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Paine EA, Lee YG, Mergenova G, Vinogradov V, Laughney CI, Davis A, Terlikbayeva A, Primbetova S, Hunt T, Wu E. Compounding vulnerabilities: victimization and discrimination is associated with COVID-19 disruptions to HIV-related care among gay, bisexual, and other men and transgender and nonbinary people who have sex with men in Kazakhstan. AIDS Care 2023; 35:651-657. [PMID: 36628449 PMCID: PMC10159880 DOI: 10.1080/09540121.2022.2148956] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 11/14/2022] [Indexed: 01/12/2023]
Abstract
Gay, bisexual, and other men and transgender and nonbinary people who have sex with men (MSM and TSM) are disproportionately impacted by the HIV epidemic in Kazakhstan. MSM and TSM in Kazakhstan also face high levels of discrimination and victimization, known barriers to engagement in HIV prevention and care. We examined data from surveys with 455 MSM and TSM collected May -- October 2020 to determine whether access to HIV testing and treatment was disproportionately limited among those exposed to victimization and discrimination during the early COVID-19 pandemic. Odds of reporting COVID-19 disruptions to HIV-related care access were significantly higher (OR: 1.96; 95% CI: 1.25-3.06; P = .003) among those who experienced recent sexual or gender-based victimization, and recent discrimination (OR: 2.93; 95% CI: 1.65-5.23; P < .001), compared to those who did not experience victimization or discrimination, respectively. Odds of reporting disruptions among those who experienced both victimization and discrimination were significantly higher (OR: 3.59; 95% CI: 1.88-6.86; P < .001) compared to those who experienced neither . Associations remained significant after adjustment for potentially confounding factors. Findings suggest the COVID-19 pandemic is compounding vulnerability among MSM and TSM in Kazakhstan - highlighting need for intervention efforts targeting the most marginalized groups.
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Affiliation(s)
- Emily Allen Paine
- Department of Psychiatry, Columbia University, New York, NY, USA
- HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute, New York, NY, USA
| | - Yong Gun Lee
- Columbia University School of Social Work, New York, NY, USA
| | | | | | | | - Alissa Davis
- Columbia University School of Social Work, New York, NY, USA
| | | | | | - Timothy Hunt
- Columbia University School of Social Work, New York, NY, USA
- Global Health Research Center of Central Asia, Almaty, Kazakhstan
| | - Elwin Wu
- Columbia University School of Social Work, New York, NY, USA
- Global Health Research Center of Central Asia, Almaty, Kazakhstan
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Bouey JZH, Han J, Liu Y, Vuckovic M, Zhu K, Zhou K, Su Y. A case study of HIV/AIDS services from community-based organizations during COVID-19 lockdown in China. BMC Health Serv Res 2023; 23:288. [PMID: 36973805 PMCID: PMC10042409 DOI: 10.1186/s12913-023-09271-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 03/10/2023] [Indexed: 03/29/2023] Open
Abstract
INTRODUCTION People living with HIV (PLHIV) relied on community-based organizations (CBOs) in accessing HIV care and support during the COVID-19 pandemic in China. However, little is known about the impact of, and challenges faced by Chinese CBOs supporting PLHIV during lockdowns. METHODS A survey and interview study was conducted among 29 CBOs serving PLHIV in China between November 10 and November 23, 2020. Participants were asked to complete a 20-minute online survey on their routine operations, organizational capacity building, service provided, and challenges during the pandemic. A focus group interview was conducted with CBOs after the survey to gather CBOs' policy recommendations. Survey data analysis was conducted using STATA 17.0 while qualitative data was examined using thematic analysis. RESULTS HIV-focused CBOs in China serve diverse clients including PLHIV, HIV high-risk groups, and the public. The scope of services provided is broad, ranging from HIV testing to peer support. All CBOs surveyed maintained their services during the pandemic, many by switching to online or hybrid mode. Many CBOs reported adding new clients and services, such as mailing medications. The top challenges faced by CBOs included service reduction due to staff shortage, lack of PPE for staff, and lack of operational funding during COVID-19 lockdowns in 2020. CBOs considered the ability to better network with other CBOs and other sectors (e.g., clinics, governments), a standard emergency response guideline, and ready strategies to help PLHIV build resilience to be critical for future emergency preparation. CONCLUSION Chinese CBOs serving vulnerable populations affected by HIV/AIDS are instrumental in building resilience in their communities during the COVID-19 pandemic, and they can play significant roles in providing uninterrupted services during emergencies by mobilizing resources, creating new services and operation methods, and utilizing existing networks. Chinese CBOs' experiences, challenges, and their policy recommendations can inform policy makers on how to support future CBO capacity building to bridge service gaps during crises and reduce health inequalities in China and globally.
