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HIV incidence in Indigenous and non-Indigenous populations in Australia: a population-level observational study. Lancet HIV 2018; 5:e506-e514. [PMID: 30097323 DOI: 10.1016/s2352-3018(18)30135-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Revised: 06/02/2018] [Accepted: 06/04/2018] [Indexed: 11/24/2022]
Abstract
BACKGROUND Australia has set a national target of ending HIV by 2020, achieving this will require the inclusion of priority populations (eg, Indigenous Australians) in strategies to reach elimination. To assist in evaluating the target of elimination, we analysed HIV notification data for Indigenous and non-Indigenous Australians. METHODS Using the National HIV Registry at The Kirby Institute at UNSW, Sydney, NSW, Australia, we collated and analysed annual HIV notification data for 1996-2015. Patients who were not born in Australia were excluded. We calculated the rates of HIV diagnoses with annual trends in notification rates for Indigenous versus non-Indigenous Australians by demographic characteristics, exposure categories, and stage of HIV at diagnosis. For missing data, assumptions were made and verified through sensitivity analyses. Annual rate ratio (RR) and 4 year summary rate ratio (SRR) trends were calculated to determine patterns of HIV diagnosis in the two populations. FINDINGS Between Jan 1, 1996, and Dec 31, 2015, 11 492 people born in Australia were reported with a diagnosis of HIV, of whom 461 (4%) were recorded as Indigenous Australians and we classified the remaining 11 031 (96%) as non-Indigenous Australians. For exposure to HIV, among Indigenous Australians a higher proportion of diagnoses occurred among women, and through injecting drug use and heterosexual sex than among non-Indigenous Australians (p<0·0001). Among Indigenous Australians, we found a significantly higher SRR of HIV diagnoses among men in the period 2012-15 than in previous periods (SRR 1·53, 95% CI 1·28-1·83; p<0·0001), and significantly higher diagnosis among Indigenous women (4·92, 4·02-6·02; p<0·0001) for the entire study period than among non-Indigenous women. Concurrently, a decrease in HIV diagnoses of 1% per annum (RR 0·99, 95% CI 0·98-0·99; p<0·0001) across the study period was seen among non-Indigenous people. Indigenous Australians were more likely to be diagnosed at an advanced stage of HIV infection than non-Indigenous Australians (20·8% vs 15·1%; p=0·0088). INTERPRETATION Greater efforts should be made to include Indigenous people in prevention strategies, particularly newer biomedical interventions, such as scale up of pre-exposure prophylaxis and treatment as prevention initiatives in Australia. More involvement of Indigenous Australians in these approaches is also required to prevent widening of the gap in HIV diagnosis rates between non-Indigenous and Indigenous Australians. FUNDING None.
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Negin J, Aspin C, Gadsden T, Reading C. HIV Among Indigenous peoples: A Review of the Literature on HIV-Related Behaviour Since the Beginning of the Epidemic. AIDS Behav 2015; 19:1720-34. [PMID: 25731659 PMCID: PMC4551545 DOI: 10.1007/s10461-015-1023-0] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
From the early days of the HIV epidemic, Indigenous peoples were identified as a population group that experiences social and economic determinants-including colonialism and racism-that increase exposure to HIV. There are now substantial disparities in HIV rates between Indigenous and non-Indigenous peoples in some countries. We conducted a comprehensive literature review to assess the evidence on HIV-related behaviors and determinants in four countries-Australia, Canada, New Zealand and the United States-in which Indigenous peoples share important features of colonization and marginalization. We identified 107 articles over more than 20 years. The review highlights the determinants of HIV-related behaviors including domestic violence, stigma and discrimination, and injecting drug use. Many of the factors associated with HIV risk also contribute to mistrust of health services, which in turn contributes to poor HIV and health outcomes among Indigenous peoples.
