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d
esig
n
in
g
ef
f
ec
tiv
e
in
ter
v
en
tio
n
s
[
1
3
]
.
T
h
e
an
aly
tical
f
r
am
ewo
r
k
u
tili
s
ed
f
o
r
in
v
esti
g
atin
g
h
ea
lth
s
y
s
t
em
s
h
ig
h
lig
h
ts
th
e
im
p
o
r
tan
ce
o
f
SNA
in
id
en
tify
in
g
a
n
d
r
ep
r
esen
tin
g
th
e
co
llab
o
r
ativ
e
in
ter
ac
tio
n
s
th
at
o
cc
u
r
with
in
h
ea
lth
ca
r
e
e
n
v
i
r
o
n
m
en
ts
[
1
4
]
.
Pre
v
io
u
s
s
tu
d
i
es
h
av
e
em
p
lo
y
ed
SNA
to
in
v
esti
g
ate
o
b
esit
y
,
d
em
o
n
s
tr
atin
g
h
o
w
n
etwo
r
k
an
aly
s
is
ca
n
p
r
o
v
id
e
in
s
i
g
h
ts
in
to
th
e
s
o
cial
d
eter
m
in
an
ts
an
d
p
ee
r
ef
f
ec
t
s
th
at
co
n
tr
ib
u
te
to
o
b
esit
y
,
f
u
r
th
er
ex
ten
d
i
n
g
th
e
s
co
p
e
o
f
SNA
b
ey
o
n
d
tr
ad
itio
n
al
f
ield
s
[
1
5
]
.
C
o
m
m
u
n
icab
le
d
is
ea
s
es
ar
e
th
o
s
e
th
at
ar
e
ca
p
a
b
le
o
f
b
ein
g
s
p
r
ea
d
f
r
o
m
o
n
e
in
d
iv
id
u
al
to
an
o
th
e
r
v
ia
v
ar
io
u
s
m
ea
n
s
,
in
clu
d
in
g
b
u
t
n
o
t
lim
ited
to
d
ir
ec
t
co
n
tact,
r
esp
ir
ato
r
y
d
r
o
p
lets
,
o
r
co
n
tam
in
ated
o
b
jects
[
1
6
]
.
Pro
m
in
en
t
in
s
tan
ce
s
o
f
co
m
m
u
n
icab
le
d
is
ea
s
es
in
clu
d
e
C
OVI
D
-
1
9
,
in
f
lu
en
za
,
HI
V/AI
DS,
an
d
tu
b
er
cu
lo
s
is
.
SNA
was
wid
ely
u
tili
s
ed
in
n
u
m
e
r
o
u
s
r
esear
ch
d
u
r
i
n
g
th
e
h
eig
h
t
o
f
th
e
C
OVI
D
-
1
9
p
an
d
em
ic
to
tr
ac
e
th
e
d
is
ea
s
e
’
s
p
r
o
g
r
ess
an
d
aid
in
co
n
tact
tr
ac
in
g
ef
f
o
r
ts
[
1
7
]
–
[
2
0
]
.
T
h
ese
d
is
ea
s
es p
o
s
e
s
ig
n
if
ican
t p
u
b
lic
h
ea
lth
ch
allen
g
es
d
u
e
to
th
e
ir
p
o
ten
tial
f
o
r
r
ap
id
s
p
r
ea
d
with
in
co
m
m
u
n
ities
an
d
p
o
p
u
latio
n
[
2
1
]
.
T
h
e
s
ig
n
if
ican
ce
o
f
SNA
is
esp
ec
ially
ev
id
en
t
in
lig
h
t
o
f
th
e
wo
r
ld
wid
e
C
OVI
D
-
1
9
p
an
d
e
m
ic,
wh
ich
n
o
t
o
n
l
y
p
r
esen
ts
a
s
u
b
s
tan
tial r
is
k
to
p
u
b
lic
h
ea
lth
b
u
t a
ls
o
d
r
aws a
tten
tio
n
to
th
e
co
m
p
le
x
m
atter
o
f
s
tig
m
a
[
2
2
]
,
[
2
3
]
.
Sti
g
m
a
is
d
ef
in
ed
as
a
n
eg
ativ
e
s
o
cial
p
h
en
o
m
e
n
o
n
th
at
af
f
e
cts
in
d
iv
id
u
als,
g
r
o
u
p
s
,
an
d
s
o
ciety
as
a
wh
o
le
[
2
2
]
,
[
2
4
]
–
[
2
6
]
.
Sti
g
m
atiza
tio
n
,
ap
ar
t
f
r
o
m
t
h
e
im
m
ed
iate
r
ep
er
cu
s
s
io
n
s
o
f
th
e
illn
ess
,
g
iv
es
r
is
e
to
in
cr
ea
s
ed
ap
p
r
eh
e
n
s
io
n
,
th
e
p
r
o
p
ag
atio
n
o
f
f
alse
in
f
o
r
m
ati
o
n
,
p
r
eju
d
ice,
an
d
s
o
cial
i
s
o
latio
n
[
2
7
]
–
[
2
9
]
.
I
n
o
r
d
er
to
ac
h
iev
e
a
th
o
r
o
u
g
h
u
n
d
er
s
tan
d
in
g
o
f
th
e
co
m
p
l
ex
d
y
n
am
ics
o
f
s
tig
m
a
s
u
r
r
o
u
n
d
in
g
c
o
n
tag
io
u
s
d
is
ea
s
es,
it
is
im
p
er
ativ
e
to
u
s
e
a
co
m
p
r
eh
en
s
iv
e
ap
p
r
o
ac
h
th
at
g
o
es
b
ey
o
n
d
s
u
p
e
r
f
icial
v
iews.
T
h
r
o
u
g
h
th
e
u
tili
s
atio
n
o
f
SNA
in
s
tig
m
a
s
tu
d
ies
co
n
ce
r
n
in
g
co
m
m
u
n
ic
ab
le
d
is
ea
s
es,
s
u
b
s
tan
tial
in
s
i
g
h
t
ca
n
b
e
ac
q
u
ir
ed
r
eg
ar
d
in
g
th
e
in
tr
icate
s
o
cial
m
ec
h
an
is
m
s
an
d
n
etwo
r
k
d
y
n
am
ics
th
at
eith
er
ex
ac
er
b
ate
o
r
m
itig
ate
s
tig
m
a.
W
ith
a
f
o
cu
s
o
n
co
m
m
u
n
icab
le
d
is
ea
s
es,
th
is
s
co
p
in
g
r
ev
ie
w
aim
s
to
in
v
esti
g
ate
th
e
u
s
e
o
f
SNA
in
s
tig
m
a
r
esear
ch
in
o
r
d
er
to
b
etter
u
n
d
er
s
tan
d
th
e
in
tr
icate
r
elatio
n
s
h
ip
b
etwe
en
s
o
cial
n
etwo
r
k
s
an
d
s
tig
m
a.
2.
M
E
T
H
O
D
T
h
is
s
co
p
in
g
r
ev
iew
was
co
n
d
u
cted
f
o
llo
win
g
th
e
p
r
ef
er
r
e
d
r
ep
o
r
tin
g
item
s
f
o
r
s
y
s
tem
a
tic
r
ev
iews
an
d
m
eta
-
a
n
aly
s
es
ex
ten
s
io
n
f
o
r
s
co
p
in
g
r
ev
iews
(
PR
I
SMA
-
ScR
)
g
u
id
elin
es
to
e
n
s
u
r
e
clar
ity
an
d
tr
an
s
p
ar
en
cy
in
th
e
r
ep
o
r
tin
g
o
f
th
e
r
ev
iew
[
3
0
]
.
Fo
llo
win
g
th
ese
g
u
id
elin
es
o
f
f
er
s
a
s
y
s
tem
atic
f
r
am
ewo
r
k
th
at
im
p
r
o
v
es
th
e
r
ev
iew
p
r
o
c
ess
’
s
r
ep
licab
ilit
y
an
d
m
eth
o
d
o
lo
g
ical
r
ig
o
u
r
,
wh
ich
in
tu
r
n
co
n
tr
ib
u
tes
to
th
e
v
alid
ity
an
d
r
eliab
ilit
y
o
f
th
e
f
in
d
i
n
g
s
.
Ad
d
itio
n
ally
,
th
e
a
p
p
licatio
n
o
f
PR
I
SMA
-
ScR
g
u
ar
an
tees
t
h
at
all
cr
u
cial
elem
en
ts
o
f
th
e
s
co
p
in
g
r
ev
iew
ar
e
m
eth
o
d
ically
ad
d
r
ess
ed
,
m
ak
in
g
it
ea
s
ier
to
f
in
d
,
p
ic
k
,
an
d
s
y
n
th
es
is
e
p
er
tin
en
t stu
d
ies in
an
im
p
ar
tial a
n
d
th
o
r
o
u
g
h
m
a
n
n
er
.
2
.
1
.
Sea
rc
h
s
t
ra
t
eg
y
I
n
J
u
n
e
2
0
2
3
,
a
n
e
x
t
e
n
s
i
v
e
s
ea
r
c
h
w
a
s
c
o
n
d
u
c
t
e
d
a
c
r
o
s
s
t
h
r
e
e
p
r
o
m
i
n
e
n
t
d
a
t
a
b
as
e
s
:
Sc
o
p
u
s
,
W
e
b
o
f
S
c
i
e
n
c
e
,
a
n
d
P
u
b
m
e
d
.