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Affiliation(s)
- Jennifer Z H Bouey
- Department of Global Health, School of Health, Georgetown University, 3700 Reservoir Road NW, Washington, DC, 20057, USA.
- RAND Corporation, Santa Monica, CA, USA.
| | - Jing Han
- Ditan Infectious Disease Hospital, Beijing, China
| | - Yuxuan Liu
- Department of Global Health, School of Health, Georgetown University, 3700 Reservoir Road NW, Washington, DC, 20057, USA
| | - Myriam Vuckovic
- Department of Global Health, School of Health, Georgetown University, 3700 Reservoir Road NW, Washington, DC, 20057, USA
| | - Keren Zhu
- RAND Corporation, Santa Monica, CA, USA
| | | | - Ye Su
- Home of Red Ribbon, Beijing, China
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Ransome Y, Hayashi K, Gamble-George JC, Dean LT, Villalonga-Olives E. Racial and ethnic differences in the association of social cohesion and social capital with HIV testing. SSM Popul Health 2023; 21:101327. [PMID: 36618543 PMCID: PMC9811247 DOI: 10.1016/j.ssmph.2022.101327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Revised: 09/24/2022] [Accepted: 12/21/2022] [Indexed: 12/24/2022] Open
Abstract
HIV testing rates vary by race and ethnicity. Whether social capital indicators are related to HIV testing and whether these associations differ by race or ethnicity is unknown. Multivariable analysis was used to examine whether social capital (collective engagement and civic and social participation), including social cohesion (trust in neighbors, neighbors willing to help, feelings of belongingness) were associated with testing for HIV in the past 12 months. Participants were white, Black or African American, and Hispanic/Latino adults ages 18 to 44 (N = 2823) from the general population, in Philadelphia, PA who participated in the Southeastern Pennsylvania Household Health Surveys 2010 and 2012. Overall HIV testing in this sample was 42%, and was higher among women, and Black compared to white people. Mean social capital scores were significantly highest among whites. Greater trust in neighbors was associated with lower odds of testing for HIV (adjusted Odds Ratio[aOR]:0.61, 95% CI = 0.49-0.74), and this relationship varied by race/ethnicity, with stronger inverse associations among Hispanic/Latino (aOR = 0.43, p < 0.001) and white adults (aOR = 0.50, p < -0.001) than among Black adults (aOR = 0.75, p < 0.05). Greater neighborhood belongingness (aOR = 1.31, 95% CI = 1.11-1.54) and working together to improve the neighborhood (aOR = 1.33, 95%CI = 1.03-1.73) were associated with higher odds of testing for HIV. Different indicators of social capital were associated with higher as well as lower odds of testing for HIV. These patterns did not vary statistically by race or ethnicity. HIV testing prevention interventions will need to address social capital in design and implementation strategies.
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Affiliation(s)
- Yusuf Ransome
- Social and Behavioral Sciences, Yale University, School of Public Health, 60 College Street, LEPH 4th Floor, New Haven, CT, 06520, USA
| | - Kamden Hayashi
- Department of Health Behavior, University of North Carolina, Gillings School of Global Public Health, 135 Dauer Drive, Chapel Hill, NC, 27599, USA
| | - Joyonna C. Gamble-George
- Behavioral Science Training in Drug Abuse Research, New York University Rory Meyers College of Nursing, 380 2nd Avenue, Suite 306, NY, 10010, USA
- Center for Interdisciplinary Research on AIDS, Yale University, School of Public Health, 135 College Street, Suite 200, New Haven, CT, 06510, USA
| | - Lorraine T. Dean
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Room E6650, Baltimore, MD, 21205, USA
| | - Ester Villalonga-Olives
- Department of Pharmaceutical Health Services Research, University of Maryland School of Pharmacy, 220 Arch Street, 12th Floor, Baltimore, MD, 21201, USA
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Dukers-Muijrers NHTM, Evers Y, Widdershoven V, Davidovich U, Adam PCG, Op de Coul ELM, Zantkuijl P, Matser A, Prins M, de Vries HJC, den Heijer C, Hoebe CJPA, Niekamp AM, Schneider F, Reyes-Urueña J, Croci R, D'Ambrosio A, van der Valk M, Posthouwer D, Ackens R, ter Waarbeek H, Noori T, Hoornenborg E. Mpox vaccination willingness, determinants, and communication needs in gay, bisexual, and other men who have sex with men, in the context of limited vaccine availability in the Netherlands (Dutch Mpox-survey). Front Public Health 2023; 10:1058807. [PMID: 36684959 PMCID: PMC9850232 DOI: 10.3389/fpubh.2022.1058807] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 12/13/2022] [Indexed: 01/07/2023] Open
Abstract
