Last data update: Jun 03, 2024. (Total: 46935 publications since 2009)
Records 1-15 (of 15 Records) |
Query Trace: Broyles LN [original query] |
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Beyond early infant diagnosis: Changing the approach to HIV-exposed infants
Modi S , Broyles LN , Montandon M , Itoh M , Ochanda B , Langat A , Sullivan D , Dale H . J Acquir Immune Defic Syndr 2018 78 Suppl 2 S107-s114 Despite dramatic global progress with implementing prevention of mother-to-child HIV transmission (PMTCT) programs, there were 160,000 new pediatric HIV infections in 2016. More than 50% of infant HIV infections now occur in the postpartum period, reflecting the relatively high coverage of interventions in the antenatal period and the need for greater attention to the breastfeeding mother and her HIV-exposed infant (HEI). Early diagnosis and treatment are critical to prevent morbidity and mortality in HIV-infected children; however, early infant HIV testing rates remain low in most high HIV-burden countries. Furthermore, systematic retention and follow-up of HEI in the postpartum period and ascertainment of final HIV status remain major program gaps. Despite multiple calls to action to improve infant HIV testing rates, progress has been marginal due to a lack of focus on the critical health care needs of HEI coupled with health system barriers that result in fragmented services for HIV-infected mothers and their families. In this paper, we describe the available evidence on the health outcomes of HEI, define a comprehensive care package for HEI that extends beyond early HIV testing, and describe successful examples of integrated services for HEI. |
Boosting ART uptake and retention among HIV-infected pregnant and breastfeeding women and their infants: the promise of innovative service delivery models
Srivastava M , Sullivan D , Phelps BR , Modi S , Broyles LN . J Int AIDS Soc 2018 21 (1) INTRODUCTION: With the rapid scale-up of antiretroviral treatment (ART) in the "Treat All" era, there has been increasing emphasis on using differentiated models of HIV service delivery. The gaps within the clinical cascade for mothers and their infants suggest that current service delivery models are not meeting families' needs and prompt re-consideration of how services are provided. This article will explore considerations for differentiated care and encourage the ongoing increase of ART coverage through innovative strategies while also addressing the unique needs of mothers and infants. DISCUSSION: Service delivery models should recognize that the timing of the mother's HIV diagnosis is a critical aspect of determining eligibility. Women newly diagnosed with HIV require a more intensive approach so that adequate counselling and monitoring of ART initiation and response can be provided. Women already on ART with evidence of virologic failure are also at high risk of transmitting HIV to their infants and require close follow-up. However, women stable on ART with a suppressed viral load before conception have a very low likelihood of HIV transmission and thus are strong candidates for multi-month ART dispensing, community-based distribution of ART, adherence clubs, community adherence support groups and longer intervals between clinical visits. A number of other factors should be considered when defining eligibility of mothers and infants for differentiated care, including location of services, viral load monitoring and duration on ART. To provide differentiated care that is client-centred and driven while encompassing a family-based approach, it will be critical to engage mothers, families and communities in models that will optimize client satisfaction, retention in care and quality of services. CONCLUSIONS: Differentiated care for mothers and infants represents an opportunity to provide client-centred care that reduces the burden on clients and health systems while improving the quality and uptake of services for families. However, with decreasing funding, stable HIV incidence, and aspirations for sustainability, it is critical to consider efficient, customized and cost-effective models of care for these populations as we aspire to eliminate mother-to-child transmission of HIV. |
Expansion of viral load testing and the potential impact on human immunodeficiency virus drug resistance
