Loading…
Predictors of non adherence to antiretroviral therapy at an urban HIV care and treatment center in Tanzania
Measurement of adherence to antiretroviral therapy (ART) can serve as a proxy for virologic failure in resource-limited settings. The aim of this study was to determine the factors underlying nonadherence measured by three methods. This is a prospective longitudinal cohort of 220 patients on ART at...
Saved in:
| Published in: | Drug, healthcare and patient safety healthcare and patient safety, 2018-01, Vol.10, p.79-88 |
|---|---|
| Main Authors: | , , , , , , , , |
| Format: | Article |
| Language: | English |
| Subjects: | |
| Citations: | Items that cite this one |
| Online Access: | Get full text |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| cited_by | cdi_FETCH-LOGICAL-c576t-3e6220a5233031b1706a135424152e8e8836cc5482bb061b8222887dce0f9fbc3 |
|---|---|
| cites | |
| container_end_page | 88 |
| container_issue | |
| container_start_page | 79 |
| container_title | Drug, healthcare and patient safety |
| container_volume | 10 |
| creator | Sangeda, Raphael Z Mosha, Fausta Aboud, Said Kamuhabwa, Appolinary Chalamilla, Guerino Vercauteren, Jurgen Van Wijngaerden, Eric Lyamuya, Eligius F Vandamme, Anne-Mieke |
| description | Measurement of adherence to antiretroviral therapy (ART) can serve as a proxy for virologic failure in resource-limited settings. The aim of this study was to determine the factors underlying nonadherence measured by three methods.
This is a prospective longitudinal cohort of 220 patients on ART at Amana Hospital in Dar es Salaam, Tanzania. We measured adherence using a structured questionnaire combining a visual analog scale (VAS) and Swiss HIV Cohort Study Adherence Questionnaire (SHCS-AQ), pharmacy refill, and appointment keeping during four periods over 1 year. Overall adherence was calculated as the mean adherence for all time points over the 1 year of follow-up. At each time point, adherence was defined as achieving a validated cutoff for adherence previously defined for each method.
The proportion of overall adherence was 86.4% by VAS, 69% by SHCS-AQ, 79.8% by appointment keeping, and 51.8% by pharmacy refill. Forgetfulness was the major reported reason for patients to skip their medications. In multivariate analysis, significant predictors to good adherence were older age, less alcohol consumption, more advanced World Health Organization clinical staging, and having a lower body mass index with odds ratio (CI): 3.11 (1.55-6.93), 0.24 (0.09-0.62), 1.78 (1.14-2.84), and 0.93 (0.88-0.98), respectively.
We found relatively good adherence to ART in this setting. Barriers to adherence include young age and perception of well-being. |
| doi_str_mv | 10.2147/DHPS.S143178 |
| format | article |
| fullrecord | <record><control><sourceid>gale_doaj_</sourceid><recordid>TN_cdi_doaj_primary_oai_doaj_org_article_cddae405d1d24e69945c980c406a7cf7</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><galeid>A575752822</galeid><doaj_id>oai_doaj_org_article_cddae405d1d24e69945c980c406a7cf7</doaj_id><sourcerecordid>A575752822</sourcerecordid><originalsourceid>FETCH-LOGICAL-c576t-3e6220a5233031b1706a135424152e8e8836cc5482bb061b8222887dce0f9fbc3</originalsourceid><addsrcrecordid>eNptkt9rFDEQxxdRbKl981kCgvjQO_N7d1-EUqt3ULDQ6mvIJrN3OfeSM8kW6l9vzjvLnZhAEmY-8w3zZarqNcFTSnj94dPs9m56RzgjdfOsOiWkbieESfH84H1Snae0wmWxlvKGvqxOGCY15xKfVj9uI1hncogJhR754JG2S4jgDaAckPbZRcgxPLioB5RLSm8ekc4lg8bYlXM2_46MjlAiFuUIOq_BZ2TKARE5j-61_6W906-qF70eEpzv77Pq2-fr-6vZ5Obrl_nV5c3EiFrmCQNJKdaCMoYZ6UiNpSZMcMqJoNBA0zBpjCiddB2WpGsopU1TWwO4b_vOsLNqvtO1Qa_UJrq1jo8qaKf-BEJcKB2zMwMoY60GjoUllnKQbcuFaRtsePmzNn1dtD7utDZjtwa7bar4cCR6nPFuqRbhQUmCWylEEXi_F4jh5wgpq7VLBoZBewhjUhS3LeaENrigb_9BV2GMvlilSouSC44PqYUuDTjfh_Kv2YqqS1GXTYshhZr-hyrbwtqZ4KF3JX5U8O6gYAl6yMsUhjG74NMxeLEDTQwpReifzCBYbYdSbYdS7Yey4G8ODXyC_44g-w0HI9ly</addsrcrecordid><sourcetype>Open Website</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2226454080</pqid></control><display><type>article</type><title>Predictors of non adherence to antiretroviral therapy at an urban HIV care and treatment center in Tanzania</title><source>Publicly Available Content Database</source><source>Taylor & Francis Open Access Journals</source><source>PubMed Central</source><creator>Sangeda, Raphael Z ; Mosha, Fausta ; Aboud, Said ; Kamuhabwa, Appolinary ; Chalamilla, Guerino ; Vercauteren, Jurgen ; Van Wijngaerden, Eric ; Lyamuya, Eligius F ; Vandamme, Anne-Mieke</creator><creatorcontrib>Sangeda, Raphael Z ; Mosha, Fausta ; Aboud, Said ; Kamuhabwa, Appolinary ; Chalamilla, Guerino ; Vercauteren, Jurgen ; Van Wijngaerden, Eric ; Lyamuya, Eligius F ; Vandamme, Anne-Mieke</creatorcontrib><description>Measurement of adherence to antiretroviral therapy (ART) can serve as a proxy for virologic failure in resource-limited settings. The aim of this study was to determine the factors underlying nonadherence measured by three methods.
