AIDS and Behavior最新文献

{"title":"Male Circumcision and HIV Risk Compensation Among Men Who Have Sex with Men: A Systematic Review and Meta-Analysis.","authors":"Xinsheng Wu, Zhongwen Wang, Yongjian Shi, Thomas Fitzpatrick, Weijie Zhang, Zixin Wang, Phoenix K H Mo, Luyao Xie, Yu Liu, Domingo Fernández Vecilla, Qianqian Luo, Aidi Zhang, Ana Claudia Ossa-Giraldo, Kate M Mitchell, Sten H Vermund, Huachun Zou","doi":"10.1007/s10461-025-04850-4","DOIUrl":"https://doi.org/10.1007/s10461-025-04850-4","url":null,"abstract":"<p><p>Male circumcision (MC) has been shown to reduce the risk of HIV infection among men who have sex with men (MSM) in a recent randomised controlled trial. A question that remains unanswered is whether MC in MSM implies HIV compensation, i.e. condomless sex and/or multiple sex partners. We searched PubMed, Embase, and the Cochrane Library for relevant studies published before November 5, 2024 and reviewed references of included studies. We included interventional and observational studies reporting original quantitative data on the association between MC and condom use or the number of sex partners among MSM. Odds ratios (ORs) and 95% confidence intervals (CIs) were extracted directly from the studies or calculated from available data when necessary. A Mantel-Haenszel random effects model was used to calculate pooled ORs and CIs. The final analysis included 41,694 MSM from 15 eligible studies. No statistically significant association was found between MC and condomless sex (OR 1.02, 95% CI 0.91-1.14; k = 13; I² = 18%) or multiple sex partners (OR 1.03, 95% CI 0.94-1.12; k = 10; I² = 12%) among MSM. The lack of association persisted in the great majority of subgroup analyses, encompassing country income, age, recruitment setting, time length, year of recruitment, circumcision assessment, proportion circumcised, or risk of bias. In conclusion, MC among MSM was not found to be associated with either condomless sex or multiple sex partners. Nonetheless, standard minimum service packages, as per WHO guidelines, should be integrated and consistently provided within MC programs to better protect MSM from HIV infection.</p>","PeriodicalId":7543,"journal":{"name":"AIDS and Behavior","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144793266","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"\"The Simplest Way to Go\": An Exploration of Why Women Who Inject Drugs Chose Long-Acting Injectable Cabotegravir Instead of Daily Oral PrEP.","authors":"Alexis M Roth, Kathleen M Ward, Erin McDowell, Elana Forman, K Rivet Amico, Tyler S Bartholomew, Douglas Krakower, Daniel Vader, Silvana Mazzella, Adam W Carrico, Susan G Sherman, Allison Groves","doi":"10.1007/s10461-025-04833-5","DOIUrl":"https://doi.org/10.1007/s10461-025-04833-5","url":null,"abstract":"<p><p>Long-acting injectable PrEP was approved for use in the US in 2021 but roll out has been slow, with few studies exploring uptake among cisgender women who inject drugs (WWID). We purposively recruited 25 WWID within 30-days of receiving a PrEP prescription from a low-barrier clinic co-located with a syringe services program to complete semi-structured interviews about PrEP product choice. We used an intersectional lens to compare decision-making between women choosing injectable PrEP versus oral PrEP and continued enrolling new participants until we reached thematic saturation (12/2022 to 2/2024). Participants represent a diverse sample of WWID (12 women of color) with median age 43 years. Daily injection drug use (72%) and ≥ 1 sex partner (64%) were common. Salient themes from interviews include: (1) PrEP provides women with a valued safety net and initiation is a form of self-preservation. (2) Co-located care, small incentives, and provider respect for WWID's medical autonomy helped participants navigate a multi-visit PrEP intake process. (3) Longer lasting HIV protection with less frequent dosing is preferrable to a shorter acting daily oral medication. When selecting a product, WWID evaluated its attributes against their medical history and personal circumstances like homelessness (64%). Most chose CAB-LA (72%) because it provides longer lasting protection which was a highly valued product attribute. Together, our findings underscore the critical importance of offering multiple PrEP options when implementing HIV prevention strategies that are patient-centered and responsive to the unique needs of WWID.