Chun HM , Obeng-Aduasare YF , Broyles LN , Ellenberger D . J Infect Dis 2017 216 S808-S811 Increasing the volume, strengthening the quality, and proactively using data of human immunodeficiency virus (HIV) load testing are pivotal to limiting the threat of HIV drug resistance (HIVDR) accumulation,and allow for optimal case-based HIVDR surveillance. Triangulation of viral load (VL) and HIVDR testing data could be pursued to answer key questions and translate data and results for program and public policy. Identification of virologic failure and early management mitigates the greater risk of HIVDR. Routine VL monitoring and evaluation systems are necessary, and countries should consider reviewing system requirements, structural needs, and procedural and technical factors for the entire VL cascade, with special emphasis on post-test result use. |
Pregnant and breastfeeding women: A priority population for HIV viral load monitoring
Myer L , Essajee S , Broyles LN , Watts DH , Lesosky M , El-Sadr WM , Abrams EJ . PLoS Med 2017 14 (8) e1002375 Landon Myer and colleagues discuss viral load monitoring for pregnant HIV-positive women and those breastfeeding; ART treatments can suppress viral load and are key to preventing transmission to the child. |
Pregnant adolescents living with HIV: What we know, what we need to know, where we need to go
Callahan T , Modi S , Swanson J , Ng'eno B , Broyles LN . J Int AIDS Soc 2017 20 (1) 1-4 INTRODUCTION: HIV-infected pregnant and breastfeeding adolescents are a particularly vulnerable group that require special attention and enhanced support to achieve optimal maternal and infant outcomes. The objective of this paper is to review published evidence about antenatal care (ANC) service delivery and outcomes for HIV-infected pregnant adolescents in low-income country settings, identify gaps in knowledge and programme services and highlight the way forward to improve clinical outcomes of this vulnerable group. DISCUSSION: Emerging data from programmes in sub-Saharan Africa highlight that HIV-infected pregnant adolescents have poorer prevention of mother-to-child HIV transmission (PMTCT) service outcomes, including lower PMTCT service uptake, compared to HIV-infected pregnant adults. In addition, the limited evidence available suggests that there may be higher rates of mother-to-child HIV transmission among infants of HIV-infected pregnant adolescents. CONCLUSIONS: While the reasons for the inferior outcomes among adolescents in ANC need to be further explored and addressed, there is sufficient evidence that immediate operational changes are needed to address the unique needs of this population. Such changes could include integration of adolescent-friendly services into PMTCT settings or targeting HIV-infected pregnant adolescents with enhanced retention and follow-up activities. |
Moving toward test and start: learning from the experience of universal antiretroviral therapy programs for HIV-infected pregnant/ breastfeeding women
Forhan SE , Modi S , Houston JC , Broyles LN . AIDS 2017 31 (10) 1489-1493 In 2015, the World Health Organization (WHO) recommended universal antiretroviral therapy (ART) for all people living with HIV (PLHIV) after two randomized controlled trials revealed lower rates of mortality and serious illnesses among PLHIV receiving immediate ART compared to those receiving deferred ART. Many countries in sub-Saharan Africa rapidly adopted this guidance and are implementing "test and start" programs.As this work begins, lessons learned from prevention of mother-to-child transmission (PMTCT) Option B+ programs can inform decisions for new universal HIV treatment programs. The Option B+ approach involved initiation of lifelong treatment for all HIV-infected pregnant and breastfeeding women. Since its inception in Malawi in 2011 and WHO endorsement in 2012, widespread scale-up of Option B+ PMTCT programs in most resource-limited countries has resulted in a dramatic increase in ART coverage for HIV-infected pregnant and breastfeeding women.Despite the overall success of the Option B+ universal lifelong treatment approach, program and operational research data highlight the need for additional focus on strategies to retain women in care. In this commentary, we highlight program considerations and lessons learned from Option B+ implementation experience in resource-limited countries which may help guide decisions and enhance the quality of general "test and start" programming. |
Overcoming health system challenges for women and children living with HIV through the Global Plan