E
m
p
l
o
y
i
n
g
a
s
t
r
a
t
e
g
i
c
a
p
p
r
o
a
c
h
,
s
p
e
c
i
f
i
c
k
e
y
w
o
r
d
s
“
s
o
ci
a
l
n
e
tw
o
r
k
a
n
a
l
y
s
i
s
”
a
n
d
“
s
t
i
g
m
a
”
w
e
r
e
c
o
m
b
i
n
e
d
u
s
i
n
g
B
o
o
l
e
a
n
o
p
e
r
a
t
o
r
s
t
o
e
n
h
a
n
c
e
s
e
a
r
c
h
p
r
e
c
i
s
i
o
n
.
T
h
e
r
e
s
u
l
t
s
o
f
t
h
is
c
o
m
p
r
e
h
e
n
s
i
v
e
s
ea
r
c
h
s
t
r
at
e
g
y
a
r
e
d
e
t
a
i
l
e
d
i
n
T
a
b
l
e
1
.
T
ab
le
1.
Key
wo
r
d
s
an
d
s
ea
r
ch
s
tr
ateg
y
D
a
t
a
b
a
s
e
K
e
y
w
o
r
d
s
N
u
mb
e
r
o
f
a
r
t
i
c
l
e
s
S
c
o
p
u
s
(
TI
TLE
-
A
B
S
-
K
EY
(
“
s
o
c
i
a
l
n
e
t
w
o
r
k
a
n
a
l
y
si
s
”
)
A
N
D
TI
TLE
-
A
B
S
-
K
EY
(
s
t
i
g
ma))
26
W
e
b
o
f
S
c
i
e
n
c
e
st
i
g
ma
(
Ti
t
l
e
)
A
N
D
“
s
o
c
i
a
l
n
e
t
w
o
r
k
a
n
a
l
y
s
i
s
”
(
A
l
l
F
i
e
l
d
s)
5
P
u
b
M
e
d
(
(
st
i
g
m
a
[
T
i
t
l
e
/
A
b
s
t
r
a
c
t
]
)
)
A
N
D
(
“
so
c
i
a
l
n
e
t
w
o
r
k
a
n
a
l
y
s
i
s
”
)
13
2
.
2
.
I
nclus
io
n
cr
it
er
ia
T
o
e
n
s
u
r
e
t
h
e
s
e
l
ec
t
i
o
n
o
f
r
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l
ev
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n
t
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t
u
d
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,
t
h
e
f
o
l
l
o
w
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n
c
lu
s
i
o
n
c
r
i
t
e
r
i
a
w
e
r
e
a
p
p
l
i
e
d
.
T
h
e
s
e
c
r
it
e
r
ia
w
e
r
e
d
e
s
i
g
n
e
d
t
o
f
il
t
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s
t
u
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s
t
h
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t
al
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t
h
t
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a
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cl
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8
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xa
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mics:
a
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co
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r
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f so
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w
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a
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d
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c
a
b
l
e
d
i
s
ea
s
es
,
i
n
c
l
u
d
i
n
g
b
u
t
n
o
t
l
i
m
i
t
e
d
t
o
C
O
V
I
D
-
1
9
,
H
I
V
/
A
I
D
S
,
t
u
b
er
c
u
l
o
s
is
,
m
a
l
a
r
i
a
,
a
n
d
o
t
h
e
r
in
f
e
c
t
i
o
u
s
d
is
e
a
s
e
s
;
i
i
i
)
s
t
i
g
m
a
a
s
a
p
r
i
m
a
r
y
o
r
s
i
g
n
i
f
i
c
a
n
t
o
u
t
c
o
m
e
:
S
t
u
d
i
es
th
a
t
e
x
p
l
i
c
it
l
y
e
x
a
m
i
n
e
d
s
ti
g
m
a
,
i
n
c
l
u
d
i
n
g
i
ts
m
e
as
u
r
e
m
e
n
t
,
c
o
n
c
e
p
t
u
a
l
i
z
at
i
o
n
,
t
r
a
n
s
m
is
s
i
o
n
,
o
r
e
f
f
e
c
t
s
wi
t
h
in
s
o
c
i
a
l
n
e
tw
o
r
k
s
;
v
i
)
e
m
p
i
r
i
c
a
l
r
es
e
a
r
c
h
:
O
n
l
y
e
m
p
i
r
i
c
a
l
r
e
s
e
a
r
c
h
s
t
u
d
i
e
s
,
i
n
c
l
u
d
i
n
g
q
u
a
n
t
i
t
a
ti
v
e
,
q
u
a
l
i
ta
t
iv
e
,
a
n
d
m
i
x
e
d
-
m
e
t
h
o
d
d
e
s
i
g
n
s
,
w
e
r
e
i
n
c
l
u
d
e
d
;
a
n
d
v
)
p
u
b
l
is
h
ed
i
n
E
n
g
l
i
s
h
.
2
.
3
.
E
x
clus
io
n
cr
it
er
ia
T
o
n
a
r
r
o
w
d
o
w
n
t
h
e
s
e
l
e
c
t
i
o
n
o
f
s
t
u
d
i
e
s
,
t
h
e
f
o
l
l
o
wi
n
g
e
x
c
l
u
s
i
o
n
c
r
i
t
e
r
i
a
w
e
r
e
e
m
p
l
o
y
e
d
.
T
h
e
s
e
c
r
i
t
e
r
i
a
a
i
d
e
d
i
n
e
x
c
l
u
d
i
n
g
s
t
u
d
i
e
s
t
h
a
t
d
i
d
n
’
t
f
i
t
t
h
e
es
t
a
b
l
is
h
e
d
c
r
i
t
e
r
i
a
.
B
y
u
s
i
n
g
t
h
e
s
e
ex
c
l
u
s
i
o
n
c
r
it
e
r
i
a
,
w
e
e
n
s
u
r
e
d
t
h
a
t
o
n
l
y
t
h
e
m
o
s
t
a
p
p
r
o
p
r
i
a
t
e
s
t
u
d
i
es
w
e
r
e
i
n
c
l
u
d
ed
i
n
o
u
r
r
e
v
i
e
w
:
i
)
r
e
v
i
e
w
a
r
t
ic
l
e
s
,
c
o
m
m
e
n
t
a
r
i
e
s
,
a
n
d
e
d
i
t
o
r
i
a
ls
w
e
r
e
e
x
c
l
u
d
ed
;
i
i
)
n
on
-
c
o
m
m
u
n
i
c
a
b
l
e
d
is
e
a
s
es
:
S
t
u
d
i
es
t
h
a
t
p
r
i
m
a
r
i
l
y
f
o
c
u
s
e
d
o
n
n
o
n
-
c
o
m
m
u
n
i
c
a
b
l
e
d
i
s
e
a
s
es
,
s
u
c
h
a
s
m
e
n
t
al
h
e
a
l
t
h
s
ti
g
m
a
,
w
e
r
e
e
x
c
l
u
d
e
d
;
i
i
i
)
i
r
r
e
l
e
v
a
n
t
m
e
t
h
o
d
o
l
o
g
y
:
S
t
u
d
i
e
s
t
h
a
t
d
i
d
n
o
t
e
m
p
l
o
y
S
N
A
o
r
d
i
d
n
o
t
h
a
v
e
a
s
u
b
s
t
a
n
t
i
al
f
o
c
u
s
o
n
t
h
e
r
o
l
e
o
f
s
o
c
i
al
n
e
t
w
o
r
k
s
i
n
s
t
ig
m
a
d
y
n
a
m
i
c
s
w
e
r
e
e
x
c
l
u
d
e
d
;
a
n
d
i
v
)
n
on
-
E
n
g
l
i
s
h
l
a
n
g
u
a
g
e
.
2
.
4
.
Study
s
elec
t
io
n pro
ce
s
s
T
h
e
s
t
u
d
y
s
el
e
c
ti
o
n
p
r
o
c
e
s
s
c
o
m
p
r
i
s
e
d
f
o
u
r
s
t
a
g
es
:
i
)
s
t
u
d
y
id
e
n
t
i
f
i
c
a
ti
o
n
t
h
r
o
u
g
h
d
a
t
a
b
a
s
es
,
ii
)
s
t
u
d
y
s
c
r
e
e
n
i
n
g
w
h
e
r
e
d
u
p
l
i
ca
t
es
w
er
e
r
e
m
o
v
e
d
,
iii
)
t
i
tl
e
/
a
b
s
t
r
a
ct
s
cr
e
e
n
i
n
g
,
a
n
d
iv
)
f
u
l
l
-
t
e
x
t
r
e
v
i
ew
.
T
w
o
i
n
d
e
p
e
n
d
e
n
t
r
e
v
i
e
w
e
r
s
c
o
n
d
u
c
t
e
d
t
h
e
s
c
r
ee
n
i
n
g
p
r
o
c
e
s
s
,
w
it
h
d
i
s
c
r
e
p
a
n
c
i
e
s
r
es
o
l
v
e
d
t
h
r
o
u
g
h
d
i
s
c
u
s
s
i
o
n
a
n
d
c
o
n
s
e
n
s
u
s
.
