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Wobeser WL, McBane JE, Balfour L, Conway B, Gill MJ, Huff H, Kilby DLP, Fergusson DA, Mallick R, Mills EJ, Muldoon KA, Rachlis A, Ralph ED, Rosenes R, Singer J, Singhal N, Tan D, Tremblay N, Vo D, Walmsley SL, Cameron DW. A randomized control trial of high-dose micronutrient-antioxidant supplementation in healthy persons with untreated HIV infection. PLoS One 2022; 17:e0270590. [PMID: 35834528 PMCID: PMC9282469 DOI: 10.1371/journal.pone.0270590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Accepted: 06/06/2022] [Indexed: 12/02/2022] Open
Abstract
Background Although micronutrient and antioxidant supplementation are widely used by persons with human immunodeficiency virus (HIV), a therapeutic role beyond recommended daily allowances (RDA) remains unproven. An oral high-dose micronutrient and antioxidant supplement (Treatment) was compared to an RDA supplement (Control) for time to progressive immunodeficiency or initiation of antiretroviral therapy (ART) in people living with HIV (PLWH). Methods This study was a randomized, double-blind, placebo-controlled multicenter clinical trial. PLWH were recruited from Canadian HIV Trials Network sites, and followed quarterly for two years. Eligible participants were asymptomatic, antiretroviral treatment (ART)-naïve, HIV-seropositive adults with a CD4 T lymphocyte count (CD4 count) between 375–750 cells/μL. Participants were randomly allocated 1:1 to receive Treatment or Control supplements. The primary outcome was a composite of time-to-first of confirmed CD4 count below 350 cells/μL, initiation of ART, AIDS-defining illness or death. Primary analysis was by intention-to-treat. Secondary outcomes included CD4 count trajectory from baseline to ART initiation or two years. A Data and Safety Monitoring Board reviewed the study for safety, recruitment and protocol adherence every six months. Results Of 171 enrolled participants: 66 (38.6%) experienced a primary outcome: 27 reached a CD4 count below 350 cells/μL, and 57 started ART. There was no significant difference in time-to-first outcome between groups (Hazard Ratio = 1.05; 95%CI: 0.65, 1.70), or in time to any component outcome. Using intent-to-treat censoring, mean annualized rates of CD4 count decline were -42.703 cells/μL and -79.763 cells/μL for Treatment and Control groups, with no statistical difference in the mean change between groups (-37.06 cells/μL/52 weeks, 95%CI: (-93.59, 19.47); p = 0.1993). Accrual was stopped at 171 of the 212 intended participants after an interim analysis for futility, although participant follow-up was completed. Conclusions In ART-naïve PLWH, high-dose antioxidant, micronutrient supplementation compared to RDA supplementation had no significant effect on disease progression or ART initiation. Clinical trial registration ClinicalTrials.gov Identifier: NCT00798772.
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Affiliation(s)
- Wendy L. Wobeser
- Department of Biomedical and Molecular Sciences and Public Health, Queen’s University, Kingston, Ontario, Canada
| | - Joanne E. McBane
- CIHR Canadian HIV Trials Network (CIHR-CTN), Vancouver, British Columbia, Canada
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Louise Balfour
- CIHR Canadian HIV Trials Network (CIHR-CTN), Vancouver, British Columbia, Canada
- Division of Infectious Diseases, Department of Medicine, University of Ottawa at The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Brian Conway
- Vancouver Infectious Disease Clinic, Vancouver, British Columbia, Canada
| | - M. John Gill
- CIHR Canadian HIV Trials Network (CIHR-CTN), Vancouver, British Columbia, Canada
- Department of Microbiology, Immunology and Infectious Diseases, University of Calgary, Calgary, Alberta, Canada
| | - Harold Huff
- Canadian College of Naturopathic Medicine, Toronto, Ontario, Canada
| | - Donald L. P. Kilby
- Faculty of Health Services, University of Ottawa, Ottawa, Ontario, Canada
| | - Dean A. Fergusson
- Clinical Epidemiology Program (CEP), University of Ottawa at The Ottawa Hospital Research Institute (OHRI), Ottawa, Ontario, Canada
| | - Ranjeeta Mallick
- Ottawa Methods Centre, Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Edward J. Mills
- CIHR Canadian HIV Trials Network (CIHR-CTN), Vancouver, British Columbia, Canada