Modi S , Callahan T , Rodrigues J , Kajoka MD , Dale HM , Langa JO , Urso M , Nchephe MI , Bongdene H , Romano S , Broyles LN . J Acquir Immune Defic Syndr 2017 75 Suppl 1 S76-s85 To meet the ambitious targets set by the Global Plan Towards the Elimination of New HIV Infections Among Children by 2015 and Keeping Their Mothers Alive (Global Plan), the initial 22 priority countries quickly developed innovative approaches for overcoming long-standing health systems challenges and providing HIV testing and treatment to pregnant and breastfeeding women and their infants. The Global Plan spurred programs for prevention of mother-to-child HIV transmission to integrate HIV-related care and treatment into broader maternal, newborn, and child health services; expand the effectiveness of the health workforce through task sharing; extend health services into communities; strengthen supply chain and commodity management systems; reduce diagnostic and laboratory hurdles; and strengthen strategic supervision and mentorship. The article reviews the ongoing challenges for prevention of mother-to-child HIV transmission programs as they continue to strive for elimination of vertical transmission of HIV infection in the post-Global Plan era. Although progress has been rapid, health systems still face important challenges, particularly follow-up and diagnosis of HIV-exposed infants, continuity of care, and the promotion of services that are respectful and client centered. |
Field evaluation of dried blood spots for HIV-1 viral load monitoring in adults and children receiving antiretroviral treatment in Kenya: Implications for scale-up in resource-limited settings
Schmitz ME , Agolory S , Junghae M , Broyles LN , Kimeu M , Ombayo J , Umuro M , Mukui I , Alwenya K , Baraza M , Ndiege K , Mwalili S , Rivadeneira E , Ng'ang'a L , Yang C , Zeh C . J Acquir Immune Defic Syndr 2016 74 (4) 399-406 BACKGROUND: WHO recommends viral load (VL) as the preferred method for diagnosing antiretroviral therapy (ART) failure; however, operational challenges have hampered the implementation of VL monitoring in most resource-limited settings. This study evaluated the accuracy of dried blood spot (DBS) VL testing under field conditions as a practical alternative to plasma in determining virologic failure (VF). METHODS: From May to December 2013, paired plasma and DBS specimens were collected from 416 adults and 377 children on ART ≥6 months at 12 clinics in Kenya. DBS were prepared from venous blood (V-DBS) using disposable transfer pipettes, and from finger-prick capillary blood using microcapillary tube (M-DBS) and directly spotting (D-DBS). All samples were tested on Abbott m2000 platform; V-DBS was also tested on Roche-CAP/CTM Version 2.0 platform. VF results were compared at three DBS thresholds (≥1000, ≥3000 and ≥5000 copies/ml) and a constant plasma threshold of ≥1000 copies/ml. RESULTS: On Abbott platform, at ≥1000 copies/ml threshold, sensitivities, specificities, and Kappa values for VF determination were ≥88.1%, ≥93.1% and ≥0.82 respectively for all DBS methods and it had the lowest percentage of downward misclassification compared to higher thresholds. V-DBS performance on CAP/CTM had significantly poorer specificity at all thresholds (1000-33.0%, 3000-60.9%, 5000-77.0%). No significant differences were found between adults and children. CONCLUSION: VL results from V-DBS, M-DBS and D-DBS were comparable to plasma for determining VF using the Abbott platform but not with CAP/CTM. A 1000 copies/ml threshold was optimal and should be considered for VF determination using DBS in adults and children. |
Early diagnosis of HIV infection in infants - one Caribbean and six sub-Saharan African countries, 2011-2015
Diallo K , Kim AA , Lecher S , Ellenberger D , Beard RS , Dale H , Hurlston M , Rivadeneira M , Fonjungo PN , Broyles LN , Zhang G , Sleeman K , Nguyen S , Jadczak S , Abiola N , Ewetola R , Muwonga J , Fwamba F , Mwangi C , Naluguza M , Kiyaga C , Ssewanyana I , Varough D , Wysler D , Lowrance D , Louis FJ , Desinor O , Buteau J , Kesner F , Rouzier V , Segaren N , Lewis T , Sarr A , Chipungu G , Gupta S , Singer D , Mwenda R , Kapoteza H , Chipeta Z , Knight N , Carmona S , MacLeod W , Sherman G , Pillay Y , Ndongmo CB , Mugisa B , Mwila A , McAuley J , Chipimo PJ , Kaonga W , Nsofwa D , Nsama D , Mwamba FZ , Moyo C , Phiri C , Borget MY , Ya-Kouadio L , Kouame A , Adje-Toure CA , Nkengasong J . MMWR Morb Mortal Wkly Rep 2016 65 (46) 1285-1290 Pediatric human immunodeficiency virus (HIV) infection remains an important public health issue in resource-limited settings. In 2015, 1.4 million children aged <15 years were estimated to be living with HIV (including 170,000 infants born in 2015), with the vast majority living in sub-Saharan Africa. In 2014, 150,000 children died from HIV-related causes worldwide. Access to timely HIV diagnosis and treatment for HIV-infected infants reduces HIV-associated mortality, which is approximately 50% by age 2 years without