F
o
l
l
o
w
i
n
g
s
c
r
e
e
n
i
n
g
,
ti
t
le
s
a
n
d
a
b
s
t
r
a
ct
s
o
f
i
d
e
n
ti
f
i
e
d
a
r
ti
c
l
es
w
e
r
e
s
c
r
ee
n
e
d
a
g
a
i
n
s
t
t
h
e
i
n
clu
s
i
o
n
a
n
d
e
x
c
l
u
s
i
o
n
c
r
i
t
e
r
i
a
.
S
t
u
d
i
es
t
h
a
t
m
et
t
h
e
c
r
i
t
e
r
i
a
o
r
h
a
d
i
n
s
u
f
f
i
ci
e
n
t
i
n
f
o
r
m
a
t
i
o
n
t
o
m
a
k
e
a
d
e
c
is
i
o
n
w
e
r
e
i
n
c
l
u
d
e
d
f
o
r
f
u
l
l
-
t
e
x
t
r
e
v
i
e
w
.
N
e
x
t
,
t
h
e
f
u
l
l
t
e
x
t
s
o
f
s
e
l
ec
t
e
d
a
r
t
i
cl
es
w
er
e
a
s
s
es
s
e
d
t
o
d
e
t
e
r
m
i
n
e
t
h
e
i
r
e
l
i
g
i
b
i
l
it
y
f
o
r
f
i
n
a
l
i
n
c
l
u
s
i
o
n
i
n
t
h
e
s
c
o
p
i
n
g
r
e
v
i
ew.
2
.
5
.
Da
t
a
e
x
t
ra
ct
i
o
n
A
s
t
a
n
d
a
r
d
f
o
r
m
w
a
s
c
r
e
at
e
d
to
g
a
t
h
e
r
i
m
p
o
r
t
a
n
t
d
e
t
a
i
ls
f
r
o
m
t
h
e
i
n
c
l
u
d
e
d
s
t
u
d
i
es
.
T
h
i
s
f
o
r
m
a
s
s
is
t
e
d
u
s
i
n
c
o
l
le
c
t
i
n
g
s
p
e
c
i
f
i
c
d
a
t
a
p
o
i
n
t
s
n
e
c
es
s
a
r
y
f
o
r
o
u
r
r
e
v
i
e
w
.
S
u
b
s
e
q
u
e
n
t
l
y
,
w
e
e
x
t
r
ac
t
e
d
t
h
e
f
o
l
l
o
w
i
n
g
i
n
f
o
r
m
a
t
i
o
n
f
r
o
m
e
a
c
h
s
t
u
d
y
:
i)
s
t
u
d
y
c
h
a
r
a
c
te
r
i
s
t
i
cs
:
A
u
t
h
o
r
(
s
)
,
y
e
a
r
o
f
p
u
b
l
i
c
at
i
o
n
,
t
it
l
e
,
jo
u
r
n
a
l
,
a
n
d
c
o
u
n
t
r
y
o
f
o
r
i
g
i
n
;
i
i
)
r
es
e
a
r
c
h
ai
m
/
o
b
je
c
t
i
v
e
:
T
h
e
p
r
i
m
a
r
y
f
o
c
u
s
o
r
r
e
s
e
a
r
c
h
q
u
e
s
t
i
o
n
o
f
t
h
e
s
t
u
d
y
;
i
i
i
)
m
e
t
h
o
d
o
l
o
g
y
:
D
e
s
c
r
i
p
t
i
o
n
o
f
t
h
e
s
t
u
d
y
d
e
s
i
g
n
,
d
a
t
a
c
o
l
l
e
c
t
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o
n
m
e
t
h
o
d
s
,
a
n
d
a
n
a
l
y
t
i
c
a
l
a
p
p
r
o
a
c
h
e
s
e
m
p
l
o
y
e
d
;
i
v
)
t
y
p
e
o
f
c
o
m
m
u
n
i
c
a
b
l
e
d
i
s
ea
s
e:
T
h
e
s
p
e
c
i
f
i
c
i
n
f
e
ct
i
o
u
s
d
is
e
as
e
u
n
d
e
r
i
n
v
e
s
t
i
g
at
i
o
n
i
n
t
h
e
s
t
u
d
y
;
v
)
s
ti
g
m
a
o
u
t
c
o
m
e
:
T
h
e
i
d
e
n
t
i
f
i
e
d
o
u
t
c
o
m
es
r
e
l
a
te
d
t
o
s
t
i
g
m
a
d
y
n
a
m
i
cs
w
it
h
i
n
s
o
ci
a
l
n
e
t
w
o
r
k
s
i
n
t
h
e
c
o
n
t
e
x
t
o
f
c
o
m
m
u
n
i
c
a
b
l
e
d
i
s
ea
s
e
;
v
i
)
s
a
m
p
l
e
s
i
z
e
:
T
h
e
n
u
m
b
e
r
o
f
p
a
r
t
i
c
i
p
a
n
ts
o
r
e
n
t
i
t
i
es
i
n
cl
u
d
e
d
i
n
t
h
e
s
t
u
d
y
;
a
n
d
v
)
k
e
y
f
i
n
d
i
n
g
s
:
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u
m
m
a
r
y
o
f
t
h
e
m
a
i
n
f
i
n
d
i
n
g
s
r
el
a
t
e
d
t
o
s
t
ig
m
a
d
y
n
a
m
i
c
s
w
it
h
i
n
s
o
ci
a
l
n
et
w
o
r
k
s
i
n
t
h
e
c
o
n
te
x
t
o
f
c
o
m
m
u
n
i
c
a
b
l
e
d
i
s
e
a
s
e
.
2
.
6
.
Da
t
a
s
yn
t
hes
is
a
nd
qu
a
l
it
y
a
s
s
ess
m
ent
A
n
a
r
r
a
t
i
v
e
s
y
n
t
h
es
is
a
p
p
r
o
a
c
h
w
a
s
e
m
p
l
o
y
e
d
t
o
s
u
m
m
a
r
i
z
e
an
d
p
r
e
s
e
n
t
t
h
e
f
i
n
d
i
n
g
s
f
r
o
m
t
h
e
i
n
c
l
u
d
e
d
s
t
u
d
i
es
,
f
o
c
u
s
i
n
g
o
n
t
h
e
el
u
c
id
a
t
i
o
n
o
f
k
e
y
t
h
e
m
es
,
c
o
n
c
e
p
ts
,
a
n
d
p
a
tt
e
r
n
s
t
h
a
t
e
m
e
r
g
e
d
f
r
o
m
t
h
e
d
a
t
a
.
T
h
i
s
m
e
t
h
o
d
f
a
c
i
l
i
ta
t
e
d
a
d
e
e
p
e
r
u
n
d
e
r
s
t
a
n
d
i
n
g
o
f
t
h
e
d
a
t
a
,
a
ll
o
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g
f
o
r
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n
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r
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t
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a
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t
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t
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d
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it
a
t
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n
d
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p
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o
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t
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e
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e
i
t
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t
h
i
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e
d
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e
n
o
m
e
n
a
.
T
h
e
i
d
en
t
i
f
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e
d
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e
m
es
a
n
d
p
a
t
t
e
r
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k
ce
n
tr
ality
,
a
n
d
th
e
d
esire
f
o
r
s
ec
r
ec
y
in
s
tig
m
a
-
r
ed
u
ctio
n
in
ter
v
e
n
tio
n
s
b
ec
o
m
es
cr
itical,
p
ar
ticu
lar
ly
as
a
s
tr
ateg
y
to
co
p
e
with
s
tig
m
a
b
y
a
s
s
o
ciatio
n
.
Similar
s
tu
d
ies
s
u
g
g
est
th
at
in
d
iv
id
u
a
ls
r
ep
o
r
tin
g
h
ig
h
er
ef
f
icac
y
in
r
esis
tin
g
HI
V
s
tig
m
a
ex
h
ib
it
g
r
ea
ter
ce
n
tr
ality
with
in
th
e
n
etwo
r
k
,
s
ig
n
if
y
in
g
th
eir
in
f
lu
e
n
tial r
o
le
in
s
p
r
ea
d
in
g
s
tig
m
a
r
esis
tan
ce
th
r
o
u
g
h
o
u
t th
e
co
m
m
u
n
ity
.
3
.
2
.
2
.
Stig
ma
dy
na
m
ics a
nd
net
wo
rk
ce
ntr
a
lity
Stu
d
y
1
s
h
ed
s
lig
h
t
o
n
th
e
co
m
p
lex
d
y
n
a
m
ics
b
etwe
en
s
tig
m
a,
n
etwo
r
k
ce
n
tr
ality
,
an
d
th
e
im
p
ac
t
o
f
s
ec
r
ec
y
d
esire
s
.
I
n
d
iv
id
u
als
a
s
s
o
ciate
d
with
p
eo
p
le
liv
in
g
with
HI
V/AI
DS
(
PLWHA)
a
n
d
d
esirin
g
g
r
ea
te
r
s
ec
r
ec
y
ab
o
u
t
a
f
am
ily
m
em
b
er
’
s
HI
V
-
p
o
s
itiv
e
d
iag
n
o
s
is
ex
h
ib
ited
lo
wer
d
eg
r
ee
s
o
f
c
en
tr
ality
with
in
th
e
n
etwo
r
k
[
3
5
]
.