This is a prospective longitudinal cohort of 220 patients on ART at Amana Hospital in Dar es Salaam, Tanzania. We measured adherence using a structured questionnaire combining a visual analog scale (VAS) and Swiss HIV Cohort Study Adherence Questionnaire (SHCS-AQ), pharmacy refill, and appointment keeping during four periods over 1 year. Overall adherence was calculated as the mean adherence for all time points over the 1 year of follow-up. At each time point, adherence was defined as achieving a validated cutoff for adherence previously defined for each method.
The proportion of overall adherence was 86.4% by VAS, 69% by SHCS-AQ, 79.8% by appointment keeping, and 51.8% by pharmacy refill. Forgetfulness was the major reported reason for patients to skip their medications. In multivariate analysis, significant predictors to good adherence were older age, less alcohol consumption, more advanced World Health Organization clinical staging, and having a lower body mass index with odds ratio (CI): 3.11 (1.55-6.93), 0.24 (0.09-0.62), 1.78 (1.14-2.84), and 0.93 (0.88-0.98), respectively.
We found relatively good adherence to ART in this setting. Barriers to adherence include young age and perception of well-being.</description><identifier>ISSN: 1179-1365</identifier><identifier>EISSN: 1179-1365</identifier><identifier>DOI: 10.2147/DHPS.S143178</identifier><identifier>PMID: 30174460</identifier><language>eng</language><publisher>New Zealand: Dove Medical Press Limited</publisher><subject>Acquired immune deficiency syndrome ; adherence barriers ; AIDS ; Analysis ; Antiretroviral drugs ; antiretroviral therapy ; appointment keeping ; Biological products industry ; Care and treatment ; Drinking (Alcoholic beverages) ; Drug resistance ; Drugstores ; Highly active antiretroviral therapy ; HIV ; HIV infections ; Human immunodeficiency virus ; in resource-limited settings ; Original Research ; Patient compliance ; Pharmacy ; pharmacy refill ; Proxy ; Public health ; Recruitment ; Self report ; Well being</subject><ispartof>Drug, healthcare and patient safety, 2018-01, Vol.10, p.79-88</ispartof><rights>COPYRIGHT 2018 Dove Medical Press Limited</rights><rights>2018. This work is licensed under https://creativecommons.org/licenses/by-nc/3.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><rights>2018 Sangeda et al. This work is published and licensed by Dove Medical Press Limited 2018</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c576t-3e6220a5233031b1706a135424152e8e8836cc5482bb061b8222887dce0f9fbc3</citedby><orcidid>0000-0002-6574-5308</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.proquest.com/docview/2226454080/fulltextPDF?pq-origsite=primo$$EPDF$$P50$$Gproquest$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.proquest.com/docview/2226454080?pq-origsite=primo$$EHTML$$P50$$Gproquest$$Hfree_for_read</linktohtml><link.rule.ids>230,314,724,777,781,882,25734,27905,27906,36993,36994,44571,53772,53774,74875</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/30174460$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Sangeda, Raphael Z</creatorcontrib><creatorcontrib>Mosha, Fausta</creatorcontrib><creatorcontrib>Aboud, Said</creatorcontrib><creatorcontrib>Kamuhabwa, Appolinary</creatorcontrib><creatorcontrib>Chalamilla, Guerino</creatorcontrib><creatorcontrib>Vercauteren, Jurgen</creatorcontrib><creatorcontrib>Van Wijngaerden, Eric</creatorcontrib><creatorcontrib>Lyamuya, Eligius F</creatorcontrib><creatorcontrib>Vandamme, Anne-Mieke</creatorcontrib><title>Predictors of non adherence to antiretroviral therapy at an urban HIV care and treatment center in Tanzania</title><title>Drug, healthcare and patient safety</title><addtitle>Drug Healthc Patient Saf</addtitle><description>Measurement of adherence to antiretroviral therapy (ART) can serve as a proxy for virologic failure in resource-limited settings. The aim of this study was to determine the factors underlying nonadherence measured by three methods.