- Global Evaluative Sciences, Vancouver, British Columbia, Canada
| | - Katherine A. Muldoon
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Obstetrics and Maternal Investigations Research Group, The Ottawa Hospital, Ottawa, Canada
- School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, Canada
- Division of Infectious Diseases, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Anita Rachlis
- CIHR Canadian HIV Trials Network (CIHR-CTN), Vancouver, British Columbia, Canada
- Division of Infectious Diseases, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Edward D. Ralph
- Division of Infectious Diseases, Department of Medicine, University of Western Ontario, London, Ontario, Canada
| | - Ron Rosenes
- CIHR Canadian HIV Trials Network (CIHR-CTN), Vancouver, British Columbia, Canada
| | - Joel Singer
- CIHR Canadian HIV Trials Network (CIHR-CTN), Vancouver, British Columbia, Canada
- Faculty of Medicine, School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Neera Singhal
- Global Evaluative Sciences, Vancouver, British Columbia, Canada
| | - Darrell Tan
- CIHR Canadian HIV Trials Network (CIHR-CTN), Vancouver, British Columbia, Canada
- La Ka Shing Knowledge Institute, St. Michael’s, Toronto, Ontario, Canada
| | - Nancy Tremblay
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Dong Vo
- Ottawa Methods Centre, Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Sharon L. Walmsley
- CIHR Canadian HIV Trials Network (CIHR-CTN), Vancouver, British Columbia, Canada
- Division of Infectious Diseases, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - D. William Cameron
- CIHR Canadian HIV Trials Network (CIHR-CTN), Vancouver, British Columbia, Canada
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Division of Infectious Diseases, Department of Medicine, University of Ottawa at The Ottawa Hospital, Ottawa, Ontario, Canada
- Clinical Epidemiology Program (CEP), University of Ottawa at The Ottawa Hospital Research Institute (OHRI), Ottawa, Ontario, Canada
- * E-mail:
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9
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Joyce VR, Sun H, Barnett PG, Bansback N, Griffin SC, Bayoumi AM, Anis AH, Sculpher M, Cameron W, Brown ST, Holodniy M, Owens DK. Mapping MOS-HIV to HUI3 and EQ-5D-3L in Patients With HIV. MDM Policy Pract 2017; 2:2381468317716440. [PMID: 30288427 PMCID: PMC6125043 DOI: 10.1177/2381468317716440] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2016] [Accepted: 05/10/2017] [Indexed: 12/25/2022] Open
Abstract
Objectives: The Medical Outcomes Study HIV Health Survey (MOS-HIV)
is frequently used in HIV clinical trials; however, scores generated from the
MOS-HIV are not suited for cost-effectiveness analyses as they do not assign
utility values to health states. Our objective was to estimate and externally
validate several mapping algorithms to predict Health Utilities Index Mark 3
(HUI3) and EQ-5D-3L utility values from the MOS-HIV. Methods: We
developed and validated mapping algorithms using data from two HIV clinical
trials. Data from the first trial (n = 367) formed the estimation data set for
the HUI3 (4,610 observations) and EQ-5D-3L (4,662 observations) mapping
algorithms; data from the second trial (n = 168) formed the HUI3 (1,135
observations) and EQ-5D-3L (1,152 observations) external validation data set. We
compared ordinary least squares (OLS) models of increasing complexity with the
more flexible two-part, beta regression, and finite mixture models. We assessed
model performance using mean absolute error (MAE) and mean squared error (MSE).
Results: The OLS model that used MOS-HIV dimension scores along
with squared terms gave the best HUI3 predictions (mean observed 0.84; mean
predicted 0.80; MAE 0.0961); the finite mixture model gave the best EQ-5D-3L
predictions (mean observed 0.90; mean predicted 0.88; MAE 0.0567). All models
produced higher prediction errors at the lower end of the HUI3 and EQ-5D-3L
score ranges (<0.40). Conclusions: The proposed mapping
algorithms can be used to predict HUI3 and EQ-5D-3L utility values from the
MOS-HIV, although greater error may pose a problem in samples where a
substantial proportion of patients are in poor health. These algorithms may be
useful for estimating utility values from the MOS-HIV for cost-effectiveness
studies when HUI3 or EQ-5D-3L data are not available.