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Affiliation(s)
- Joel Negin
- Sydney School of Public Health, University of Sydney, Edward Ford Building (A27), Sydney, NSW, 2006, Australia,
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Templeton DJ, Wright ST, McManus H, Lawrence C, Russell DB, Law MG, Petoumenos K. Antiretroviral treatment use, co-morbidities and clinical outcomes among Aboriginal participants in the Australian HIV Observational Database (AHOD). BMC Infect Dis 2015; 15:326. [PMID: 26265164 PMCID: PMC4533935 DOI: 10.1186/s12879-015-1051-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2015] [Accepted: 07/22/2015] [Indexed: 11/24/2022] Open
Abstract
Background There are few data regarding clinical care and outcomes of Indigenous Australians living with HIV and it is unknown if these differ from non-Indigenous HIV-positive Australians. Methods AHOD commenced enrolment in 1999 and is a prospective cohort of HIV-positive participants attending HIV outpatient services throughout Australia, of which 20 (74 %) sites report Indigenous status. Data were collected up until March 2013 and compared between Indigenous and non-Indigenous participants. Person-year methods were used to compare death rates, rates of loss to follow-up and rates of laboratory testing during follow-up between Indigenous and non-Indigenous participants. Factors associated with time to first combination antiretroviral therapy (cART) regimen change were assessed using Kaplan Meier and Cox Proportional hazards methods. Results Forty-two of 2197 (1.9 %) participants were Indigenous. Follow-up amongst Indigenous and non-Indigenous participants was 332 & 16270 person-years, respectively. HIV virological suppression was achieved in similar proportions of Indigenous and non-Indigenous participants 2 years after initiation of cART (81.0 % vs 76.5 %, p = 0.635). Indigenous status was not independently associated with shorter time to change from first- to second-line cART (aHR 0.95, 95 % CI 0.51-1.76, p = 0.957). Compared with non-Indigenous participants, Indigenous participants had significantly less frequent laboratory monitoring of CD4 count (rate:2.76 tests/year vs 2.97 tests/year, p = 0.025) and HIV viral load (rate:2.53 tests/year vs 2.93 tests/year, p < 0.001), while testing rates for lipids and blood glucose were almost half that of non-indigenous participants (rate:0.43/year vs 0.71 tests/year, p < 0.001). Loss to follow-up (23.8 % vs 29.8 %, p = 0.496) and death (2.4 % vs 7.1 %, p = 0.361) occurred in similar proportions of indigenous and non-Indigenous participants, respectively, although causes of death in both groups were mostly non-HIV-related. Conclusions As far as we are aware, these are the first data comparing clinical outcomes between Indigenous and non-Indigenous HIV-positive Australians. The forty-two Indigenous participants represent over 10 % of all Indigenous Australians ever diagnosed with HIV. Although outcomes were not significantly different, Indigenous patients had lower rates of laboratory testing for HIV and lipid/glucose parameters. Given the elevated risk of cardiovascular disease in the general Indigenous community, the additional risk factor of HIV infection warrants further focus on modifiable risk factors to maximise life expectancy in this population.
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Affiliation(s)
- David J Templeton
- The Kirby Institute, UNSW Australia, Sydney, NSW, 2052, Australia. .,RPA Sexual Health, Sydney Local Health District, Camperdown, NSW, 2050, Australia. .,Central Clinical School, The University of Sydney, Sydney, NSW, 2006, Australia.
| | - Stephen T Wright
- The Kirby Institute, UNSW Australia, Sydney, NSW, 2052, Australia.
| | - Hamish McManus
- The Kirby Institute, UNSW Australia, Sydney, NSW, 2052, Australia.
| | - Chris Lawrence
- The George Institute for Global Health, Level 10, King George V Building, 83-117 Missenden Rd, Camperdown, NSW, 2050, Australia.
| | - Darren B Russell
- Cairns Sexual Health Service, PO Box 902, Cairns, QLD 4870, Australia. .,The University of Melbourne, VIC, Australia. .,James Cook University, Queensland, Australia.
| | - Matthew G Law
- The Kirby Institute, UNSW Australia, Sydney, NSW, 2052, Australia.
| | - Kathy Petoumenos
- The Kirby Institute, UNSW Australia, Sydney, NSW, 2052, Australia.