T
h
is
f
in
d
in
g
s
u
g
g
ests
th
e
p
r
esen
ce
o
f
co
u
r
tesy
s
tig
m
a
o
r
s
tig
m
a
b
y
a
s
s
o
ciatio
n
,
lead
in
g
in
d
iv
id
u
als
to
p
ar
ticip
ate
in
s
m
aller
,
m
o
r
e
s
elec
tiv
e
p
ar
ts
o
f
th
e
co
m
m
u
n
ity
n
etwo
r
k
.
T
h
e
d
esire
f
o
r
f
am
ily
s
ec
r
ec
y
r
eg
ar
d
in
g
HI
V
d
iag
n
o
s
es m
ay
s
er
v
e
as a
s
tr
ateg
y
to
ad
d
r
ess
th
e
s
tig
m
a
-
by
-
ass
o
ciatio
n
p
h
e
n
o
m
e
n
o
n
.
Ad
d
itio
n
ally
,
th
e
s
tu
d
y
r
ev
ea
led
th
at
in
d
iv
i
d
u
als
p
er
ce
iv
i
n
g
HI
V
as
tab
o
o
e
r
an
d
h
o
ld
in
g
s
tr
o
n
g
e
r
HI
V/AI
DS
s
tig
m
a
b
elief
s
ex
h
ib
ited
h
ig
h
er
d
e
g
r
ee
s
o
f
ce
n
tr
ality
with
in
th
e
co
m
m
u
n
ity
n
etwo
r
k
.
Ho
wev
er
,
in
d
iv
id
u
a
ls
wh
o
r
ep
o
r
ted
g
r
ea
ter
ef
f
icac
y
in
r
esis
tin
g
HI
V
s
tig
m
a
d
em
o
n
s
tr
ated
h
ig
h
e
r
ce
n
tr
ality
with
in
th
e
n
etwo
r
k
.
A
d
d
itio
n
ally
,
th
e
s
t
u
d
y
r
ev
ea
led
t
h
at
in
d
iv
i
d
u
als
p
er
ce
iv
in
g
HI
V
as
tab
o
o
er
a
n
d
h
o
ld
in
g
s
tr
o
n
g
e
r
HI
V/AI
DS
s
tig
m
a
b
elief
s
ex
h
ib
ited
h
ig
h
e
r
d
e
g
r
ee
s
o
f
ce
n
tr
ality
with
in
th
e
co
m
m
u
n
ity
n
e
two
r
k
.
T
h
is
m
a
y
b
e
in
d
icativ
e
o
f
co
m
m
u
n
ity
g
r
o
u
p
s
with
s
tr
o
n
g
e
r
s
tig
m
a
b
elief
s
r
ejec
tin
g
in
d
iv
id
u
als
d
ee
m
ed
d
ev
ia
n
t,
th
e
r
eb
y
in
cr
ea
s
in
g
th
eir
ce
n
t
r
ality
with
in
th
e
n
etwo
r
k
.
Similar
to
t
h
e
r
esear
ch
co
n
d
u
cted
b
y
T
s
ai
et
a
l.
[
3
8
]
,
r
esu
lts
f
r
o
m
th
is
r
ev
iew
em
p
h
asize
th
e
cr
itical
r
o
le
o
f
ad
d
r
ess
in
g
th
e
co
m
p
lex
in
te
r
p
lay
b
etwe
e
n
s
tig
m
a,
n
etwo
r
k
ce
n
tr
ality
,
an
d
th
e
d
esire
f
o
r
s
ec
r
ec
y
in
s
tig
m
a
-
r
ed
u
ctio
n
in
ter
v
en
tio
n
s
,
p
ar
ticu
la
r
ly
as
a
s
t
r
ateg
y
to
co
p
e
with
s
tig
m
a
b
y
ass
o
ciatio
n
[
3
5
]
.
3
.
2
.
3
.
Sig
nifica
nce
o
f
co
m
m
u
nity
g
ro
ups
T
h
e
co
m
m
u
n
ity
g
r
o
u
p
s
with
th
e
h
i
g
h
est
ce
n
tr
ality
in
s
tu
d
y
1
wer
e
c
h
u
r
c
h
es,
a
c
h
u
r
c
h
-
af
f
iliated
AI
DS
ac
tio
n
g
r
o
u
p
,
an
d
s
h
eb
ee
n
s
(
b
ar
s
)
[
3
5
]
.
T
h
e
au
t
h
o
r
s
s
u
g
g
ested
th
at
th
ese
o
r
g
an
izatio
n
s
p
lay
a
s
ig
n
if
ican
t
r
o
le
in
th
e
s
o
cial
life
o
f
th
e
co
m
m
u
n
ity
a
n
d
ar
e
p
o
ten
tially
im
p
o
r
tan
t
in
t
h
e
co
n
tex
t
o
f
HI
V/AI
DS
in
ter
v
en
tio
n
s
.
T
h
ey
also
p
r
o
p
o
s
ed
th
at
lim
ited
p
a
r
ticip
atio
n
in
s
u
ch
g
r
o
u
p
s
m
ay
b
e
d
u
e
to
th
e
s
tig
m
a
ass
o
ciate
d
with
b
ein
g
ass
o
ci
ated
with
HI
V/AI
DS.
T
h
e
f
i
n
d
in
g
s
f
r
o
m
s
tu
d
y
1
wer
e
f
u
r
th
er
s
u
p
p
o
r
ted
b
y
Dijk
er
an
d
Ko
o
m
en
s
u
g
g
esti
n
g
th
at
co
m
m
u
n
ity
g
r
o
u
p
s
with
s
tr
o
n
g
er
s
tig
m
a
b
elief
s
m
a
y
r
ejec
t
in
d
iv
id
u
als
d
ee
m
ed
d
e
v
ian
t,
th
er
e
b
y
in
cr
e
asin
g
th
eir
c
en
tr
ality
with
in
t
h
e
n
etwo
r
k
[
3
9
]
.
Similar
ly
,
s
tu
d
y
1
c
o
r
r
o
b
o
r
ated
th
e
r
esu
lts
o
f
Ko
llm
an
n
et
a
l.
[
40]
,
wh
ich
d
em
o
n
s
tr
ated
th
at
in
d
iv
id
u
als
r
ep
o
r
tin
g
h
ig
h
e
r
e
f
f
icac
y
in
r
esis
tin
g
HI
V
s
tig
m
a
ex
h
ib
ited
g
r
ea
te
r
ce
n
tr
ality
with
in
th
e
n
etwo
r
k
,
s
ig
n
if
y
i
n
g
t
h
eir
in
f
lu
en
tial
r
o
le
i
n
s
p
r
ea
d
i
n
g
s
tig
m
a
r
esis
tan
ce
th
r
o
u
g
h
o
u
t
th
e
co
m
m
u
n
ity
.
T
h
e
r
esu
lts
o
f
s
tu
d
y
1
r
ein
f
o
r
ce
d
th
e
s
ig
n
if
ican
ce
o
f
in
ter
-
o
r
g
an
izatio
n
al
co
llab
o
r
atio
n
a
n
d
co
o
p
er
atio
n
in
e
n
s
u
r
in
g
ef
f
ec
tiv
e
in
ter
v
e
n
tio
n
s
an
d
s
u
p
p
o
r
t
f
o
r
in
d
iv
id
u
als
wh
o
tr
an
s
ce
n
d
b
ar
r
ier
s
im
p
o
s
ed
b
y
s
tig
m
a
[
3
5
]
,
[
4
1
]
.
3
.
2
.
4
.
P
a
t
t
er
ns
o
f
s
t
ig
ma
co
m
m
un
ica
t
io
n
Stu
d
y
2
aim
ed
t
o
in
v
esti
g
ate
p
atter
n
s
o
f
s
tig
m
a
co
m
m
u
n
ica
tio
n
an
d
in
f
lu
en
tial
ac
to
r
s
in
t
h
e
co
n
tex
t
o
f
C
OVI
D
-
19
[
8
]
.
T
h
e
s
tu
d
y
f
o
cu
s
ed
o
n
T
witter
co
n
v
er
s
atio
n
s
r
elate
d
to
co
m
m
u
n
ica
b
le
d
i
s
ea
s
es,
p
ar
ticu
lar
ly
C
OVI
D
-
1
9
.
T
h
r
o
u
g
h
th
e
a
n
al
y
s
is
o
f
v
ar
io
u
s
ty
p
es
o
f
s
tig
m
atizin
g
cu
es
em
b
e
d
d
ed
in
twe
ets,
in
clu
d
in
g
p
er
il,
etio
lo
g
y
,
an
d
lab
elin
g
,
th
e
s
tu
d
y
r
ev
ea
led
th
e
s
p
ec
if
ic
elem
e
n
ts
o
f
s
tig
m
a
ass
o
ciate
d
w
ith
em
er
g
in
g
in
f
ec
tio
u
s
d
is
ea
s
e
s
.
T
h
is
p
r
o
v
id
ed
u
n
iq
u
e
in
s
ig
h
ts
in
to
th
e
p
atter
n
s
o
f
s
tig
m
a
co
m
m
u
n
icatio
n
r
eg
ar
d
in
g
C
OVI
D
-
1
9
o
n
T
witter
an
d
s
h
ed
lig
h
t
o
n
h
o
w
s
tig
m
a
is
m
an
if
ested
an
d
co
m
m
u
n
icate
d
with
in
s
o
cial
m
e
d
ia
p
latf
o
r
m
s
.