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Affiliation(s)
- Vilija R Joyce
- VA Palo Alto Health Care System, VA Cooperative Studies Program Coordinating Center, VA HSR&D Health Economics Resource Center, Menlo Park, California (VRJ, PGB).,Centre for Health Evaluation and Outcome Sciences, St. Paul's Hospital, Vancouver, British Columbia, Canada (HS, NB, AHA).,Canadian HIV Trials Network, Vancouver, British Columbia, Canada (HS).,School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada (NB, AHA).,Centre for Health Economics, University of York, York, UK (SCG, MS).,Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute and Division of General Internal Medicine, St. Michael's Hospital, Toronto, Ontario, Canada (AMB).,Departments of Medicine and Health Policy, Management and Evaluation, University of Toronto, Ontario, Canada (AMB).,Division of Infectious Diseases, University of Ottawa at The Ottawa Hospital, Ottawa, Ontario, Canada (WC).,James J. Peters VA Medical Center, Bronx, New York (STB).,VA Palo Alto Health Care System, Palo Alto, California (MH, DKO).,Center for Primary Care and Outcomes Research, Stanford University, Stanford, California (DKO)
| | - Huiying Sun
- VA Palo Alto Health Care System, VA Cooperative Studies Program Coordinating Center, VA HSR&D Health Economics Resource Center, Menlo Park, California (VRJ, PGB).,Centre for Health Evaluation and Outcome Sciences, St. Paul's Hospital, Vancouver, British Columbia, Canada (HS, NB, AHA).,Canadian HIV Trials Network, Vancouver, British Columbia, Canada (HS).,School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada (NB, AHA).,Centre for Health Economics, University of York, York, UK (SCG, MS).,Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute and Division of General Internal Medicine, St. Michael's Hospital, Toronto, Ontario, Canada (AMB).,Departments of Medicine and Health Policy, Management and Evaluation, University of Toronto, Ontario, Canada (AMB).,Division of Infectious Diseases, University of Ottawa at The Ottawa Hospital, Ottawa, Ontario, Canada (WC).,James J. Peters VA Medical Center, Bronx, New York (STB).,VA Palo Alto Health Care System, Palo Alto, California (MH, DKO).,Center for Primary Care and Outcomes Research, Stanford University, Stanford, California (DKO)
| | - Paul G Barnett
- VA Palo Alto Health Care System, VA Cooperative Studies Program Coordinating Center, VA HSR&D Health Economics Resource Center, Menlo Park, California (VRJ, PGB).,Centre for Health Evaluation and Outcome Sciences, St. Paul's Hospital, Vancouver, British Columbia, Canada (HS, NB, AHA).,Canadian HIV Trials Network, Vancouver, British Columbia, Canada (HS).,School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada (NB, AHA).,Centre for Health Economics, University of York, York, UK (SCG, MS).,Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute and Division of General Internal Medicine, St. Michael's Hospital, Toronto, Ontario, Canada (AMB).,Departments of Medicine and Health Policy, Management and Evaluation, University of Toronto, Ontario, Canada (AMB).,Division of Infectious Diseases, University of Ottawa at The Ottawa Hospital, Ottawa, Ontario, Canada (WC).,James J. Peters VA Medical Center, Bronx, New York (STB).,VA Palo Alto Health Care System, Palo Alto, California (MH, DKO).,Center for Primary Care and Outcomes Research, Stanford University, Stanford, California (DKO)
| | - Nick Bansback
- VA Palo Alto Health Care System, VA Cooperative Studies Program Coordinating Center, VA HSR&D Health Economics Resource Center, Menlo Park, California (VRJ, PGB).,Centre for Health Evaluation and Outcome Sciences, St. Paul's Hospital, Vancouver, British Columbia, Canada (HS, NB, AHA).,Canadian HIV Trials Network, Vancouver, British Columbia, Canada (HS).,School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada (NB, AHA).,Centre for Health Economics, University of York, York, UK (SCG, MS).,Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute and Division of General Internal Medicine, St. Michael's Hospital, Toronto, Ontario, Canada (AMB).,Departments of Medicine and Health Policy, Management and Evaluation, University of Toronto, Ontario, Canada (AMB).,Division of Infectious Diseases, University of Ottawa at The Ottawa Hospital, Ottawa, Ontario, Canada (WC).,James J. Peters VA Medical Center, Bronx, New York (STB).,VA Palo Alto Health Care System, Palo Alto, California (MH, DKO).,Center for Primary Care and Outcomes Research, Stanford University, Stanford, California (DKO)