</p>","PeriodicalId":7543,"journal":{"name":"AIDS and Behavior","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144788007","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Single-Session Interventions To Enhance HIV Outcomes among Adolescents and Young Adults: A Systematic Scoping Review and Implications for Integrating HIV and Mental Health Services.","authors":"Juan Pablo Zapata, Andy Rapoport, Annie Wescott, Shivranjani Gandhi, Tyra Cole Bergstrom, Andrés Alvarado Avila, Lisa M Kuhns, Robert Garofalo, Jessica Lee Schleider","doi":"10.1007/s10461-025-04834-4","DOIUrl":"https://doi.org/10.1007/s10461-025-04834-4","url":null,"abstract":"<p><p>Significant progress has been made in HIV prevention and treatment for adolescents and young adults (AYA), but integrating mental healthcare remains essential to address risks and improve treatment engagement. Single-session interventions (SSIs) offer a cost-effective, scalable way to improve access to HIV and mental health services. While evidence shows SSIs reduce sexual risk behaviors and enhance mental health, their combined impact on both areas has not yet been reviewed. This scoping review evaluates SSIs designed for AYA that target HIV treatment and prevention outcomes, while assessing whether these SSIs had any secondary effects on co-occurring mental health outcomes. A systematic search of databases through August 2024 identified 21 SSIs that included HIV-related outcomes, such as intentions to test, improvements in HIV knowledge, attitudes toward HIV, PrEP uptake, and treatment engagement, and any reported mental health outcomes. Of the 21 studies analyzed, 19 focused on HIV prevention, showing significant improvements in knowledge, reduced stigma, and better self-assessment of HIV risk. The remaining two studies examined treatment-related outcomes, with some interventions like video-based programs and motivational interviews improving treatment initiation and attitudes toward adherence among AYA. Notably, only two of the 21 studies explicitly integrated mental health-related outcomes, despite nearly all interventions targeting change mechanisms common to mental health-focused interventions. Findings from this review highlight the promise of SSIs for improving HIV-related outcomes among AYA. However, to maximize their impact, future research should incorporate mental health-related outcomes into these interventions.</p>","PeriodicalId":7543,"journal":{"name":"AIDS and Behavior","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144764368","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Correction: A Competing Risks Duration Model to Study PrEP Discontinuation Among MSM in France: The ERAS 2023 Study","authors":"Clément Boutet,&nbsp;Marion Di Ciaccio,&nbsp;Bruno Spire,&nbsp;Annie Velter,&nbsp;Luis Sagaon-Teyssier","doi":"10.1007/s10461-025-04836-2","DOIUrl":"10.1007/s10461-025-04836-2","url":null,"abstract":"","PeriodicalId":7543,"journal":{"name":"AIDS and Behavior","volume":"29 9","pages":"2728 - 2728"},"PeriodicalIF":2.4,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144758954","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Dialectical Behavior Therapy (DBT)-Informed mHealth Intervention to Enhance Coping Skills and Mental Health among Men Who Have Sex with Men Living with HIV in China: A Mixed-Methods Feasibility Pilot Study.","authors":"Liying Wang, Weichao Yuwen, Vibh Forsythe Cox, Lingxiao Chen, Huang Zheng, Zhen Ning, Jane Simoni","doi":"10.1007/s10461-025-04812-w","DOIUrl":"https://doi.org/10.1007/s10461-025-04812-w","url":null,"abstract":"&lt;p&gt;&lt;p&gt;Men who have sex with men (MSM) bear a disproportionate burden of HIV and mental health problems in China, hindering HIV-related care engagement and medication adherence. We developed a culturally-tailored dialectical behavior therapy (DBT)-informed mHealth intervention composed of individual skills training through a mobile app, online skills group, and on-demand skills coaching. The primary objective of this feasibility study was to assess the intervention acceptability, feasibility, and app usability. The secondary aim is to explore preliminary intervention effects. Participants were recruited in collaboration with Shanghai China Sex Worker & Men Who Have Sex with Men Center (SCMC), a community-based organization that provides HIV-related services in Shanghai, China. Eligible participants were randomly assigned to a 4-week mHealth intervention or control arm (treatment as usual). The intervention included individual skills learning using an app, online skills group facilitated by trained SCMC staff, and on-demand skills coaching by trained SCMC staff. Both groups completed weekly surveys for 4 weeks. Quantitative data were analyzed using linear mixed-effects models to evaluate the intervention's impact on primary outcomes (depression, anxiety, quality of life, medication adherence) and intermediate outcomes (emotion regulation