treatment. Since 2011, the annual number of HIV-infected children has declined by 50%. Despite this gain, in 2014, only 42% of HIV-exposed infants received a diagnostic test for HIV, and in 2015, only 51% of children living with HIV received antiretroviral therapy (1). Access to services for early infant diagnosis of HIV (which includes access to testing for HIV-exposed infants and clinical diagnosis of HIV-infected infants) is critical for reducing HIV-associated mortality in children aged <15 years. Using data collected from seven countries supported by the U.S. President's Emergency Plan for AIDS Relief (PEPFAR), progress in the provision of HIV testing services for early infant diagnosis was assessed. During 2011-2015, the total number of HIV diagnostic tests performed among HIV-exposed infants within 6 weeks after birth (tests for early infant diagnosis of HIV), as recommended by the World Health Organization (WHO) increased in all seven countries (Cote d'Ivoire, the Democratic Republic of the Congo, Haiti, Malawi, South Africa, Uganda, and Zambia); however, in 2015, the rate of testing for early infant diagnosis among HIV-exposed infants was <50% in five countries. HIV positivity among those tested declined in all seven countries, with three countries (Cote d'Ivoire, the Democratic Republic of the Congo, and Uganda) reporting >50% decline. The most common challenges for access to testing for early infant diagnosis included difficulties in specimen transport, long turnaround time between specimen collection and receipt of results, and limitations in supply chain management. Further reductions in HIV mortality in children can be achieved through continued expansion and improvement of services for early infant diagnosis in PEPFAR-supported countries, including initiatives targeted to reach HIV-exposed infants, ensure access to programs for early infant diagnosis of HIV, and facilitate prompt linkage to treatment for children diagnosed with HIV infection. |
Children and alternative service delivery models: a case for inclusion
Mirkovic KR , Rivadeneira ED , Broyles LN . AIDS 2016 30 (16) 2569-2570 The global commitment to reach the United Nations 90-90-90 targets will require a tremendous effort to almost double the number of HIV-infected individuals receiving antiretroviral treatment (ART), from 15.8 to 29.9 million, in the next 4 years [1]. In sub-Saharan Africa alone, ART initiation for an additional 6.2 million persons will be needed to reach this target. Given the infrastructure constraints and healthcare worker shortages in many resource-limited settings, there is increasing recognition that traditional facility-based models of clinician-led HIV service delivery will not be feasible with the increase in patient volume. In response, multiple proposed alternative service delivery models have been developed that center on transitioning at least some aspects of care out of health facilities into the community to decongest clinics and maximize the use of limited healthcare worker resources [2]. | Several commonly employed service delivery modifications have documented success in improving patient outcomes. One of the most common focuses on multimonth prescribing in which pharmacies dispense more than a month's supply of ART, requiring fewer patient visits to collect medications [2]. Another employs alternative ART delivery points; for example, HIV-infected patients can collect their ART at a community pharmacy/drug delivery site or have ART delivered to their homes by a cadre of lay workers [3]. A third model reduces the number of required follow-up visits for certain patients, most often those considered ‘stable’ by criteria such as time on ART and/or viral load suppression. These patients are seen at the facility by medical staff only once or twice per year [4]. Other models employ community adherence clubs, where groups of HIV-infected individuals receive all of their medication and care in the community on a particular day [5]. Finally, community ART groups rely on the member of the group to collect monthly antiretrovirals (ARVs) for all members while visiting the health facility for their yearly/biyearly visit [6]. This list is not exhaustive, and new strategies ideally suited for specific populations are continuing to be implemented. However, one commonality among most alternative models of ART service delivery is that children have almost uniformly been excluded. |
Secondary infections with Ebola virus in rural communities, Liberia and Guinea, 2014-2015