| | - Susan C Griffin
- VA Palo Alto Health Care System, VA Cooperative Studies Program Coordinating Center, VA HSR&D Health Economics Resource Center, Menlo Park, California (VRJ, PGB).,Centre for Health Evaluation and Outcome Sciences, St. Paul's Hospital, Vancouver, British Columbia, Canada (HS, NB, AHA).,Canadian HIV Trials Network, Vancouver, British Columbia, Canada (HS).,School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada (NB, AHA).,Centre for Health Economics, University of York, York, UK (SCG, MS).,Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute and Division of General Internal Medicine, St. Michael's Hospital, Toronto, Ontario, Canada (AMB).,Departments of Medicine and Health Policy, Management and Evaluation, University of Toronto, Ontario, Canada (AMB).,Division of Infectious Diseases, University of Ottawa at The Ottawa Hospital, Ottawa, Ontario, Canada (WC).,James J. Peters VA Medical Center, Bronx, New York (STB).,VA Palo Alto Health Care System, Palo Alto, California (MH, DKO).,Center for Primary Care and Outcomes Research, Stanford University, Stanford, California (DKO)
| | - Ahmed M Bayoumi
- VA Palo Alto Health Care System, VA Cooperative Studies Program Coordinating Center, VA HSR&D Health Economics Resource Center, Menlo Park, California (VRJ, PGB).,Centre for Health Evaluation and Outcome Sciences, St. Paul's Hospital, Vancouver, British Columbia, Canada (HS, NB, AHA).,Canadian HIV Trials Network, Vancouver, British Columbia, Canada (HS).,School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada (NB, AHA).,Centre for Health Economics, University of York, York, UK (SCG, MS).,Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute and Division of General Internal Medicine, St. Michael's Hospital, Toronto, Ontario, Canada (AMB).,Departments of Medicine and Health Policy, Management and Evaluation, University of Toronto, Ontario, Canada (AMB).,Division of Infectious Diseases, University of Ottawa at The Ottawa Hospital, Ottawa, Ontario, Canada (WC).,James J. Peters VA Medical Center, Bronx, New York (STB).,VA Palo Alto Health Care System, Palo Alto, California (MH, DKO).,Center for Primary Care and Outcomes Research, Stanford University, Stanford, California (DKO)
| | - Aslam H Anis
- VA Palo Alto Health Care System, VA Cooperative Studies Program Coordinating Center, VA HSR&D Health Economics Resource Center, Menlo Park, California (VRJ, PGB).,Centre for Health Evaluation and Outcome Sciences, St. Paul's Hospital, Vancouver, British Columbia, Canada (HS, NB, AHA).,Canadian HIV Trials Network, Vancouver, British Columbia, Canada (HS).,School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada (NB, AHA).,Centre for Health Economics, University of York, York, UK (SCG, MS).,Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute and Division of General Internal Medicine, St. Michael's Hospital, Toronto, Ontario, Canada (AMB).,Departments of Medicine and Health Policy, Management and Evaluation, University of Toronto, Ontario, Canada (AMB).,Division of Infectious Diseases, University of Ottawa at The Ottawa Hospital, Ottawa, Ontario, Canada (WC).,James J. Peters VA Medical Center, Bronx, New York (STB).,VA Palo Alto Health Care System, Palo Alto, California (MH, DKO).,Center for Primary Care and Outcomes Research, Stanford University, Stanford, California (DKO)
| | - Mark Sculpher
- VA Palo Alto Health Care System, VA Cooperative Studies Program Coordinating Center, VA HSR&D Health Economics Resource Center, Menlo Park, California (VRJ, PGB).,Centre for Health Evaluation and Outcome Sciences, St. Paul's Hospital, Vancouver, British Columbia, Canada (HS, NB, AHA).,Canadian HIV Trials Network, Vancouver, British Columbia, Canada (HS).,School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada (NB, AHA).,Centre for Health Economics, University of York, York, UK (SCG, MS).,Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute and Division of General Internal Medicine, St. Michael's Hospital, Toronto, Ontario, Canada (AMB).,Departments of Medicine and Health Policy, Management and Evaluation, University of Toronto, Ontario, Canada (AMB).,Division of Infectious Diseases, University of Ottawa at The Ottawa Hospital, Ottawa, Ontario, Canada (WC).,James J. Peters VA Medical Center, Bronx, New York (STB).,VA Palo Alto Health Care System, Palo Alto, California (MH, DKO).,Center for Primary Care and Outcomes Research, Stanford University, Stanford, California (DKO)
| | - William Cameron
