recommended serial retinopathy screening. MEASUREMENTS Hydroxychloroquine dose was assessed from pharmacy dispensing records. Incident hydroxychloroquine retinopathy was assessed by central adjudication of spectral domain optical coherence tomography with severity assessment (mild, moderate, or severe). Risk for hydroxychloroquine retinopathy was estimated over 15 years of use according to hydroxychloroquine weight-based dose (>6, 5 to 6, or ≤5 mg/kg per day) using the Kaplan-Meier estimator. RESULTS Among 3325 patients in the primary study population, 81 developed hydroxychloroquine retinopathy (56 mild, 17 moderate, and 8 severe), with overall cumulative incidences of 2.5% and 8.6% at 10 and 15 years, respectively. The cumulative incidences of retinopathy at 15 years were 21.6% for higher than 6 mg/kg per day, 11.4% for 5 to 6 mg/kg per day, and 2.7% for 5 mg/kg per day or lower. The corresponding risks for moderate to severe retinopathy at 15 years were 5.9%, 2.4%, and 1.1%, respectively. LIMITATION Possible misclassifications of dose due to nonadherence to filled prescriptions. CONCLUSION In this large, contemporary cohort with active surveillance retinopathy screening, the overall risk for hydroxychloroquine retinopathy was 8.6% after 15 years, and most cases were mild. Higher hydroxychloroquine dose was associated with progressively greater risk for incident retinopathy. PRIMARY FUNDING SOURCE National Institutes of Health.
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Affiliation(s)
- Ronald B Melles
- Department of Ophthalmology, Kaiser Permanente Northern California, Redwood City, California (R.B.M.)
| | - April M Jorge
- Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, and Harvard Medical School, Boston, Massachusetts (A.M.J., Y.Z., H.K.C.)
| | - Michael F Marmor
- Department of Ophthalmology and Byers Eye Institute, Stanford University School of Medicine, Palo Alto, California (M.F.M.)
| | - Baijun Zhou
- Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, Boston, Massachusetts (B.Z.)
| | - Carol Conell
- Division of Research, Kaiser Permanente Northern California, Oakland, California (C.C.)
| | - Jingbo Niu
- Department of Medicine, Baylor College of Medicine, Houston, Texas (J.N.)
| | - Natalie McCormick
- Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, Boston, Massachusetts, and Arthritis Research Canada, Vancouver, British Columbia, Canada (N.M.)
| | - Yuqing Zhang
- Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, and Harvard Medical School, Boston, Massachusetts (A.M.J., Y.Z., H.K.C.)
| | - Hyon K Choi
- Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, and Harvard Medical School, Boston, Massachusetts (A.M.J., Y.Z., H.K.C.)
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Chan PY, Perlman SE, Lee DC, Smolen JR, Lim S. Neighborhood-Level Chronic Disease Surveillance: Utility of Primary Care Electronic Health Records and Emergency Department Claims Data. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2022; 28:E109-E118. [PMID: 32487918 DOI: 10.1097/phh.0000000000001142] [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: 11/25/2022]
Abstract
CONTEXT Disease burden may vary substantively across neighborhoods in an urban setting. Yet, data available for monitoring chronic conditions at the neighborhood level are scarce. Large health care data sets have potential to complement population health surveillance. Few studies have examined the utility of health care data for neighborhood-level surveillance. OBJECTIVE We examined the use of primary care electronic health records (EHRs) and emergency department (ED) claims for identifying neighborhoods with higher chronic disease burden and neighborhood-level prevalence estimation. DESIGN Comparison of hypertension and diabetes estimates from EHRs and ED claims with survey-based estimates. SETTING Forty-two United Hospital Fund neighborhoods in New York City. PARTICIPANTS The EHR sample comprised 708 452 patients from the Hub Population Health System (the Hub) in 2015, and the ED claim sample comprised 1 567 870 patients from the Statewide Planning and Research Cooperative System in 2015. We derived survey-based estimates from 2012 to 2016 Community Health Survey (n = 44 189). MAIN OUTCOME MEASURE We calculated hypertension and diabetes prevalence estimates by neighborhood from each data source. We obtained Pearson correlation and absolute difference between EHR-based or claims-based estimates and survey-based estimates. RESULTS Both EHR-based and claims-based estimates correlated strongly with survey-based estimates for hypertension (0.91 and 0.72, respectively) and diabetes (0.83 and 0.82, respectively) and identified similar neighborhoods of higher burden. For hypertension, 10 and 17 neighborhoods from the EHRs and ED claims, respectively, had an absolute difference of more than 5 percentage points from the survey-based estimate. For diabetes, 15 and 4 neighborhoods from the EHRs and ED claims, respectively, differed from the survey-based estimate by more than 5 percentage points. CONCLUSIONS Both EHRs and ED claims data are useful for identifying neighborhoods with greater disease burden and have potential for monitoring chronic conditions at the neighborhood level.