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Ward J, Bryant J, Wand H, Kaldor J, Delaney-Thiele D, Worth H, Betts S, Waples-Crowe P, Cairnduff S, Coburn T, Donovan B, Pitts M. Methods of a national survey of young Aboriginal and Torres Strait Islander people regarding sexually transmissible infections and bloodborne viruses. Aust N Z J Public Health 2015; 40 Suppl 1:S96-101. [PMID: 26259735 DOI: 10.1111/1753-6405.12427] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2014] [Revised: 03/01/2015] [Accepted: 04/01/2015] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE To describe the methods and basic demographics of participants in a national survey of Aboriginal and Torres Strait Islander (Aboriginal) people specific to sexually transmissible infections and bloodborne viruses. METHODS A national cross-sectional survey of Aboriginal people aged 16-29 years in all Australian jurisdictions between 2011 and 2013 conducted at Aboriginal community events. Questions comprised demographic information, knowledge, risk behaviours and health service utilisation. Questionnaires were completed on personal digital assistants (PDAs). RESULTS A total of 2,877 people at 21 unique community events completed the questionnaire. A total of 59% of participants were female, median age was 21 years and more than 60% were single at the time of the survey. Just over half the participants were resident in an urban area (53%) and 38% were from a regional area. Aboriginal health organisations played an important role in implementing the research. PDAs were found to be an acceptable method for collecting health information. CONCLUSION This survey has recruited a large representative sample of Aboriginal people aged 16-29 years using a methodology that is feasible, acceptable and repeatable. IMPLICATIONS The methodology provides a model for ongoing monitoring of this population as programs and policies are implemented to address young Aboriginal people's STI and BBV risks.
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Affiliation(s)
- James Ward
- South Australian Health and Medical Research Institute
| | - Joanne Bryant
- Centre for Social Health Research, University of New South Wales
| | - Handan Wand
- Kirby Institute, University of New South Wales
| | - John Kaldor
- Kirby Institute, University of New South Wales
| | | | - Heather Worth
- School of Public Health and Community Medicine, University of New South Wales
| | - Sarah Betts
- Aboriginal Health Council of South Australia
| | | | - Sallie Cairnduff
- Aboriginal Health and Medical Research Council of New South Wales
| | - Tony Coburn
- Queensland Aboriginal and Islander Health Council
| | - Basil Donovan
- Kirby Institute, University of New South Wales
- Sydney Sexual Health Centre, Sydney Hospital, New South Wales
| | - Marian Pitts
- Australian Research Centre in Sex, Health and Society, La Trobe University, Victoria
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Ward J, Akre SP, Kaldor JM. Guarding against an HIV epidemic within an Aboriginal community and cultural framework; lessons from NSW. NSW PUBLIC HEALTH BULLETIN 2011; 21:78-82. [PMID: 20513306 DOI: 10.1071/nb10015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
The rate of HIV diagnosis in the Aboriginal and Torres Strait Islander population in Australia has been stable over the past 5 years. It is similar to the rate in non-Indigenous people overall, but there are major differences in the demographical and behaviour patterns associated with infection, with a history of injecting drug use and heterosexual contact much more prominent in Aboriginal people with HIV infection. Moreover there are a range of factors, such as social disadvantage, a higher incidence of sexually transmitted infections and poor access to health services that place Aboriginal people at special risk of HIV infection. Mainstream and Aboriginal community-controlled health services have an important role in preventing this epidemic. Partnerships developed within NSW have supported a range of services for Aboriginal people. There is a continuing need to support these services in their response to HIV, with a particular focus on Aboriginal Sexual Health Workers, to ensure that the prevention of HIV remains a high priority.
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Affiliation(s)
- James Ward
- National Centre in HIV Epidemiology and Clinical Research, University of New South Wales.
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Improving Aboriginal health data capture: evidence from a health registry evaluation. Epidemiol Infect 2010; 139:1774-83. [PMID: 21134324 DOI: 10.1017/s095026881000275x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
The lack of high-quality health information for accurately estimating burdens of disease in some Aboriginal populations is a challenge for developing effective and relevant public health programmes and for health research. We evaluated data from a health registry system that captured patient consultations, provided by Labrador Grenfell Health (Labrador, Canada). The goal was to evaluate the registry's utility and attributes using modified CDC guidelines for evaluating surveillance systems. Infectious gastrointestinal illness data were used as a reference syndrome to determine various aspects of data collection and quality. Key-informant interviews were conducted to provide information about system utility. The study uncovered limitations in data quality and accessibility, resulting in region-specific recommendations including conversion to an electronic system. More generally, this study emphasized how a systematic and standardized evaluation of health registry systems can help address challenges to obtaining quality health data in often remote areas where many Aboriginal communities are found.