Lindblade KA , Nyenswah T , Keita S , Diallo B , Kateh F , Amoah A , Nagbe TK , Raghunathan P , Neatherlin JC , Kinzer M , Pillai SK , Attfield KR , Hajjeh R , Dweh E , Painter J , Barradas DT , Williams SG , Blackley DJ , Kirking HL , Patel MR , Dea M , Massoudi MS , Barskey AE , Zarecki SL , Fomba M , Grube S , Belcher L , Broyles LN , Maxwell TN , Hagan JE , Yeoman K , Westercamp M , Mott J , Mahoney F , Slutsker L , DeCock KM , Marston B , Dahl B . Emerg Infect Dis 2016 22 (9) 1653-5 Persons who died of Ebola virus disease at home in rural communities in Liberia and Guinea resulted in more secondary infections than persons admitted to Ebola treatment units. Intensified monitoring of contacts of persons who died of this disease in the community is an evidence-based approach to reduce virus transmission in rural communities. |
Decreased Ebola transmission after rapid response to outbreaks in remote areas, Liberia, 2014
Lindblade KA , Kateh F , Nagbe TK , Neatherlin JC , Pillai SK , Attfield KR , Dweh E , Barradas DT , Williams SG , Blackley DJ , Kirking HL , Patel MR , Dea M , Massoudi MS , Wannemuehler K , Barskey AE , Zarecki SL , Fomba M , Grube S , Belcher L , Broyles LN , Maxwell TN , Hagan JE , Yeoman K , Westercamp M , Forrester J , Mott J , Mahoney F , Slutsker L , DeCock KM , Nyenswah T . Emerg Infect Dis 2015 21 (10) 1800-7 We measured the reproduction number before and after interventions were implemented to reduce Ebola transmission in 9 outbreaks in Liberia during 2014. We evaluated risk factors for secondary cases and the association between patient admission to an Ebola treatment unit (ETU) and survival. The reproduction number declined 94% from 1.7 (95% CI 1.1-2.6) to 0.1 (95% CI 0.02-0.6) after interventions began. The risk for secondary infections was 90% lower for patients admitted to an ETU (risk ratio 0.1, 95% CI 0.04-0.3) than for those who died in the community. The case-fatality rate was 68% (95% CI 60-74), and ETU admission was associated with a 50% reduction in death (hazard ratio 0.5, 95% CI 0.4-0.8). Isolation and treatment of Ebola patients had the dual benefit of interrupting community transmission and improving survival. |
Rapid intervention to reduce Ebola transmission in a remote village - Gbarpolu County, Liberia, 2014
Blackley DJ , Lindblade KA , Kateh F , Broyles LN , Westercamp M , Neatherlin JC , Pillai SK , Tucker A , Mott JA , Walke H , Nyenswah T . MMWR Morb Mortal Wkly Rep 2015 64 (7) 175-178 As late as September 14, 2014, Liberia's Gbarpolu County had reported zero cases of Ebola virus disease (Ebola). On October 25, the Bong County Health Team, a local health department in the Liberian Ministry of Health and Social Welfare (MOHSW), received confirmation of Ebola in a man who had recently left Geleyansiesu, a remote village of approximately 800 residents, after his wife and daughter had died of illnesses consistent with Ebola. MOHSW requested assistance from CDC, the World Health Organization, and other international partners to investigate and confirm the outbreak in Geleyansiesu and begin interventions to interrupt transmission. A total of 22 cases were identified, of which 18 (82%) were laboratory confirmed by real-time polymerase chain reaction. There were 16 deaths (case-fatality rate = 73%). Without road access to or direct telecommunications with the village, interventions had to be tailored to the local context. Public health interventions included 1) education of the community about Ebola, transmission of the virus, signs and symptoms, the importance of isolating ill patients from family members, and the potential benefits of early diagnosis and treatment; 2) establishment of mechanisms to alert health authorities of possibly infected persons leaving the village to facilitate safe transport to the closest Ebola treatment unit (ETU); 3) case investigation, contact tracing, and monitoring of contacts; 4) training in hygienic burial of dead bodies; 5) active case finding and diagnosis; and 6) isolation and limited no-touch treatment in the village of patients unwilling or unable to seek care at an ETU. The findings of this investigation could inform interventions aimed at controlling focal outbreaks in difficult-to-reach communities, which has been identified as an important component of the effort to eliminate Ebola from Liberia. |
Rapid response to Ebola outbreaks in remote areas - Liberia, July-November 2014