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Affiliation(s)
- Pui Ying Chan
- Divisions of Epidemiology (Ms Chan and Perlman and Dr Lim) and Prevention and Primary Care (Ms Smolen), New York City Department of Health and Mental Hygiene, Long Island City, New York; and Ronald O. Perelman Department of Emergency Medicine, New York University Grossman School of Medicine, New York, New York (Dr Lee)
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Golembiewski E, Allen KS, Blackmon AM, Hinrichs RJ, Vest JR. Combining Nonclinical Determinants of Health and Clinical Data for Research and Evaluation: Rapid Review. JMIR Public Health Surveill 2019; 5:e12846. [PMID: 31593550 PMCID: PMC6803891 DOI: 10.2196/12846] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Revised: 05/23/2019] [Accepted: 07/19/2019] [Indexed: 02/06/2023] Open
Abstract
Background Nonclinical determinants of health are of increasing importance to health care delivery and health policy. Concurrent with growing interest in better addressing patients’ nonmedical issues is the exponential growth in availability of data sources that provide insight into these nonclinical determinants of health. Objective This review aimed to characterize the state of the existing literature on the use of nonclinical health indicators in conjunction with clinical data sources. Methods We conducted a rapid review of articles and relevant agency publications published in English. Eligible studies described the effect of, the methods for, or the need for combining nonclinical data with clinical data and were published in the United States between January 2010 and April 2018. Additional reports were obtained by manual searching. Records were screened for inclusion in 2 rounds by 4 trained reviewers with interrater reliability checks. From each article, we abstracted the measures, data sources, and level of measurement (individual or aggregate) for each nonclinical determinant of health reported. Results A total of 178 articles were included in the review. The articles collectively reported on 744 different nonclinical determinants of health measures. Measures related to socioeconomic status and material conditions were most prevalent (included in 90% of articles), followed by the closely related domain of social circumstances (included in 25% of articles), reflecting the widespread availability and use of standard demographic measures such as household income, marital status, education, race, and ethnicity in public health surveillance. Measures related to health-related behaviors (eg, smoking, diet, tobacco, and substance abuse), the built environment (eg, transportation, sidewalks, and buildings), natural environment (eg, air quality and pollution), and health services and conditions (eg, provider of care supply, utilization, and disease prevalence) were less common, whereas measures related to public policies were rare. When combining nonclinical and clinical data, a majority of studies associated aggregate, area-level nonclinical measures with individual-level clinical data by matching geographical location. Conclusions A variety of nonclinical determinants of health measures have been widely but unevenly used in conjunction with clinical data to support population health research.