This is a prospective longitudinal cohort of 220 patients on ART at Amana Hospital in Dar es Salaam, Tanzania. We measured adherence using a structured questionnaire combining a visual analog scale (VAS) and Swiss HIV Cohort Study Adherence Questionnaire (SHCS-AQ), pharmacy refill, and appointment keeping during four periods over 1 year. Overall adherence was calculated as the mean adherence for all time points over the 1 year of follow-up. At each time point, adherence was defined as achieving a validated cutoff for adherence previously defined for each method.
The proportion of overall adherence was 86.4% by VAS, 69% by SHCS-AQ, 79.8% by appointment keeping, and 51.8% by pharmacy refill. Forgetfulness was the major reported reason for patients to skip their medications. In multivariate analysis, significant predictors to good adherence were older age, less alcohol consumption, more advanced World Health Organization clinical staging, and having a lower body mass index with odds ratio (CI): 3.11 (1.55-6.93), 0.24 (0.09-0.62), 1.78 (1.14-2.84), and 0.93 (0.88-0.98), respectively.
We found relatively good adherence to ART in this setting. Barriers to adherence include young age and perception of well-being.</description><subject>Acquired immune deficiency syndrome</subject><subject>adherence barriers</subject><subject>AIDS</subject><subject>Analysis</subject><subject>Antiretroviral drugs</subject><subject>antiretroviral therapy</subject><subject>appointment keeping</subject><subject>Biological products industry</subject><subject>Care and treatment</subject><subject>Drinking (Alcoholic beverages)</subject><subject>Drug resistance</subject><subject>Drugstores</subject><subject>Highly active antiretroviral therapy</subject><subject>HIV</subject><subject>HIV infections</subject><subject>Human immunodeficiency virus</subject><subject>in resource-limited settings</subject><subject>Original Research</subject><subject>Patient compliance</subject><subject>Pharmacy</subject><subject>pharmacy refill</subject><subject>Proxy</subject><subject>Public health</subject><subject>Recruitment</subject><subject>Self report</subject><subject>Well being</subject><issn>1179-1365</issn><issn>1179-1365</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2018</creationdate><recordtype>article</recordtype><sourceid>PIMPY</sourceid><sourceid>DOA</sourceid><recordid>eNptkt9rFDEQxxdRbKl981kCgvjQO_N7d1-EUqt3ULDQ6mvIJrN3OfeSM8kW6l9vzjvLnZhAEmY-8w3zZarqNcFTSnj94dPs9m56RzgjdfOsOiWkbieESfH84H1Snae0wmWxlvKGvqxOGCY15xKfVj9uI1hncogJhR754JG2S4jgDaAckPbZRcgxPLioB5RLSm8ekc4lg8bYlXM2_46MjlAiFuUIOq_BZ2TKARE5j-61_6W906-qF70eEpzv77Pq2-fr-6vZ5Obrl_nV5c3EiFrmCQNJKdaCMoYZ6UiNpSZMcMqJoNBA0zBpjCiddB2WpGsopU1TWwO4b_vOsLNqvtO1Qa_UJrq1jo8qaKf-BEJcKB2zMwMoY60GjoUllnKQbcuFaRtsePmzNn1dtD7utDZjtwa7bar4cCR6nPFuqRbhQUmCWylEEXi_F4jh5wgpq7VLBoZBewhjUhS3LeaENrigb_9BV2GMvlilSouSC44PqYUuDTjfh_Kv2YqqS1GXTYshhZr-hyrbwtqZ4KF3JX5U8O6gYAl6yMsUhjG74NMxeLEDTQwpReifzCBYbYdSbYdS7Yey4G8ODXyC_44g-w0HI9ly</recordid><startdate>20180101</startdate><enddate>20180101</enddate><creator>Sangeda, Raphael Z</creator><creator>Mosha, Fausta</creator><creator>Aboud, Said</creator><creator>Kamuhabwa, Appolinary</creator><creator>Chalamilla, Guerino</creator><creator>Vercauteren, Jurgen</creator><creator>Van Wijngaerden, Eric</creator><creator>Lyamuya, Eligius F</creator><creator>Vandamme, Anne-Mieke</creator><general>Dove Medical Press Limited</general><general>Taylor & Francis Ltd</general><general>Dove Medical Press</general><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7RV</scope><scope>7XB</scope><scope>88C</scope><scope>8C1</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>8G5</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>GUQSH</scope><scope>KB0</scope><scope>M0T</scope><scope>M2O</scope><scope>MBDVC</scope><scope>NAPCQ</scope><scope>PIMPY</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>Q9U</scope><scope>7X8</scope><scope>5PM</scope><scope>DOA</scope><orcidid>https://orcid.org/0000-0002-6574-5308</orcidid></search><sort><creationdate>20180101</creationdate><title>Predictors