difficulties, HIV-related stigma, and coping self-efficacy). Quantitative and qualitative data on intervention feasibility, acceptability, and app usability were analyzed using content analysis and supplemented with quantitative data summarized with descriptive statistics. Of the 64 people who completed the screening survey, 31 enrolled and completed the study without dropping out. The intervention (n = 16) and control arm (n = 14) did not differ in demographic characteristics, primary outcomes, or intermediate outcomes at baseline. Most participants were 23-30 years old, college-educated, employed, and single. Overall, the intervention was perceived to be highly feasible and acceptable, with above-average app usability. Compared to the control group, time was significantly associated with a greater decrease in the following outcomes in the intervention group: depression (β = - 0.73, 95% CI [-1.37, - 0.10]), emotion regulation difficulties (β = - 1.56, 95% CI [-2.72, - 0.41]), specifically non-acceptance of emotions (β = - 0.48, 95% CI [- 0.88, - 0.09]), and impact of emotions on goals (β = - 0.37, 95% CI [- 0.72, - 0.03]). Participants in the intervention group also showed more improvement in HIV mastery (β = 0.37, 95% CI [0.01, 0.74]), life satisfaction (β = 0.85, 95% CI [0.11, 1.59], coping efficacy around emotions (β = 0.97, 95% CI [0.06, 1.88]), and seeking social support from family and friend (β = 0.82, 95% CI [0.08, 1.57], compared with the control group. The DBT-informed mHealth intervention is acceptable and feasible among MSM living with HIV in China. The intervention shows promise in reducing depression","PeriodicalId":7543,"journal":{"name":"AIDS and Behavior","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144758953","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"What Is the Effect of Medicaid Expansions on Preexposure Prophylaxis for HIV Prevention Use among Women?","authors":"Dion C Allen, Silvia E Rabionet, Sannisha K Dale, Ioana Popovici","doi":"10.1007/s10461-025-04828-2","DOIUrl":"10.1007/s10461-025-04828-2","url":null,"abstract":"<p><p>Pre-exposure prophylaxis (PrEP) is a key biomedical tool for combatting HIV spread, but women account for only 5% of users. Between 2015 and 2019, men saw a 9% decrease in new HIV diagnoses, while rates among women remained constant. Using a difference-in-differences regression model and state level HIV surveillance data (utilizing sex assigned at birth) reported by AIDSVu from 2012 to 2021, we examined the impact of Medicaid expansions under the Affordable Care Act on PrEP outcomes. The study revealed that Medicaid expansions were associated with better PrEP outcomes overall, with increases of 18.9% in PrEP rate and 40.4% in PrEP-to-need ratio for every state that expanded Medicaid. Males experienced better outcomes with a 43% increase in PrEP-to-need ratio, while females saw a 15.6% increase that was not statistically significant. Medicaid expansion improves PrEP access for all, however more targeted strategies are needed to increase PrEP uptake among women vulnerable to HIV.</p>","PeriodicalId":7543,"journal":{"name":"AIDS and Behavior","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144726473","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Resistance Training Improves Cognitive Function and Depression Without Changing BDNF Levels in People Living with HIV: a Randomized Controlled Clinical Trial.","authors":"Dayane Cristina de Souza, Kauana Borges Marchini, Pollyana Mayara Nunhes, Wagner Jorge Rodrigues Domingues, Dennis Armando Bertolini, Vitor Oliveira, Oldemar Mazzardo, Ademar Avelar","doi":"10.1007/s10461-025-04824-6","DOIUrl":"https://doi.org/10.1007/s10461-025-04824-6","url":null,"abstract":"<p><p>The increased life expectancy provided by Antiretroviral Therapy(ART) has led to the incidence of different comorbidities in people living with the Human Immunodeficiency Virus (HIV), especially comorbidities related to aging and mental health. Among these, cognitive impairment and depression increased in this population. Therefore, non-pharmacological strategies, such as physical exercise, have been studied to improve these outcomes. This study aimed to investigate the effects of eight weeks of resistance training(RT) on cognitive function and depression status in people with HIV. The sample consisted of 20 subjects (12 men and eight women), randomized in two groups: Control Group (CG, n = 9) and Training Group (TG, n = 11). Cognitive function (Stroop Test), depression status (Beck Depression Inventory- BDI), and plasma levels of Brain-Derived Neurotrophic Factor (BDNF) were assessed before and after the resistance training intervention. The results indicated thatRT was able to promote significant improvements in the cognitive domains and reduce symptoms of depression (ΔCG: 1.56 ± 2.46; ΔTG -3.18 ± 1.66, P > 0.001). Regarding BDNF, no significant change was observed (P > 0.05). In conclusion, eight weeks ofRT improves cognitive function and depression status in people with HIV, without changing the circulating BDNF levels (NCT03879993).