Introduction In the 2022 multicountry mpox (formerly named monkeypox) outbreak, several countries offered primary preventive vaccination (PPV) to people at higher risk for infection. We study vaccine acceptance and its determinants, to target and tailor public health (communication-) strategies in the context of limited vaccine supply in the Netherlands. Methods Online survey in a convenience sample of gay, bisexual and other men who have sex with men, including transgender persons (22/07-05/09/2022, the Netherlands). We assessed determinants for being (un)willing to accept vaccination. We used multivariable multinominal regression and logistic regression analyses, calculating adjusted odds ratios (aOR) and 95 percent confidence-intervals. An open question asked for campaigning and procedural recommendations. Results Of respondents, 81.5% (n = 1,512/1,856) were willing to accept vaccination; this was 85.2% (799/938) in vaccination-eligible people and 77.7% (713/918) in those non-eligible. Determinants for non-acceptance included: urbanization (rural: aOR:2.2;1.2-3.7; low-urban: aOR:2.4;1.4-3.9; vs. high-urban), not knowing mpox-vaccinated persons (aOR:2.4;1.6-3.4), and lack of connection to gay/queer-community (aOR:2.0;1.5-2.7). Beliefs associated with acceptance were: perception of higher risk/severity of mpox, higher protection motivation, positive outcome expectations post vaccination, and perceived positive social norms regarding vaccination. Respondents recommended better accessible communication, delivered regularly and stigma-free, with facts on mpox, vaccination and procedures, and other preventive options. Also, they recommended, "vaccine provision also at non-clinic settings, discrete/anonymous options, self-registration" to be vaccinated and other inclusive vaccine-offers (e.g., also accessible to people not in existing patient-registries). Conclusion In the public health response to the mpox outbreak, key is a broad and equitable access to information, and to low-threshold vaccination options for those at highest risk. Communication should be uniform and transparent and tailored to beliefs, and include other preventive options. Mpox vaccine willingness was high. Public health efforts may be strengthened in less urbanized areas and reach out to those who lack relevant (community) social network influences.
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Affiliation(s)
- Nicole H. T. M. Dukers-Muijrers
- Department of Sexual Health, Infectious Diseases, and Environmental Health, South Limburg Public Health Service, Heerlen, Netherlands
- Department of Health Promotion, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, Netherlands
| | - Ymke Evers
- Department of Sexual Health, Infectious Diseases, and Environmental Health, South Limburg Public Health Service, Heerlen, Netherlands
- Department of Social Medicine, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, Netherlands
| | - Veja Widdershoven
- Department of Sexual Health, Infectious Diseases, and Environmental Health, South Limburg Public Health Service, Heerlen, Netherlands
- Department of Social Medicine, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, Netherlands
| | - Udi Davidovich
- Department of Infectious Diseases, Public Health Service of Amsterdam (GGD Amsterdam), Amsterdam, Netherlands
- Department of Social Psychology, University of Amsterdam, Amsterdam, Netherlands
| | - Philippe C. G. Adam
- Institute for Prevention and Social Research in Utrecht, Utrecht, Netherlands
- Centre for Social Research in Health, University of New South Wales (UNSW) Sydney, Kensington, NSW, Australia
| | - Eline L. M. Op de Coul
- Epidemiology and Surveillance Unit, Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, Netherlands
| | | | - Amy Matser
- Department of Infectious Diseases, Public Health Service of Amsterdam (GGD Amsterdam), Amsterdam, Netherlands
- Amsterdam University Medical Center (UMC) Location University of Amsterdam, Infectious Diseases, Amsterdam, Netherlands
- Amsterdam Institute for Infection and Immunity (AII), Amsterdam UMC Location University of Amsterdam, Amsterdam, Netherlands
| | - Maria Prins
- Department of Infectious Diseases, Public Health Service of Amsterdam (GGD Amsterdam), Amsterdam, Netherlands
- Amsterdam University Medical Center (UMC) Location University of Amsterdam, Infectious Diseases, Amsterdam, Netherlands
- Amsterdam Institute for Infection and Immunity (AII), Amsterdam UMC Location University of Amsterdam, Amsterdam, Netherlands
| | - Henry J. C. de Vries
- Department of Infectious Diseases, Public Health Service of Amsterdam (GGD Amsterdam), Amsterdam, Netherlands
- Epidemiology and Surveillance Unit, Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, Netherlands