3
.
2
.
5
.
I
nfluent
ia
l
a
ct
o
rs in stig
m
a
c
o
mm
un
ica
t
io
n
Stu
d
y
2
also
id
en
tifie
d
in
f
lu
e
n
tial
ac
to
r
s
an
d
g
atek
ee
p
er
s
with
in
th
e
T
witter
n
etwo
r
k
wh
o
p
lay
ed
a
cr
u
cial
r
o
le
in
s
h
ap
in
g
th
e
d
i
s
co
u
r
s
e
ar
o
u
n
d
C
OVI
D
-
1
9
s
t
ig
m
a
[
8
]
.
T
h
ese
f
ig
u
r
es
in
clu
d
ed
m
e
d
ia
o
u
tlets
,
h
ea
lth
o
r
g
a
n
izatio
n
s
,
in
f
lu
en
c
er
s
,
an
d
lay
p
eo
p
le,
wield
in
g
th
e
p
o
wer
to
co
n
s
tr
u
ct
an
d
d
is
s
em
in
ate
s
t
ig
m
a
-
r
elate
d
in
f
o
r
m
atio
n
,
in
f
lu
en
ci
n
g
p
u
b
lic
p
er
ce
p
tio
n
s
an
d
r
e
in
f
o
r
cin
g
s
tig
m
as.
So
cial
m
e
d
ia
in
f
lu
en
ce
r
s
,
in
p
ar
ticu
lar
,
wer
e
f
o
u
n
d
to
b
e
in
f
lu
en
tial in
s
h
ap
in
g
s
tig
m
a
n
ar
r
ativ
es a
n
d
p
er
ce
p
tio
n
s
r
elate
d
to
C
OVI
D
-
1
9
.
T
h
ese
f
in
d
in
g
s
u
n
d
e
r
s
co
r
e
th
e
im
p
o
r
tan
ce
o
f
u
n
d
er
s
tan
d
in
g
th
e
r
o
le
o
f
in
f
lu
en
ce
r
s
in
s
h
ap
in
g
p
u
b
lic
d
is
co
u
r
s
e
an
d
th
e
p
o
ten
tial
im
p
licatio
n
s
o
f
th
eir
ac
tio
n
s
.
T
h
e
p
er
s
u
asiv
e
p
o
wer
o
f
s
o
cial
m
ed
ia
in
f
l
u
en
ce
r
s
i
n
s
h
ap
in
g
s
tig
m
a
-
r
elate
d
n
ar
r
ati
v
es
o
n
T
witter
wer
e
s
u
p
p
o
r
te
d
b
y
f
in
d
i
n
g
s
b
y
Har
f
f
et
a
l.
[
4
2
]
th
at
in
f
lu
en
ce
r
s
ca
n
b
e
in
s
tr
u
m
en
tal
in
d
is
s
em
in
atin
g
ac
cu
r
ate
in
f
o
r
m
ati
o
n
an
d
p
r
o
m
o
tin
g
p
o
s
itiv
e
b
eh
av
io
r
c
h
an
g
es.
T
h
er
ef
o
r
e,
it
b
ec
o
m
es
cr
u
cial
f
o
r
i
n
f
lu
en
ce
r
s
to
ex
er
cise
ca
u
tio
n
an
d
r
esp
o
n
s
ib
ilit
y
in
s
h
ar
in
g
co
n
ten
t
r
elate
d
Evaluation Warning : The document was created with Spire.PDF for Python.
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t J Pu
b
lic
Hea
lth
Sci
,
Vo
l.
1
4
,
No
.
1
,
Ma
r
ch
20
2
5
:
5
1
9
-
528
524
to
co
m
m
u
n
icab
le
d
is
ea
s
es
an
d
alig
n
th
eir
m
ess
ag
es
wit
h
ev
id
en
ce
-
b
ased
p
u
b
lic
h
ea
lth
g
u
id
elin
es
[
4
3
]
.
C
o
llab
o
r
atin
g
with
in
f
lu
en
ce
r
s
to
en
s
u
r
e
ac
cu
r
ate
in
f
o
r
m
atio
n
d
is
s
em
in
atio
n
an
d
s
tig
m
a
r
ed
u
ctio
n
ef
f
o
r
ts
ca
n
be
an
ef
f
ec
tiv
e
s
tr
ateg
y
in
m
itig
atin
g
th
e
n
eg
ativ
e
im
p
ac
t
o
f
s
tig
m
a
o
n
p
u
b
lic
h
ea
lth
o
u
tco
m
es [
4
4
]
.
3
.
2
.
6
.
Ro
le
o
f
hea
lt
h o
rg
a
niz
a
t
io
ns
in s
t
ig
m
a
m
i
t
ig
a
t
io
n
Hea
lth
o
r
g
an
izatio
n
s
,
esp
ec
ial
ly
h
ea
lth
ca
r
e
o
r
g
an
izatio
n
s
,
wer
e
id
en
tifie
d
as
k
ey
ac
t
o
r
s
with
in
th
e
s
o
cial
n
etwo
r
k
in
s
tig
m
a
m
it
ig
atio
n
.
Stu
d
y
2
em
p
h
asized
th
eir
im
p
o
r
tan
t
r
o
le
in
ad
d
r
e
s
s
in
g
an
d
r
ed
u
ci
n
g
s
tig
m
a
ass
o
ciate
d
with
in
f
ec
tio
u
s
d
is
ea
s
es
[
8
]
.
R
ec
o
m
m
en
d
atio
n
s
wer
e
m
a
d
e
f
o
r
h
ea
lt
h
o
r
g
an
izatio
n
s
t
o
ac
tiv
ely
m
o
n
ito
r
th
eir
s
o
cial
m
ed
ia
ac
co
u
n
ts
,
p
r
o
m
p
tly
a
d
d
r
ess
s
tig
m
a
-
lad
en
m
ess
ag
es,
an
d
p
er
io
d
ically
d
is
s
em
in
ate
d
e
-
s
tig
m
atiza
tio
n
m
ess
ag
es.
L
ev
er
ag
i
n
g
th
e
i
n
s
ig
h
ts
g
ain
ed
th
r
o
u
g
h
s
o
cia
l
n
etwo
r
k
an
aly
s
is
,
h
ea
lth
o
r
g
an
izatio
n
s
ca
n
ac
tiv
ely
co
n
tr
ib
u
te
to
r
ed
u
ci
n
g
s
ti
g
m
a,
en
c
o
u
r
a
g
in
g
a
p
p
r
o
p
r
iate
h
ea
lth
ca
r
e
-
s
ee
k
in
g
b
eh
av
io
r
,
an
d
s
u
p
p
o
r
tin
g
e
f
f
ec
tiv
e
p
u
b
lic
h
ea
lth
r
esp
o
n
s
es
[
4
5
]
.
3
.
2
.
7
.
E
f
f
ec
t
iv
eness
o
f
inte
rv
ent
io
n a
pp
ro
a
ch
in a
dd
re
s
s
i
ng
s
t
ig
m
a
a
nd
pro
m
o
t
ing
a
d
v
o
ca
cy
Stu
d
y
3
f
o
cu
s
es
o
n
an
i
n
ter
v
en
tio
n
a
p
p
r
o
ac
h
to
ad
d
r
ess
s
tig
m
a
an
d
p
r
o
m
o
te
ad
v
o
ca
cy
am
o
n
g
in
d
iv
id
u
als liv
in
g
with
HI
V
i
n
Ug
an
d
a,
r
e
f
er
r
e
d
to
as th
e
Ga
m
e
C
h
an
g
er
s
in
ter
v
e
n
tio
n
[
3
6
]
.
T
h
e
s
tu
d
y
r
ev
ea
ls
im
p
r
o
v
em
e
n
ts
in
s
ev
er
al
k
ey
ar
ea
s
,
in
clu
d
in
g
in
te
r
n
alize
d
HI
V
s
tig
m
a,
an
ticip
ated
HI
V
s
tig
m
a,
co
n
ce
r
n
s
ab
o
u
t
d
is
clo
s
u
r
e,
s
er
o
s
tatu
s
d
is
clo
s
u
r
e,
p
r
ev
en
tio
n
ad
v
o
ca
cy
,
s
o
cial
n
etwo
r
k
d
y
n
am
ics,
an
d
th
e
in
f
lu
en
ce
o
n
alter
s
with
in
p
ar
ticip
a
n
ts
’
s
o
cial
n
etwo
r
k
s
.
T
h
e
Gam
e
C
h
an
g
er
s
i
n
ter
v
en
tio
n
s
ig
n
if
ican
tly
in
cr
ea
s
e
d
s
er
o
s
tatu
s
d
is
clo
s
u
r
e
an
d
em
p
o
wer
ed
p
ar
ticip
an
ts
to
en
g
a
g
e
in
o
p
e
n
d
is
cu
s
s
io
n
s
ab
o
u
t
th
ei
r
HI
V
s
tatu
s
with
in
th
eir
s
o
cial
n
etwo
r
k
s
,
em
p
h
asi
zin
g
th
e
im
p
o
r
tan
ce
o
f
d
is
clo
s
u
r
e
f
o
r
a
d
v
o
ca
tin
g
HI
V
p
r
ev
e
n
tio
n
an
d
f
o
s
ter
in
g
s
u
p
p
o
r
tiv
e
r
elatio
n
s
h
ip
s
.