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Ho V, Whiteman D, Miller M, Raulli A, Ombiga J, Boyd P. Esophageal cancer in Indigenous Australians in Far North Queensland. J Gastroenterol Hepatol 2009; 24:1683-6. [PMID: 19798782 DOI: 10.1111/j.1440-1746.2009.05897.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
Abstract
BACKGROUND AND AIMS There is very little information known about esophageal cancer in Indigenous persons. In this retrospective study, we investigated the epidemiological and clinical features of Indigenous Australians with esophageal cancer. METHODS A retrospective study was carried out on Indigenous and non-Indigenous Australians diagnosed with esophageal cancer at Cairns Base Hospital during the period 1 January 2001 to 31 December 2006. Information was obtained from hospital medical records, Queensland Cancer Registry survival data and Queensland Health Pathology Services laboratory results. RESULTS Thirteen Indigenous and 53 non-Indigenous patients were diagnosed with esophageal cancer. Squamous cell carcinoma accounted for a significantly higher proportion of esophageal cancers among Indigenous (11/13) than non-Indigenous patients (24/53) (P = 0.0135). Among patients with esophageal squamous cell cancer, Indigenous patients were more likely than non-Indigenous patients to present with metastatic disease (P = 0.0271) at a younger mean age (50.7 years vs 67.2 years; P = 0.0002). There was no significant difference between Indigenous and non-Indigenous patients concerning their mean survival time from date of biopsy (P = 0.7834) and whether patients had ever smoked (P = 0.0721) or consumed alcohol (P = 0.2849). CONCLUSION There is a high incidence of squamous esophageal cancer in the Indigenous population in Far North Queensland. Indigenous persons tend to present at a younger age and with metastatic disease.
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Affiliation(s)
- Vincent Ho
- James Cook University School of Medicine, Townsville, Queensland, Australia.
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Andrews D. MANAGEMENT OF HIV/AIDS ON THE MID NORTH COAST: A COLLABORATIVE MODEL OF CARE INVOLVING GENERAL PRACTITIONERS AND THE PUBLIC HEALTH SYSTEM. Aust J Rural Health 2008. [DOI: 10.1111/j.1440-1584.2002.tb00039.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Newman CE, Bonar M, Greville HS, Thompson SC, Bessarab D, Kippax SC. Barriers and incentives to HIV treatment uptake among Aboriginal people in Western Australia. AIDS 2007; 21 Suppl 1:S13-7. [PMID: 17159582 DOI: 10.1097/01.aids.0000255080.46976.18] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To examine the barriers and incentives to HIV treatment uptake among Aboriginal people in Western Australia. METHODS In-depth, semi-structured interviews were conducted between February and September 2003 with 20 Aboriginal people who were HIV-positive; almost half the total number of Aboriginal people known to be living with HIV in Western Australia at that time. RESULTS Despite having access to treatments in both urban and rural areas, only 11 of the 20 participants were on antiretroviral treatment at the time of interview. Four of the women had been prescribed treatment during pregnancy only. The main barriers to treatment uptake were fear of disclosure and discrimination, heavy alcohol consumption and poverty. The incentives were pregnancy and access to services whose approach can be described as broad-based and holistic, i.e. supporting people in the context of their everyday lives by providing psychosocial and welfare support as well as healthcare. CONCLUSION For many Aboriginal people, maintaining social relationships, everyday routines and the respect of friends, families and community is a greater priority than individual health per se. Treatment regimens must be tailored to fit the logistical, social and cultural context of everyday life, and be delivered within the context of broad-based health services, in order to be feasible and sustainable.
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Affiliation(s)
- Christy E Newman
- National Centre in HIV Social Research, The University of New South Wales, Sydney, New South Wales, Australia.