- Amsterdam University Medical Center (UMC) Location University of Amsterdam, Infectious Diseases, Amsterdam, Netherlands
- Department of Dermatology, Location Academic Medical Centre, Amsterdam Institute for Infection and Immunity (AII), Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Casper den Heijer
- Department of Sexual Health, Infectious Diseases, and Environmental Health, South Limburg Public Health Service, Heerlen, Netherlands
- Department of Social Medicine, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, Netherlands
| | - Christian J. P. A. Hoebe
- Department of Sexual Health, Infectious Diseases, and Environmental Health, South Limburg Public Health Service, Heerlen, Netherlands
- Department of Social Medicine, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, Netherlands
- Department of Medical Microbiology, Care and Public Health Research Institute (CAPHRI), Maastricht University Medical Center (MUMC+), Maastricht, Netherlands
| | - Anne-Marie Niekamp
- Department of Sexual Health, Infectious Diseases, and Environmental Health, South Limburg Public Health Service, Heerlen, Netherlands
- Department of Social Medicine, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, Netherlands
| | - Francine Schneider
- Department of Health Promotion, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, Netherlands
| | | | - Roberto Croci
- European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden
| | - Angelo D'Ambrosio
- European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden
| | - Marc van der Valk
- Amsterdam University Medical Center (UMC) Location University of Amsterdam, Infectious Diseases, Amsterdam, Netherlands
- Stichting HIV Monitoring, Amsterdam, Netherlands
| | - Dirk Posthouwer
- Department of Medical Microbiology, Care and Public Health Research Institute (CAPHRI), Maastricht University Medical Center (MUMC+), Maastricht, Netherlands
- Department of Internal Medicine, Care and Public Health Research Institute (CAPHRI), Maastricht University Medical Center (MUMC+), Maastricht, Netherlands
| | - Robin Ackens
- Department of Integrated Care, Maastricht University Medical Centre (MUMC+), Maastricht, Netherlands
| | - Henriette ter Waarbeek
- Department of Sexual Health, Infectious Diseases, and Environmental Health, South Limburg Public Health Service, Heerlen, Netherlands
| | - Teymur Noori
- European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden
| | - Elske Hoornenborg
- Department of Infectious Diseases, Public Health Service of Amsterdam (GGD Amsterdam), Amsterdam, Netherlands
- Amsterdam University Medical Center (UMC) Location University of Amsterdam, Infectious Diseases, Amsterdam, Netherlands
- Amsterdam Institute for Infection and Immunity (AII), Amsterdam UMC Location University of Amsterdam, Amsterdam, Netherlands
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Pharr JR, Terry E, Wade A, Haboush-Deloye A, Marquez E. Impact of COVID-19 on Sexual and Gender Minority Communities: Focus Group Discussions. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 20:50. [PMID: 36612372 PMCID: PMC9819493 DOI: 10.3390/ijerph20010050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 12/16/2022] [Accepted: 12/18/2022] [Indexed: 06/17/2023]
Abstract
BACKGROUND People who identify as sexual and gender minorities (SGM) experienced disproportionate economic and mental health issues related to COVID-19 when compared to the general population. The purpose of this study was to better understand how COVID-19 has impacted the SGM community and ways to address vaccine hesitancy. METHODS Three focus groups were conducted with 21 members of the SGM community between 5 November and 10 December 2020. A thematic analysis using the reflexive approach was applied to the transcripts of the focus groups. RESULTS Four themes emerged: (1) Impact of COVID-19 on the Community, (2) Perceptions of Contact Tracing and Testing, (3) Perceptions of a Potential COVID-19 Vaccine, and (4) Decreasing Vaccine Hesitancy. The most relevant subthemes were that social isolation led to anxiety, stress, and fear in the SGM community during COVID-19; resilience and adaptation were positive outcomes of the pandemic; histories of medical racism contributed to hesitancy to get tested; and specific messaging from trusted messengers may be needed to encourage SGM communities to get vaccinated. These findings support other COVID-19 research on the SGM community during the start of the pandemic. CONCLUSIONS This study provides insight into the impact of the early stages of COVID-19 on the SGM community, highlighting the unique hurdles faced by SGM individuals with regard to contact tracing and vaccine hesitancy.