Ad
d
i
tio
n
ally
,
th
e
in
ter
v
en
tio
n
p
o
s
it
iv
ely
in
f
lu
en
c
ed
HI
V
p
r
ev
en
ti
o
n
ad
v
o
ca
cy
,
with
p
ar
ticip
an
ts
in
th
e
in
ter
v
en
tio
n
g
r
o
u
p
h
av
in
g
m
o
r
e
f
r
eq
u
e
n
t d
is
cu
s
s
io
n
s
ab
o
u
t H
I
V
-
r
elate
d
to
p
ics co
m
p
ar
ed
t
o
th
e
co
n
tr
o
l
g
r
o
u
p
.
Mo
s
t
im
p
o
r
tan
tly
,
th
e
in
ter
v
en
tio
n
i
n
f
lu
e
n
ce
d
s
o
cial
n
etwo
r
k
d
y
n
a
m
ics.
C
o
m
p
ar
ed
to
th
e
co
n
tr
o
l
g
r
o
u
p
,
in
ter
v
e
n
tio
n
p
a
r
ticip
an
ts
ex
p
er
ien
ce
d
less
ch
an
g
e
in
n
etwo
r
k
d
en
s
ity
o
v
er
tim
e,
in
d
icatin
g
th
e
m
ain
ten
an
ce
o
f
s
o
cial
co
n
n
ec
tio
n
s
.
3
.
2
.
8
.
I
m
pa
ct
o
n
a
lt
er
s
Stu
d
y
3
d
em
o
n
s
tr
ated
th
at
alth
o
u
g
h
t
h
e
in
ter
v
en
ti
o
n
f
o
c
u
s
ed
o
n
in
d
ex
p
ar
ticip
an
ts
o
f
th
e
Gam
e
C
h
an
g
er
s
,
th
er
e
wer
e
in
d
icati
o
n
s
th
at
alter
s
(
in
d
iv
id
u
als
with
in
th
e
s
o
cial
n
etwo
r
k
s
o
f
i
n
d
ex
p
a
r
ticip
an
ts
)
wer
e
also
af
f
ec
ted
[
3
6
]
.
Alt
er
s
in
th
e
in
te
r
v
en
tio
n
g
r
o
u
p
ex
h
i
b
ited
in
cr
ea
s
ed
p
r
e
v
en
tio
n
ad
v
o
ca
cy
a
n
d
m
ar
g
in
ally
l
o
wer
lev
els
o
f
c
o
n
d
o
m
less
s
ex
c
o
m
p
ar
e
d
to
th
e
co
n
t
r
o
l
g
r
o
u
p
.
T
h
ese
f
in
d
i
n
g
s
s
u
p
p
o
r
ted
t
h
at
in
ter
v
en
tio
n
h
ad
p
o
ten
tial
s
p
illo
v
er
ef
f
ec
ts
,
in
f
l
u
en
cin
g
th
e
b
eh
av
io
r
s
an
d
attitu
d
es
o
f
in
d
iv
id
u
als
with
in
th
e
s
o
cial
n
etwo
r
k
s
o
f
in
d
ex
p
ar
ticip
an
ts
[
4
6
]
.
3
.
3
.
Resea
rc
h
g
a
ps
a
nd
f
uture
re
s
ea
rc
h
Sti
g
m
a
is
a
p
er
v
asiv
e
s
o
cial
p
h
en
o
m
en
o
n
th
at
h
as
g
ar
n
e
r
e
d
s
ig
n
if
ican
t
atten
tio
n
d
u
r
in
g
th
e
g
lo
b
al
C
OVI
D
-
1
9
p
an
d
em
ic
[
4
7
]
.
H
o
wev
er
,
d
esp
ite
th
ese
ev
id
en
c
e
[
8
]
,
[
3
5
]
,
[
3
6
]
,
th
e
e
x
p
lo
r
atio
n
o
f
s
tig
m
a
th
r
o
u
g
h
SNA
wi
th
in
th
e
co
n
tex
t
o
f
co
m
m
u
n
icab
le
d
is
ea
s
es
r
em
ain
s
lim
ited
.
T
h
e
f
in
d
in
g
s
f
r
o
m
th
e
r
ev
iewe
d
ar
ticles
p
r
o
v
id
e
v
alu
ab
le
in
s
ig
h
ts
in
to
h
o
w
SNA
ca
n
b
e
ef
f
ec
tiv
ely
em
p
lo
y
ed
to
u
n
r
av
el
th
e
c
o
m
p
lex
r
elatio
n
s
h
ip
b
etwe
en
s
tig
m
a
an
d
c
o
m
m
u
n
icab
le
d
is
ea
s
es.
W
h
ile
SN
A
h
as
b
ee
n
wid
ely
u
s
ed
in
th
e
co
n
tex
t
o
f
s
tu
d
y
i
n
g
th
e
s
p
r
ea
d
o
f
co
m
m
u
n
icab
l
e
d
is
ea
s
e
s
s
u
ch
as
C
OVI
D
-
19
[
1
7
]
,
[
1
9
]
,
[
2
0
]
,
t
h
er
e
is
g
r
o
win
g
ev
id
en
ce
to
s
u
g
g
est
th
at
s
tig
m
a
to
war
d
s
th
e
d
is
ea
s
es
ca
n
also
s
p
r
ea
d
th
r
o
u
g
h
s
o
cial
n
et
wo
r
k
s
,
ju
s
t
lik
e
th
e
d
is
ea
s
e
its
elf
[
8
]
,
[
3
5
]
,
[
3
6
]
.
Ho
wev
er
,
t
h
is
s
co
p
in
g
r
ev
iew,
wh
ile
o
f
f
er
in
g
v
alu
a
b
le
in
s
ig
h
ts
in
to
th
e
u
tili
za
tio
n
o
f
s
o
cial
n
etwo
r
k
an
al
y
s
is
in
th
e
s
tu
d
y
o
f
s
tig
m
a
d
y
n
am
ics
r
elate
d
to
co
m
m
u
n
icab
le
d
is
ea
s
es,
id
en
tifie
s
s
ev
er
al
ar
ea
s
th
at
war
r
an
t f
u
r
th
er
in
v
esti
g
atio
n
.
First,
th
e
id
en
tifie
d
s
tu
d
ies
wer
e
f
o
cu
s
ed
o
n
HI
V/AI
DS
an
d
C
OVI
D
-
19
-
r
elate
d
s
tig
m
a,
in
d
icatin
g
p
o
ten
tial
b
ias
to
war
d
s
th
ese
d
i
s
ea
s
es.
Giv
en
th
at
th
er
e
wer
e
o
n
ly
th
r
ee
s
tu
d
ies
in
th
e
b
o
d
y
o
f
liter
atu
r
e,
th
er
e
is
r
o
o
m
f
o
r
m
o
r
e
ex
p
lo
r
atio
n
o
f
SNA
an
d
s
tig
m
a
r
elativ
e
to
co
m
m
u
n
icab
le
d
is
ea
s
es,
in
clu
d
in
g
o
th
er
in
f
ec
tio
u
s
d
is
ea
s
es
s
u
ch
as
tu
b
er
cu
lo
s
is
,
m
alar
ia,
an
d
em
er
g
in
g
in
f
ec
tio
u
s
d
is
ea
s
es.
E
x
p
an
d
in
g
r
esear
ch
to
in
clu
d
e
a
b
r
o
ad
er
r
an
g
e
o
f
co
m
m
u
n
icab
l
e
d
is
ea
s
es
wo
u
ld
p
r
o
v
id
e
a
m
o
r
e
c
o
m
p
r
e
h
en
s
iv
e
u
n
d
er
s
tan
d
i
n
g
o
f
s
tig
m
a
d
y
n
am
ics ac
r
o
s
s
d
if
f
er
en
t c
o
n
tex
ts
an
d
p
o
p
u
latio
n
s
.
Mo
r
eo
v
er
,
th
e
d
if
f
u
s
io
n
m
eth
o
d
o
lo
g
y
f
o
r
tr
ac
k
in
g
in
f
o
r
m
atio
n
s
p
r
ea
d
o
v
er
s
o
ci
al
in
ter
ac
tio
n
s
tr
u
ctu
r
es
o
p
e
n
s
n
ew
av
en
u
es
f
o
r
u
n
d
er
s
tan
d
in
g
h
o
w
s
tig
m
a
r
elate
d
to
co
m
m
u
n
icab
le
d
is
ea
s
es
p
r
o
life
r
ates
with
in
an
d
a
cr
o
s
s
co
m
m
u
n
ities
[
4
8
]
.
T
h
is
ap
p
r
o
ac
h
n
o
t
o
n
l
y
em
p
h
asizes
th
e
r
o
le
o
f
n
etwo
r
k
to
p
o
lo
g
y
in
th
e
d
if
f
u
s
io
n
p
r
o
ce
s
s
b
u
t
also
h
ig
h
lig
h
t
s
th
e
p
o
ten
tial
f
o
r
in
d
iv
id
u
al
n
o
d
es
with
in
a
n
etwo
r
k
to
s
ig
n
if
ican
tly
in
f
lu
en
c
e
th
e
s
p
r
ea
d
o
f
s
tig
m
a,
s
im
ilar
to
th
e
s
p
r
ea
d
o
f
th
e
d
is
ea
s
es th
em
s
elv
es.