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Abstract
We know what to do, but doing it is the challenge.
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Wright MR, Giele CM, Dance PR, Thompson SC. Fulfilling prophecy? Sexually transmitted infections and HIV in Indigenous people in Western Australia. Med J Aust 2005; 183:124-8. [PMID: 16053413 DOI: 10.5694/j.1326-5377.2005.tb06955.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2004] [Accepted: 05/18/2005] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To compare trends and rates of HIV and sexually transmitted infections in Indigenous and non-Indigenous people of Western Australia. DESIGN AND SETTING Analysis of WA notification data for chlamydia, gonorrhoea, and primary and secondary syphilis in 2002, and for HIV infections from 1983 to 2002. MAIN OUTCOME MEASURES Rates of HIV and sexually transmitted infection by Indigenous status. RESULTS In 2002, there were 3046 notifications for chlamydia, 1380 for gonorrhoea and 64 for syphilis. When information on Indigenous status was available, Indigenous people accounted for 41% of chlamydia and 76% of gonorrhoea notifications, with Indigenous:non-Indigenous age-standardised rate ratios of 16 (95% CI, 14-17) and 77 (95% CI, 67-88), respectively. Indigenous people accounted for 90.6% of syphilis notifications (age-standardised Indigenous:non-Indigenous rate ratio, 242 [95% CI, 104-561]). From 1985 to 2002, HIV notification rates for non-Indigenous people in WA declined and rates for Indigenous people increased. From 1994 to 2002, there were 421 notifications of HIV infection in WA residents, 52 (12.4%) in Indigenous people and 369 (87.6%) in non-Indigenous people. Indigenous people accounted for 39% and 6.2% of all notifications in WA females and males, respectively. The Indigenous:non-Indigenous rate ratios were 18 (95% CI, 12-29) for females and 2 (95% CI, 1-3) for males. CONCLUSIONS Indigenous Western Australians are at greater risk of HIV transmission than non-Indigenous people. Strategies to prevent further HIV infection in Indigenous Australians should include control of sexually transmitted infections.
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Affiliation(s)
- Michael R Wright
- Communicable Disease Control Directorate, PO Box 8172, Stirling Street, Perth, WA 6849.
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Andrews D. Management of HIV/AIDS on the Mid North Coast: a collaborative model of care involving general practitioners and the public health system. Aust J Rural Health 2002; 10:244-8. [PMID: 12230432 DOI: 10.1046/j.1440-1584.2002.00448.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The Coffs Harbour AIDS Information Network was set up to co-ordinate care planning and support service delivery for HIV/AIDS patients. This paper describes a collaborative model of care that brought together private general practitioners, a community nurse and a sexual health counsellor. Time involved in delivering services was monitored for each of the health professional groups during a 6 month period. Twenty-three patients were involved in our study. Doctors averaged 23 min per consultation over 57 occasions of service. Travel or telephone contact took up 17% of the time spent on these patients. Corresponding figures for the nurse and counsellor were an average of 67 min over 144 services and 71 min over 16 services. They spent 16% and 27% of their time travelling or on the phone, respectively. HIV/AIDS care is time consuming for health professionals but comprehensive care can be given in rural areas with adequate support and integration.
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Affiliation(s)
- Doug Andrews
- Coffs Harbour Health Campus, Coffs Harbour, New South Wales, Australia
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Abstract
In many developed countries, ethnic minority communities bear the brunt of poor sexual health outcomes, with high rates of HIV/AIDS, sexually transmitted infections and their sequelae. Economic disadvantage, social exclusion and racism experienced by these communities all contribute to the observed inequalities. However, culturally prescribed attitudes and behaviours also play an important role. A review of the literature suggests that multifaceted and sustained approaches are needed to improve the sexual health of ethnic minority communities. Chief among these approaches are improving sexually transmitted infection surveillance and research tools; creating collaborative partnerships with communities; targeting high-risk groups and networks; and improving access to, and the utilization of, proven effective interventions.
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Affiliation(s)
- K A Fenton
- Department of Sexually Transmitted Diseases, Royal Free and University College Medical School, and PHLS Communicable Disease Surveillance Centre, London, UK.
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