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Affiliation(s)
- Jennifer R. Pharr
- Department of Environmental and Occupational Health, School of Public Health, University of Nevada, Las Vegas, Las Vegas, NV 89119, USA
- Nevada Minority Health and Equity Coalition, School of Public Health, University of Nevada, Las Vegas, Las Vegas, NV 89119, USA
| | - Emylia Terry
- Department of Environmental and Occupational Health, School of Public Health, University of Nevada, Las Vegas, Las Vegas, NV 89119, USA
- Nevada Minority Health and Equity Coalition, School of Public Health, University of Nevada, Las Vegas, Las Vegas, NV 89119, USA
| | - André Wade
- Nevada Minority Health and Equity Coalition, School of Public Health, University of Nevada, Las Vegas, Las Vegas, NV 89119, USA
- Silver State Equality, North Las Vegas, NV 89031, USA
| | - Amanda Haboush-Deloye
- Nevada Minority Health and Equity Coalition, School of Public Health, University of Nevada, Las Vegas, Las Vegas, NV 89119, USA
- Nevada Institute for Children’s Research and Policy, School of Public Health, University of Nevada, Las Vegas, Las Vegas, NV 89119, USA
| | - Erika Marquez
- Department of Environmental and Occupational Health, School of Public Health, University of Nevada, Las Vegas, Las Vegas, NV 89119, USA
- Nevada Minority Health and Equity Coalition, School of Public Health, University of Nevada, Las Vegas, Las Vegas, NV 89119, USA
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Regencia ZJG, Castelo AV, Eustaquio PC, Araña YS, Corciega JOL, Rosadiño JDT, Pagtakhan RG, Baja ES. Non-uptake of HIV testing among trans men and trans women: cross-sectional study of client records from 2017 to 2019 in a community-based transgender health center in Metro Manila, Philippines. BMC Public Health 2022; 22:1755. [PMID: 36114481 PMCID: PMC9479240 DOI: 10.1186/s12889-022-14158-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 09/05/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Transgender individuals are considered at high risk of contracting HIV infection. Integrating HIV testing and counseling (HTC) services into current transgender health programs is necessary to increase its uptake. Our study aimed to describe the characteristics of trans men (TM) and trans women (TW) who accessed HTC services in a community-based transgender health center in Metro Manila, Philippines, and to examine the relationship between gender identity and their non-uptake of HIV testing. METHODS: We conducted a cross-sectional study of TM and TW seeking care from 2017 to 2019. Medical records of clients were reviewed to ascertain their age, gender identity, year and frequency of clinic visits, lifestyle factors, and non-uptake of HIV testing. The effect of gender identity on the non-uptake of HIV testing was estimated using a generalized linear model with Poisson distribution, log link function, and a robust variance, adjusted for confounding variables. RESULTS: Five hundred twenty-five clients were included in the study, of which about 82.3% (432/525) of the clients declined the HTC services being offered. In addition, the prevalence of non-uptake of HIV testing was 48% higher (Adjusted Prevalence Ratio: 1.48; 95% Confidence Interval: 1.31-1.67) among TM compared to TW. Approximately 3.7% (1/27) and 10.6% (7/66) of the TM and TW, respectively, who accessed the HTC services were reactive. Moreover, most reactive clients were on treatment 87.5% (7/8); three were already virally suppressed, four were on ART but not yet virally suppressed, and one TW client was lost to follow up. CONCLUSION The non-uptake of HTC service of TM and TW is high. HIV program implementers should strategize solutions to reach this vulnerable population for increased and better HTC service uptake and linkage to care.
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Affiliation(s)
- Zypher Jude G Regencia
- Department of Clinical Epidemiology, College of Medicine, University of the Philippines Manila, City of Manila, 1000, Philippines
- Institute of Clinical Epidemiology, National Institutes of Health, University of the Philippines Manila, City of Manila, 1000, Philippines
| | - Aisia V Castelo
- LoveYourself Inc, Mandaluyong City, 1552, Metro Manila, Philippines
| | | | - Yanyan S Araña
- LoveYourself Inc, Mandaluyong City, 1552, Metro Manila, Philippines
| | | | - John Danvic T Rosadiño
- LoveYourself Inc, Mandaluyong City, 1552, Metro Manila, Philippines
- Faculty of Management and Development Studies, University of the Philippines - Open University, Los Baños, 4031, Laguna, Philippines
| | | | - Emmanuel S Baja
- Department of Clinical Epidemiology, College of Medicine, University of the Philippines Manila, City of Manila, 1000, Philippines.
- Institute of Clinical Epidemiology, National Institutes of Health, University of the Philippines Manila, City of Manila, 1000, Philippines.
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