Ad
d
itio
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ally
,
f
u
tu
r
e
r
esear
ch
s
h
o
u
ld
p
r
io
r
itize
th
e
ex
p
lo
r
atio
n
o
f
s
o
cial
n
etwo
r
k
an
aly
s
is
f
o
r
co
m
p
r
eh
e
n
d
in
g
s
tig
m
a
d
y
n
a
m
ics
ac
r
o
s
s
v
ar
ied
cu
ltu
r
al
an
d
g
e
o
g
r
a
p
h
ical
lan
d
s
ca
p
es.
T
h
e
p
e
r
ce
p
tio
n
o
f
Evaluation Warning : The document was created with Spire.PDF for Python.
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8
8
0
6
E
xa
min
in
g
s
tig
ma
d
y
n
a
mics:
a
s
co
p
in
g
r
ev
iew
o
f so
cia
l n
et
w
o
r
k
a
n
a
lysi
s
…
(
I
z
ya
n
Ha
z
w
a
n
i B
a
h
a
r
u
d
d
in
)
525
s
tig
m
a
an
d
its
r
am
if
icatio
n
s
o
n
s
o
cial
n
etwo
r
k
s
ca
n
s
ig
n
if
ican
tly
d
if
f
er
am
o
n
g
d
iv
er
s
e
p
o
p
u
latio
n
s
an
d
co
n
tex
ts
.
Delv
in
g
in
to
th
ese
v
ar
iatio
n
s
ca
n
y
ield
in
s
ig
h
ts
t
h
at
p
av
e
th
e
way
f
o
r
tar
g
eted
a
n
d
co
n
tex
t
-
s
p
ec
if
ic
in
ter
v
en
tio
n
s
,
aim
ed
at
ef
f
ec
tiv
ely
co
m
b
atin
g
s
tig
m
a.
Fu
r
th
er
m
o
r
e,
th
e
in
v
esti
g
atio
n
in
to
th
e
r
o
le
o
f
d
ig
ital
p
latf
o
r
m
s
a
n
d
s
o
cial
m
ed
ia
i
n
th
e
co
m
m
u
n
icatio
n
o
f
s
tig
m
a
d
u
r
in
g
o
u
tb
r
ea
k
s
o
f
co
m
m
u
n
icab
le
d
is
ea
s
es
war
r
an
ts
u
r
g
en
t
atten
tio
n
.
Giv
en
th
e
p
r
ev
alen
t
r
elian
ce
o
n
s
o
cial
m
ed
ia
as
a
p
r
im
ar
y
co
n
d
u
it
f
o
r
in
f
o
r
m
atio
n
an
d
co
m
m
u
n
icatio
n
in
th
e
m
id
s
t
o
f
p
u
b
lic
h
ea
lth
em
er
g
e
n
cies,
g
r
asp
in
g
th
e
m
ec
h
an
is
m
s
th
r
o
u
g
h
wh
ic
h
s
tig
m
a
is
p
r
o
p
ag
ated
an
d
en
tr
en
ch
ed
with
in
o
n
lin
e
n
etwo
r
k
s
b
ec
o
m
es
cr
u
cial
[
4
9
]
–
[
5
1
]
.
Su
ch
u
n
d
er
s
tan
d
i
n
g
is
im
p
er
ativ
e
f
o
r
th
e
f
o
r
m
u
latio
n
o
f
s
tr
ateg
ies
th
at
ef
f
ec
tiv
ely
co
u
n
te
r
m
is
in
f
o
r
m
atio
n
an
d
th
e
p
er
p
etu
atio
n
o
f
s
tig
m
a.
3
.
4
.
Str
eng
t
hs
o
f
inclu
ded st
ud
ies a
nd
re
v
iew
T
h
e
s
tr
en
g
th
o
f
th
e
i
n
clu
d
ed
s
tu
d
ies
lies
in
th
eir
u
s
e
o
f
s
o
cial
n
etwo
r
k
a
n
aly
s
is
as
a
p
o
wer
f
u
l
m
eth
o
d
o
l
o
g
y
to
ex
p
lo
r
e
s
tig
m
a
d
y
n
am
ics
with
in
th
e
c
o
n
tex
t
o
f
co
m
m
u
n
ica
b
le
d
is
ea
s
es.
B
y
lev
er
ag
in
g
n
etwo
r
k
t
h
eo
r
y
an
d
q
u
an
tita
tiv
e
an
aly
s
is
,
th
ese
s
tu
d
ies
p
r
o
v
id
e
v
alu
a
b
le
in
s
ig
h
ts
i
n
to
th
e
u
n
d
e
r
ly
in
g
ar
ch
itectu
r
e
o
f
s
o
cial
n
etwo
r
k
s
an
d
th
e
way
s
in
wh
ich
s
tig
m
a
s
p
r
ea
d
s
,
co
n
s
o
lid
ates,
o
r
is
r
esis
ted
with
in
th
ese
n
etwo
r
k
s
.
Mo
r
eo
v
er
,
th
is
s
co
p
in
g
r
ev
iew
f
o
llo
ws
th
e
PR
I
SMA
-
ScR
g
u
id
elin
es,
en
s
u
r
in
g
tr
an
s
p
ar
en
cy
an
d
r
ig
o
r
i
n
th
e
r
ev
iew
p
r
o
ce
s
s
[
3
0
]
.
T
h
e
co
m
p
r
eh
e
n
s
iv
e
s
ea
r
ch
s
tr
ateg
y
ac
r
o
s
s
m
u
ltip
l
e
d
ata
b
ases
an
d
th
e
u
s
e
o
f
in
clu
s
io
n
an
d
e
x
clu
s
io
n
cr
iter
i
a
co
n
tr
ib
u
te
t
o
th
e
co
m
p
leten
e
s
s
an
d
r
elev
an
ce
o
f
th
e
in
cl
u
d
ed
s
tu
d
ies.
3
.
5
.
L
im
it
a
t
io
ns
o
f
t
he
s
co
pi
ng
re
v
iew
Desp
ite
its
co
n
tr
ib
u
tio
n
s
,
t
h
is
s
co
p
in
g
r
e
v
iew
h
as
s
o
m
e
lim
itatio
n
s
.
On
e
m
ajo
r
lim
ita
tio
n
is
th
e
s
m
all
n
u
m
b
er
o
f
eli
g
ib
le
s
tu
d
ies
id
en
tifie
d
d
u
r
in
g
t
h
e
s
ea
r
ch
p
r
o
ce
s
s
.
T
h
is
co
u
ld
b
e
attr
ib
u
t
ed
to
th
e
e
m
er
g
in
g
n
atu
r
e
o
f
r
esear
ch
a
p
p
ly
i
n
g
s
o
cial
n
etwo
r
k
a
n
aly
s
is
s
p
ec
if
ically
to
th
e
s
tu
d
y
o
f
s
tig
m
a
in
co
m
m
u
n
icab
le
d
is
ea
s
e
co
n
tex
ts
.
As
a
r
esu
l
t,
th
e
f
in
d
in
g
s
f
r
o
m
th
e
in
clu
d
e
d
s
tu
d
ies
m
ay
n
o
t
f
u
lly
ca
p
tu
r
e
th
e
b
r
ea
d
th
a
n
d
d
ep
th
o
f
th
e
ap
p
licatio
n
o
f
s
o
cial
n
etwo
r
k
a
n
aly
s
is
in
th
is
a
r
ea
.
Fu
r
th
e
r
m
o
r
e,
th
e
f
o
cu
s
o
n
E
n
g
lis
h
-
la
n
g
u
a
g
e
p
u
b
licatio
n
s
m
a
y
h
a
v
e
led
to
t
h
e
ex
clu
s
io
n
o
f
r
elev
a
n
t
s
tu
d
i
es
p
u
b
l
is
h
ed
i
n
o
th
e
r
lan
g
u
ag
e
s
.
Ad
d
itio
n
ally
,
t
h
e
lack
o
f
q
u
ality
ass
ess
m
en
t
o
f
th
e
in
clu
d
ed
s
tu
d
ies
is
an
o
th
er
lim
itatio
n
.
W
h
ile
s
co
p
in
g
r
ev
iews
d
o
n
o
t
ty
p
ically
co
n
d
u
ct
f
o
r
m
al
q
u
ali
ty
ass
ess
m
en
ts
[
3
2
]
,
ac
k
n
o
wled
g
in
g
t
h
is
lim
itatio
n
is
ess
en
tial
f
o
r
in
ter
p
r
etin
g
th
e
f
in
d
in
g
s
.
4.
CO
NCLU
SI
O
N
T
h
is
r
ev
iew
h
ig
h
lig
h
ts
th
e
d
iv
er
s
e
way
s
in
wh
ich
s
o
cial
n
etwo
r
k
a
n
aly
s
is
h
as
b
ee
n
ap
p
lied
to
ex
p
lo
r
e
s
tig
m
a
d
y
n
am
ics.