of non adherence to antiretroviral therapy at an urban HIV care and treatment center in Tanzania</title><author>Sangeda, Raphael Z ; Mosha, Fausta ; Aboud, Said ; Kamuhabwa, Appolinary ; Chalamilla, Guerino ; Vercauteren, Jurgen ; Van Wijngaerden, Eric ; Lyamuya, Eligius F ; Vandamme, Anne-Mieke</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c576t-3e6220a5233031b1706a135424152e8e8836cc5482bb061b8222887dce0f9fbc3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2018</creationdate><topic>Acquired immune deficiency syndrome</topic><topic>adherence barriers</topic><topic>AIDS</topic><topic>Analysis</topic><topic>Antiretroviral drugs</topic><topic>antiretroviral therapy</topic><topic>appointment keeping</topic><topic>Biological products industry</topic><topic>Care and treatment</topic><topic>Drinking (Alcoholic beverages)</topic><topic>Drug resistance</topic><topic>Drugstores</topic><topic>Highly active antiretroviral therapy</topic><topic>HIV</topic><topic>HIV infections</topic><topic>Human immunodeficiency virus</topic><topic>in resource-limited settings</topic><topic>Original Research</topic><topic>Patient compliance</topic><topic>Pharmacy</topic><topic>pharmacy refill</topic><topic>Proxy</topic><topic>Public health</topic><topic>Recruitment</topic><topic>Self report</topic><topic>Well being</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Sangeda, Raphael Z</creatorcontrib><creatorcontrib>Mosha, Fausta</creatorcontrib><creatorcontrib>Aboud, Said</creatorcontrib><creatorcontrib>Kamuhabwa, Appolinary</creatorcontrib><creatorcontrib>Chalamilla, Guerino</creatorcontrib><creatorcontrib>Vercauteren, Jurgen</creatorcontrib><creatorcontrib>Van Wijngaerden, Eric</creatorcontrib><creatorcontrib>Lyamuya, Eligius F</creatorcontrib><creatorcontrib>Vandamme, Anne-Mieke</creatorcontrib><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Nursing & Allied Health Database</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Healthcare Administration Database (Alumni)</collection><collection>Public Health Database</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>Research Library (Alumni Edition)</collection><collection>ProQuest Central (Alumni)</collection><collection>ProQuest Central</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>Research Library Prep</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Healthcare Administration Database</collection><collection>Research Library</collection><collection>Research Library (Corporate)</collection><collection>Nursing & Allied Health Premium</collection><collection>Publicly Available Content Database</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>ProQuest Central Basic</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><collection>DOAJ Directory of Open Access Journals</collection><jtitle>Drug, healthcare and patient safety</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Sangeda, Raphael Z</au><au>Mosha, Fausta</au><au>Aboud, Said</au><au>Kamuhabwa, Appolinary</au><au>Chalamilla, Guerino</au><au>Vercauteren, Jurgen</au><au>Van Wijngaerden, Eric</au><au>Lyamuya, Eligius F</au><au>Vandamme, Anne-Mieke</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Predictors of non adherence to antiretroviral therapy at an urban HIV care and treatment center in Tanzania</atitle><jtitle>Drug, healthcare and patient safety</jtitle><addtitle>Drug Healthc Patient Saf</addtitle><date>2018-01-01</date><risdate>2018</risdate><volume>10</volume><spage>79</spage><epage>88</epage><pages>79-88</pages><issn>1179-1365</issn><eissn>1179-1365</eissn><abstract>Measurement of adherence to antiretroviral therapy (ART) can serve as a proxy for virologic failure in resource-limited settings. The aim of this study was to determine the factors underlying nonadherence measured by three methods.