Kateh F , Nagbe T , Kieta A , Barskey A , Gasasira AN , Driscoll A , Tucker A , Christie A , Karmo B , Scott C , Barradas D , Blackley D , Dweh E , Warren F , Mahoney F , Kassay G , Calvert GM , Castro G , Logan G , Appiah G , Kirking H , Koon H , Papowitz H , Walke H , Cole IB , Montgomery J , Neatherlin J , Tappero JW , Forrester J , Woodring J , Mott J , Attfield K , DeCock K , Lindblade KA , Powell K , Yeoman K , Adams L , Broyles LN , Slutsker L , Belcher L , Cooper L , Santos M , Westercamp M , Weinberg MP , Massoudi M , Dea M , Patel M , Hennessey M , Fomba M , Lubogo M , Maxwell N , Moonan P , Arzoaquoi S , Gee S , Zayzay S , Pillai S , Williams S , Zarecki SM , Yett S , James S , Grube S , Gupta S , Nelson T , Malibiche T , Frank W , Smith W , Nyenswah T . MMWR Morb Mortal Wkly Rep 2015 64 (7) 188-192 West Africa is experiencing its first epidemic of Ebola virus disease (Ebola). As of February 9, Liberia has reported 8,864 Ebola cases, of which 3,147 were laboratory-confirmed. Beginning in August 2014, the Liberia Ministry of Health and Social Welfare (MOHSW), supported by CDC, the World Health Organization (WHO), and others, began systematically investigating and responding to Ebola outbreaks in remote areas. Because many of these areas lacked mobile telephone service, easy road access, and basic infrastructure, flexible and targeted interventions often were required. Development of a national strategy for the Rapid Isolation and Treatment of Ebola (RITE) began in early October. The strategy focuses on enhancing capacity of county health teams (CHT) to investigate outbreaks in remote areas and lead tailored responses through effective and efficient coordination of technical and operational assistance from the MOHSW central level and international partners. To measure improvements in response indicators and outcomes over time, data from investigations of 12 of 15 outbreaks in remote areas with illness onset dates of index cases during July 16-November 20, 2014, were analyzed. The times to initial outbreak alerts and durations of the outbreaks declined over that period while the proportions of patients who were isolated and treated increased. At the same time, the case-fatality rate in each outbreak declined. Implementation of strategies, such as RITE, to rapidly respond to rural outbreaks of Ebola through coordinated and tailored responses can successfullyreduce transmission and improve outcomes. |
Genetic relationships deduced from emm and multilocus sequence typing of invasive Streptococcus dysgalactiae subsp. equisimilis and S. canis recovered from isolates collected in the United States
Ahmad Y , Gertz RE Jr , Li Z , Sakota V , Broyles LN , Van Beneden C , Facklam R , Shewmaker PL , Reingold A , Farley MM , Beall BW . J Clin Microbiol 2009 47 (7) 2046-54 Beta-hemolytic group C and G streptococci cause a considerable invasive disease burden and sometimes cause disease outbreaks. Little is known about the critical epidemiologic parameter of genetic relatedness between isolates. We determined the emm types of 334 Streptococcus dysgalactiae subsp. equisimilis isolates, and attempted emm typing of 5 Streptococcus canis isolates from a recent population-based surveillance for invasive isolates. Thirty-four emm types were observed, including one from S. canis. We formulated multilocus sequence typing (MLST) primers with six of the seven loci corresponding to the Streptococcus pyogenes MLST scheme. We performed MLST with 65 of the 334 surveillance isolates (61 S. dysgalactiae subsp. equisimilis isolates, 4 S. canis isolates) to represent each emm type identified, including 2 to 3 isolates for each of the 25 redundantly represented emm types. Forty-one MLST sequence types (STs) were observed. Isolates within 16 redundantly represented S. dysgalactiae subsp. equisimilis emm types shared identical or nearly identical STs, demonstrating concordance between the emm type and genetic relatedness. However, seven STs were each represented by two to four different emm types, and 7 of the 10 S. dysgalactiae subsp. equisimilis eBURST groups represented up to six different emm types. Thus, S. dysgalactiae subsp. equisimilis isolates were similar to S. pyogenes isolates, in that strains of the same emm type were often highly related, but they differed from S. pyogenes, in that S. dysgalactiae subsp. equisimilis strains with identical or closely similar STs often exhibited multiple unrelated emm types. The phylogenetic relationships between S. dysgalactiae subsp. equisimilis and S. pyogenes alleles revealed a history of interspecies recombination, with either species often serving as genetic donors. The four S. canis isolates shared highly homologous alleles but were unrelated clones without evidence of past recombination with S. dysgalactiae subsp. equisimilis or S. pyogenes. |
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- Page last updated:Jun 03, 2024
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