T
h
e
f
in
d
in
g
s
em
p
h
asize
th
e
i
m
p
o
r
tan
ce
o
f
ad
d
r
ess
in
g
s
tig
m
a
n
o
t
o
n
ly
at
th
e
in
d
iv
id
u
al
lev
el
b
u
t
also
with
in
t
h
e
co
n
tex
t
o
f
s
o
cial
n
etwo
r
k
s
,
wh
er
e
it
ca
n
s
p
r
ea
d
,
m
o
r
p
h
,
an
d
im
p
ac
t
e
n
tire
co
m
m
u
n
ities
.
As
th
e
wo
r
ld
co
n
tin
u
es
to
g
r
ap
p
le
with
co
m
m
u
n
icab
le
d
is
ea
s
es,
co
m
b
atin
g
s
tig
m
a
r
em
ain
s
a
p
r
ess
in
g
p
u
b
lic
h
ea
lth
ch
allen
g
e.
T
h
is
s
co
p
in
g
r
ev
iew
ca
lls
f
o
r
th
e
n
ee
d
f
o
r
m
o
r
e
r
esear
c
h
u
tili
zin
g
SNA
in
th
is
co
n
tex
t
to
f
o
s
ter
in
clu
s
iv
e,
em
p
ath
etic
s
o
cieties.
B
y
d
o
in
g
s
o
,
we
ca
n
en
h
a
n
ce
o
u
r
u
n
d
er
s
tan
d
in
g
o
f
th
e
co
m
p
lex
ities
o
f
s
tig
m
a,
id
en
t
if
y
ef
f
ec
tiv
e
in
ter
v
e
n
tio
n
s
,
a
n
d
u
ltima
tely
c
o
n
tr
ib
u
te
to
t
h
e
g
lo
b
al
ef
f
o
r
ts
to
co
m
b
at
co
m
m
u
n
icab
le
d
is
ea
s
e
s
tig
m
a.
RE
F
E
R
E
NC
E
S
[
1
]
N
.
H
a
a
g
e
n
se
n
a
n
d
L.
F
.
H
e
n
r
i
k
se
n
,
S
o
c
i
a
l
n
e
t
w
o
r
k
a
n
a
l
y
si
s:
t
h
e
s
i
g
n
i
f
i
c
a
n
c
e
o
f
r
e
l
a
t
i
o
n
s
.
2
0
2
1
.
[
2
]
J.
L.
M
o
r
e
n
o
,
Wh
o
s
h
a
l
l
s
u
rv
i
v
e
?
:
A
n
e
w
a
p
p
ro
a
c
h
t
o
t
h
e
p
r
o
b
l
e
m
o
f
h
u
m
a
n
i
n
t
e
rr
e
l
a
t
i
o
n
s.
W
a
s
h
i
n
g
t
o
n
:
N
e
r
v
o
u
s
a
n
d
M
e
n
t
a
l
D
i
sea
s
e
P
u
b
l
i
s
h
i
n
g
C
o
,
1
9
3
4
,
d
o
i
:
1
0
.
1
0
3
7
/
1
0
6
4
8
-
0
0
0
.
[
3
]
T.
W
.
V
a
l
e
n
t
e
,
S
o
c
i
a
l
n
e
t
w
o
rks
a
n
d
h
e
a
l
t
h
.
O
x
f
o
r
d
U
n
i
v
e
r
si
t
y
P
r
e
ssN
e
w
Y
o
r
k
,
2
0
1
0
,
d
o
i
:
1
0
.
1
0
9
3
/
a
c
p
r
o
f
:
o
so
/
9
7
8
0
1
9
5
3
0
1
0
1
4
.
0
0
1
.
0
0
0
1
.
[
4
]
S
.
W
a
ss
e
r
ma
n
a
n
d
K
.
F
a
u
st
,
S
o
c
i
a
l
n
e
t
w
o
rk
a
n
a
l
y
s
i
s
.
C
a
mb
r
i
d
g
e
U
n
i
v
e
r
si
t
y
P
r
e
ss,
1
9
9
4
,
d
o
i
:
1
0
.
1
0
1
7
/
C
B
O
9
7
8
0
5
1
1
8
1
5
4
7
8
.
[
5
]
A
.
M
.
D
o
z
i
e
r
e
t
a
l
.
,
“
I
d
e
n
t
i
f
y
i
n
g
e
mer
g
i
n
g
r
e
s
e
a
r
c
h
c
o
l
l
a
b
o
r
a
t
i
o
n
s a
n
d
n
e
t
w
o
r
k
s
,
”
Ev
a
l
u
a
t
i
o
n
a
n
d
t
h
e
H
e
a
l
t
h
Pro
f
e
ssi
o
n
s
,
v
o
l
.
3
7
,
n
o
.
1
,
p
p
.
1
9
–
3
2
,
M
a
r
.
2
0
1
4
,
d
o
i
:
1
0
.
1
1
7
7
/
0
1
6
3
2
7
8
7
1
3
5
0
1
6
9
3
.
[
6
]
E.
R
i
c
e
,
E
.
Tu
l
b
e
r
t
,
J
.
C
e
d
e
r
b
a
u
m,
A
.
B
a
r
ma
n
A
d
h
i
k
a
r
i
,
a
n
d
N
.
G
.
M
i
l
b
u
r
n
,
“
M
o
b
i
l
i
z
i
n
g
h
o
me
l
e
ss
y
o
u
t
h
f
o
r
H
I
V
p
r
e
v
e
n
t
i
o
n
:
a
so
c
i
a
l
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l
o
r
o
f
S
u
r
g
e
ry
fro
m
th
e
M
e
d
ica
l
In
stit
u
te
Ra
n
g
o
o
n
,
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rm
a
.
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e
a
rn
e
d
a
M
a
ste
r
o
f
P
u
b
li
c
He
a
lt
h
a
n
d
a
Dip
lo
m
a
in
Tr
o
p
ica
l
M
e
d
icin
e
a
n
d
Hy
g
ien
e
fro
m
M
a
h
i
d
o
l
Un
i
v
e
rsity
,
f
o
ll
o
we
d
b
y
a
M
a
ste
r
o
f
M
e
d
ica
l
S
tatisti
c
s
fro
m
Ne
wc
a
stle
Un
iv
e
rsity
in
2
0
0
1
.
Wi
t
h
a
n
e
x
t
e
n
siv
e
p
u
b
li
c
a
ti
o
n
re
c
o
r
d
in
re
p
u
tab
le
i
n
tern
a
ti
o
n
a
l
j
o
u
r
n
a
ls,
h
e
h
a
s
e
sta
b
li
sh
e
d
h
ims
e
lf
a
s
a
le
a
d
in
g
a
u
th
o
rit
y
in
h
is
field
.
He
c
a
n
b
e
c
o
n
tac
ted
a
t
e
m
a
il
:
s
y
e
d
h
a
ti
m
@u
n
isz
a
.
e
d
u
.
m
y
.
K
h
a
li
d
Ibra
h
im
is
a
d
isti
n
g
u
ish
e
d
m
e
d
ica
l
p
ro
fe
ss
io
n
a
l
with
e
x
p
e
rien
c
e
in
h
e
a
lt
h
c
a
re
a
d
m
in
istratio
n
a
n
d
p
u
b
li
c
se
rv
ice
.
Wi
th
a
r
o
b
u
st
a
c
a
d
e
m
ic
b
a
c
k
g
ro
u
n
d
,
in
c
l
u
d
i
n
g
a
n
M
.
S
c
.
in
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s
p
it
a
l
a
n
d
He
a
lt
h
S
e
rv
ice
M
a
n
a
g
e
m
e
n
t
fro
m
th
e
Un
iv
e
rsity
o
f
S
o
u
th
Ba
n
k
,
Lo
n
d
o
n
,
a
n
d
a
n
M
BBS
fro
m
Un
i
v
e
rsiti
M
a
lay
a
,
he
h
a
s
b
e
e
n
a
trail
b
laz
e
r
in
v
a
rio
u
s
h
e
a
lt
h
c
a
re
ro
les
.
His
e
x
ten
si
v
e
se
rv
ice
sp
a
n
s
d
irec
to
rial
p
o
siti
o
n
s
i
n
h
o
s
p
it
a
l
s,
c
o
n
tri
b
u
ti
n
g
sig
n
ifi
c
a
n
tl
y
to
c
li
n
ica
l
g
o
v
e
rn
a
n
c
e
a
n
d
p
a
ti
e
n
t
sa
fe
ty
in
it
iativ
e
s.
Be
y
o
n
d
h
is
p
r
o
fe
ss
io
n
a
l
a
c
h
iev
e
m
e
n
ts,
he
is
a
d
e
d
ica
ted
c
o
n
tri
b
u
t
o
r
t
o
so
c
i
e
ty
,
h
a
v
i
n
g
c
h
a
ired
v
a
ri
o
u
s
o
r
g
a
n
iza
ti
o
n
s
a
n
d
p
lay
e
d
p
i
v
o
tal
ro
les
in
h
u
m
a
n
it
a
rian
m
issio
n
s.
H
is
n
u
m
e
ro
u
s
a
wa
rd
s
re
flec
t
h
is
c
o
m
m
it
m
e
n
t
to
e
x
c
e
ll
e
n
c
e
in
th
e
m
e
d
ica
l
field
a
n
d
b
e
y
o
n
d
.
He
c
a
n
b
e
c
o
n
tac
ted
a
t
e
m
a
il
:
d
rk
h
a
li
d
@u
it
m
.
e
d
u
.
m
y
.
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