- VA Palo Alto Health Care System, VA Cooperative Studies Program Coordinating Center, VA HSR&D Health Economics Resource Center, Menlo Park, California (VRJ, PGB).,Centre for Health Evaluation and Outcome Sciences, St. Paul's Hospital, Vancouver, British Columbia, Canada (HS, NB, AHA).,Canadian HIV Trials Network, Vancouver, British Columbia, Canada (HS).,School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada (NB, AHA).,Centre for Health Economics, University of York, York, UK (SCG, MS).,Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute and Division of General Internal Medicine, St. Michael's Hospital, Toronto, Ontario, Canada (AMB).,Departments of Medicine and Health Policy, Management and Evaluation, University of Toronto, Ontario, Canada (AMB).,Division of Infectious Diseases, University of Ottawa at The Ottawa Hospital, Ottawa, Ontario, Canada (WC).,James J. Peters VA Medical Center, Bronx, New York (STB).,VA Palo Alto Health Care System, Palo Alto, California (MH, DKO).,Center for Primary Care and Outcomes Research, Stanford University, Stanford, California (DKO)
| | - Sheldon T Brown
- VA Palo Alto Health Care System, VA Cooperative Studies Program Coordinating Center, VA HSR&D Health Economics Resource Center, Menlo Park, California (VRJ, PGB).,Centre for Health Evaluation and Outcome Sciences, St. Paul's Hospital, Vancouver, British Columbia, Canada (HS, NB, AHA).,Canadian HIV Trials Network, Vancouver, British Columbia, Canada (HS).,School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada (NB, AHA).,Centre for Health Economics, University of York, York, UK (SCG, MS).,Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute and Division of General Internal Medicine, St. Michael's Hospital, Toronto, Ontario, Canada (AMB).,Departments of Medicine and Health Policy, Management and Evaluation, University of Toronto, Ontario, Canada (AMB).,Division of Infectious Diseases, University of Ottawa at The Ottawa Hospital, Ottawa, Ontario, Canada (WC).,James J. Peters VA Medical Center, Bronx, New York (STB).,VA Palo Alto Health Care System, Palo Alto, California (MH, DKO).,Center for Primary Care and Outcomes Research, Stanford University, Stanford, California (DKO)
| | - Mark Holodniy
- VA Palo Alto Health Care System, VA Cooperative Studies Program Coordinating Center, VA HSR&D Health Economics Resource Center, Menlo Park, California (VRJ, PGB).,Centre for Health Evaluation and Outcome Sciences, St. Paul's Hospital, Vancouver, British Columbia, Canada (HS, NB, AHA).,Canadian HIV Trials Network, Vancouver, British Columbia, Canada (HS).,School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada (NB, AHA).,Centre for Health Economics, University of York, York, UK (SCG, MS).,Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute and Division of General Internal Medicine, St. Michael's Hospital, Toronto, Ontario, Canada (AMB).,Departments of Medicine and Health Policy, Management and Evaluation, University of Toronto, Ontario, Canada (AMB).,Division of Infectious Diseases, University of Ottawa at The Ottawa Hospital, Ottawa, Ontario, Canada (WC).,James J. Peters VA Medical Center, Bronx, New York (STB).,VA Palo Alto Health Care System, Palo Alto, California (MH, DKO).,Center for Primary Care and Outcomes Research, Stanford University, Stanford, California (DKO)
| | - Douglas K Owens
- VA Palo Alto Health Care System, VA Cooperative Studies Program Coordinating Center, VA HSR&D Health Economics Resource Center, Menlo Park, California (VRJ, PGB).,Centre for Health Evaluation and Outcome Sciences, St. Paul's Hospital, Vancouver, British Columbia, Canada (HS, NB, AHA).,Canadian HIV Trials Network, Vancouver, British Columbia, Canada (HS).,School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada (NB, AHA).,Centre for Health Economics, University of York, York, UK (SCG, MS).,Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute and Division of General Internal Medicine, St. Michael's Hospital, Toronto, Ontario, Canada (AMB).,Departments of Medicine and Health Policy, Management and Evaluation, University of Toronto, Ontario, Canada (AMB).,Division of Infectious Diseases, University of Ottawa at The Ottawa Hospital, Ottawa, Ontario, Canada (WC).,James J. Peters VA Medical Center, Bronx, New York (STB).,VA Palo Alto Health Care System, Palo Alto, California (MH, DKO).,Center for Primary Care and Outcomes Research, Stanford University, Stanford, California (DKO)
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