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Affiliation(s)
| | - Katie S Allen
- IUPUI Richard M Fairbanks School of Public Health, Indianapolis, IN, United States.,Regenstrief Institute, Inc, Indianapolis, IN, United States
| | - Amber M Blackmon
- IUPUI Richard M Fairbanks School of Public Health, Indianapolis, IN, United States
| | | | - Joshua R Vest
- IUPUI Richard M Fairbanks School of Public Health, Indianapolis, IN, United States.,Regenstrief Institute, Inc, Indianapolis, IN, United States
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Wiese AD, Roumie CL, Buse JB, Guzman H, Bradford R, Zalimeni E, Knoepp P, Morris HL, Donahoo WT, Fanous N, Epstein BF, Katalenich BL, Ayala SG, Cook MM, Worley KJ, Bachmann KN, Grijalva CG, Rothman RL, Chakkalakal RJ. Performance of a computable phenotype for identification of patients with diabetes within PCORnet: The Patient-Centered Clinical Research Network. Pharmacoepidemiol Drug Saf 2019; 28:632-639. [PMID: 30680840 DOI: 10.1002/pds.4718] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Revised: 11/27/2018] [Accepted: 12/02/2018] [Indexed: 01/14/2023]
Abstract
PURPOSE PCORnet, the National Patient-Centered Clinical Research Network, represents an innovative system for the conduct of observational and pragmatic studies. We describe the identification and validation of a retrospective cohort of patients with type 2 diabetes (T2DM) from four PCORnet sites. METHODS We adapted existing computable phenotypes (CP) for the identification of patients with T2DM and evaluated their performance across four PCORnet sites (2012-2016). Patients entered the cohort on the earliest date they met one of three CP categories: (CP1) coded T2DM diagnosis (ICD-9/ICD-10) and an antidiabetic prescription, (CP2) diagnosis and glycosylated hemoglobin (HbA1c) ≥6.5%, or (CP3) an antidiabetic prescription and HbA1c ≥6.5%. We required evidence of health care utilization in each of the 2 prior years for each patient, as we also developed an incident T2DM CP to identify the subset of patients without documentation of T2DM in the 365 days before t0 . Among a systematic sample of patients, we calculated the positive predictive value (PPV) for the T2DM CP and incident-T2DM CP using electronic health record (EHR) review as reference. RESULTS The CP identified 50 657 patients with T2DM. The PPV of patients randomly selected for validation was 96.2% (n = 1572; CI:95.1-97.0) and was consistently high across sites. The PPV for the incident-T2DM CP was 5.8% (CI:4.5-7.5). CONCLUSIONS The T2DM CP accurately and efficiently identified patients with T2DM across multiple sites that participate in PCORnet, although the incident T2DM CP requires further study. PCORnet is a valuable data source for future epidemiological and comparative effectiveness research among patients with T2DM.
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Affiliation(s)
- Andrew D Wiese
- Department of Health Policy, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Christianne L Roumie
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA.,Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA.,Veterans Health Administration-Tennessee Valley Healthcare System, Geriatric Research Education Clinical Center (GRECC), Nashville, TN, USA
| | - John B Buse
- Department of Medicine, University of North Carolina, Chapel Hill, NC, USA
| | - Herodes Guzman
- Department of Medicine, University of North Carolina, Chapel Hill, NC, USA
| | - Robert Bradford
- Department of Medicine, University of North Carolina, Chapel Hill, NC, USA
| | - Emily Zalimeni
- Department of Medicine, University of North Carolina, Chapel Hill, NC, USA
| | - Patricia Knoepp
- Department of Medicine, University of North Carolina, Chapel Hill, NC, USA
| | - Heather L Morris
- Department of Health Outcomes and Biomedical Informatics, University of Florida, Gainesville, FL, USA
| | | | - Nada Fanous
- Department of Medicine, University of Florida, Gainesville, FL, USA
| | | | - Bonnie L Katalenich
- LA CaTS Clinical Translational Unit, Tulane University School of Medicine, Tulane, LA, USA
| | - Sujata G Ayala
- Institute for Medicine and Public Health, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Megan M Cook
- Institute for Medicine and Public Health, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Katherine J Worley
- Vanderbilt Institute for Clinical and Translational Research, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Katherine N Bachmann
- Veterans Health Administration-Tennessee Valley Healthcare System, CSR&D, Nashville, TN, USA.,Vanderbilt Translational and Clinical Cardiovascular Research Center, Vanderbilt University Medical Center, Nashville, TN, USA.,Division of Diabetes, Endocrinology, and Metabolism, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Carlos G Grijalva
- Department of Health Policy, Vanderbilt University Medical Center, Nashville, TN, USA.,Veterans Health Administration-Tennessee Valley Healthcare System, Geriatric Research Education Clinical Center (GRECC), Nashville, TN, USA