This is a prospective longitudinal cohort of 220 patients on ART at Amana Hospital in Dar es Salaam, Tanzania. We measured adherence using a structured questionnaire combining a visual analog scale (VAS) and Swiss HIV Cohort Study Adherence Questionnaire (SHCS-AQ), pharmacy refill, and appointment keeping during four periods over 1 year. Overall adherence was calculated as the mean adherence for all time points over the 1 year of follow-up. At each time point, adherence was defined as achieving a validated cutoff for adherence previously defined for each method.
The proportion of overall adherence was 86.4% by VAS, 69% by SHCS-AQ, 79.8% by appointment keeping, and 51.8% by pharmacy refill. Forgetfulness was the major reported reason for patients to skip their medications. In multivariate analysis, significant predictors to good adherence were older age, less alcohol consumption, more advanced World Health Organization clinical staging, and having a lower body mass index with odds ratio (CI): 3.11 (1.55-6.93), 0.24 (0.09-0.62), 1.78 (1.14-2.84), and 0.93 (0.88-0.98), respectively.
We found relatively good adherence to ART in this setting. Barriers to adherence include young age and perception of well-being.</abstract><cop>New Zealand</cop><pub>Dove Medical Press Limited</pub><pmid>30174460</pmid><doi>10.2147/DHPS.S143178</doi><tpages>10</tpages><orcidid>https://orcid.org/0000-0002-6574-5308</orcidid><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 1179-1365 |
| ispartof | Drug, healthcare and patient safety, 2018-01, Vol.10, p.79-88 |
| issn | 1179-1365 1179-1365 |
| language | eng |
| recordid | cdi_doaj_primary_oai_doaj_org_article_cddae405d1d24e69945c980c406a7cf7 |
| source | Publicly Available Content Database; Taylor & Francis Open Access Journals; PubMed Central |
| subjects | Acquired immune deficiency syndrome adherence barriers AIDS Analysis Antiretroviral drugs antiretroviral therapy appointment keeping Biological products industry Care and treatment Drinking (Alcoholic beverages) Drug resistance Drugstores Highly active antiretroviral therapy HIV HIV infections Human immunodeficiency virus in resource-limited settings Original Research Patient compliance Pharmacy pharmacy refill Proxy Public health Recruitment Self report Well being |
| title | Predictors of non adherence to antiretroviral therapy at an urban HIV care and treatment center in Tanzania |
| url | http://sfxeu10.hosted.exlibrisgroup.com/loughborough?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-01-19T20%3A38%3A44IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-gale_doaj_&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Predictors%20of%20non%20adherence%20to%20antiretroviral%20therapy%20at%20an%20urban%20HIV%20care%20and%20treatment%20center%20in%20Tanzania&rft.jtitle=Drug,%20healthcare%20and%20patient%20safety&rft.au=Sangeda,%20Raphael%20Z&rft.date=2018-01-01&rft.volume=10&rft.spage=79&rft.epage=88&rft.pages=79-88&rft.issn=1179-1365&rft.eissn=1179-1365&rft_id=info:doi/10.2147/DHPS.S143178&rft_dat=%3Cgale_doaj_%3EA575752822%3C/gale_doaj_%3E%3Cgrp_id%3Ecdi_FETCH-LOGICAL-c576t-3e6220a5233031b1706a135424152e8e8836cc5482bb061b8222887dce0f9fbc3%3C/grp_id%3E%3Coa%3E%3C/oa%3E%3Curl%3E%3C/url%3E&rft_id=info:oai/&rft_pqid=2226454080&rft_id=info:pmid/30174460&rft_galeid=A575752822&rfr_iscdi=true |