| | - Russell L Rothman
- Department of Health Policy, Vanderbilt University Medical Center, Nashville, TN, USA.,Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA.,Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA
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Namulanda G, Qualters J, Vaidyanathan A, Roberts E, Richardson M, Fraser A, McVeigh KH, Patterson S. Electronic health record case studies to advance environmental public health tracking. J Biomed Inform 2018; 79:98-104. [PMID: 29476967 DOI: 10.1016/j.jbi.2018.02.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Revised: 02/01/2018] [Accepted: 02/19/2018] [Indexed: 01/10/2023]
Abstract
Data from traditional public health surveillance systems can have some limitations, e.g., timeliness, geographic level, and amount of data accessible. Electronic health records (EHRs) could present an opportunity to supplement current sources of routinely collected surveillance data. The National Environmental Public Health Tracking Program (Tracking Program) sought to explore the use of EHRs for advancing environmental public health surveillance practices. The Tracking Program funded four state/local health departments to obtain and pilot the use of EHR data to address several issues including the challenges and technical requirements for accessing EHR data, and the core data elements required to integrate EHR data within their departments' Tracking Programs. The results of these pilot projects highlighted the potential of EHR data for public health surveillance of rare diseases that may lack comprehensive registries, and surveillance of prevalent health conditions or risk factors for health outcomes at a finer geographic level. EHRs therefore, may have potential to supplement traditional sources of public health surveillance data.
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Affiliation(s)
- Gonza Namulanda
- Environmental Health Tracking Branch, Division of Environmental Hazards and Health Effects, National Center for Environmental Health, Centers for Disease Control and Prevention, 4770 Buford Highway, NE, MS F-60, Atlanta, GA 30341, United States.
| | - Judith Qualters
- Division of Environmental Hazards and Health Effects, National Center for Environmental Health, Centers for Disease Control and Prevention, 4770 Buford Highway, NE, MS F-60, Atlanta, GA 30341, United States
| | - Ambarish Vaidyanathan
- Environmental Health Tracking Branch, Division of Environmental Hazards and Health Effects, National Center for Environmental Health, Centers for Disease Control and Prevention, 4770 Buford Highway, NE, MS F-60, Atlanta, GA 30341, United States
| | - Eric Roberts
- California Environmental Health Tracking Program, Public Health Institute, c/o Environmental Health Investigations Branch, 850 Marina Bay Pkwy, P-3, Richmond, CA 94804, United States
| | - Max Richardson
- California Environmental Health Tracking Program, Public Health Institute, c/o Environmental Health Investigations Branch, 850 Marina Bay Pkwy, P-3, Richmond, CA 94804, United States
| | - Alicia Fraser
- Massachusetts Department of Public Health, Bureau of Environmental Health, 250 Washington Street, 7th Floor, Boston, MA 02108, United States
| | - Katharine H McVeigh
- Division of Family and Child Health, New York City Department of Health and Mental Hygiene, 42-09 28th Street, Queens, NY 11101, United States
| | - Scott Patterson
- Missouri Department of Health and Senior Services, PO Box 570, Jefferson City, MO 65102, United States
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Valdiserri RO, Sullivan PS. Data Visualization Promotes Sound Public Health Practice: The AIDSvu Example. AIDS EDUCATION AND PREVENTION : OFFICIAL PUBLICATION OF THE INTERNATIONAL SOCIETY FOR AIDS EDUCATION 2018; 30:26-34. [PMID: 29481299 DOI: 10.1521/aeap.2018.30.1.26] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
The ability to depict surveillance and other complex health-related data in a visual manner promotes sound public health practice by supporting the three core functions of public health: assessment, policy development, and assurance. Further, such efforts potentiate the use of surveillance data beyond traditional public health audiences and venues, thus fostering a "culture of health." This practice report provides several recent examples of how data from AIDSVu-an interactive map of the U.S. showing the impact of HIV at national, state, and local levels-has been used to: fine tune the assessment of HIV-related disparities at a community level, educate and empower communities about HIV and its consequences, and better target HIV interventions to reach underserved, vulnerable populations.
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Affiliation(s)
- Ronald O Valdiserri
- Department of Health, Behavior & Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Patrick S Sullivan
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
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