</p>","PeriodicalId":7543,"journal":{"name":"AIDS and Behavior","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144706004","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Experiences in Healthcare Predicts Pre-Exposure Prophylaxis Awareness and Attitudes: A Brief Report on Adolescent Sexual Minority Males.","authors":"Trey V Dellucci, Leslie A Hulvershorn, Tamika C B Zapolski, Zachary W Adams, Tyrel J Starks","doi":"10.1007/s10461-025-04825-5","DOIUrl":"10.1007/s10461-025-04825-5","url":null,"abstract":"<p><p>This study examines the association between healthcare experiences and LGBTQ + connectedness with beliefs about pre-exposure prophylaxis (PrEP) among adolescent sexual minority males in romantic relationships. Results revealed that connection to the LGBTQ + community and comfort discussing sexual health with a healthcare provider was positively associated with perceived confidence in taking PrEP daily, while experiences of discrimination by a healthcare provider was negatively associated with the perceived PrEP effectiveness to prevent HIV. Findings highlight the importance of fostering an affirming environment for learning about HIV prevention and for increasing confidence in taking care of one's sexual health.</p>","PeriodicalId":7543,"journal":{"name":"AIDS and Behavior","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12403222/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144706003","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"WeChat-based Messaging and Behavioral Counseling for Smoking Cessation for People with HIV in China: a Randomized Controlled Pilot Trial.","authors":"Jiegang Huang, Shanyin Yang, Zhiman Xie, Baodong Guo, Yingji Lan, Yanjun Li, Yuan Jiang, Leah S Forman, Karsten Lunze, Bingyu Liang, Abu S Abdullah, Li Ye, Hao Liang, Lisa M Quintiliani","doi":"10.1007/s10461-025-04823-7","DOIUrl":"https://doi.org/10.1007/s10461-025-04823-7","url":null,"abstract":"<p><p>Cigarette smoking among people with HIV is a leading preventable cause of morbidity and mortality, particularly in China given its immense burden of smoking. This pilot study aimed to evaluate the feasibility, acceptability, and efficacy on smoking cessation of a community-informed WeChat-based messaging and behavioral counseling intervention for people with HIV who smoke called Quit for Life. The study design was a 2-group randomized clinical trial. Data collection occurred between February 2022 and August 2023 within a tertiary infectious disease hospital in Nanning city, Guangxi, China. Participants included adults with HIV who smoked, were willing to set a quit date, and received HIV care at the hospital. Participants were randomized to the 8-week Quit for Life intervention group (nicotine replacement therapy gum, self-help quitting smoking guide, behavioral counseling, and WeChat-based messaging), or the control group (nicotine replacement therapy gum and self-help guide only). Complete case analysis was performed. Of 219 people assessed for eligibility, 109 participants were randomized (mean [SD] age, 45.3 [15.1] years; men [96.3%]) and 98 completed the 12-week assessment (89.9% retention rate). At 12-week follow-up, the biochemically verified smoking cessation rate (primary outcome) was significantly higher in the intervention group compared to the control group (59.1% abstinence vs. 25.6%, adjusted odds ratio 5.3 [1.5,19.2]. Implementation and feasibility metrics indicated most participants receiving the intervention as intended gave high ratings of the usefulness of counseling sessions and WeChat-based messaging. Given these findings, subsequent studies should investigate implementation and scale-up of this intervention for people with HIV in China.Clinical trial registration details: Trial registration number: ClinicalTrials.gov Identifier: NCT05020899. Date of trial registration: 8-19-2021.</p>","PeriodicalId":7543,"journal":{"name":"AIDS and Behavior","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144697376","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Strengthening HIV Activism Among Clinicians in Malaysia: A Randomised Controlled Trial.","authors":"Norman Chong, Iskandar Azwa, Asfarina Amir Hassan, Mohammad Mousavi, Pui Li Wong, Rong Xiang Ng, Rumana Saifi, Sazali Basri, Sharifah Faridah Syed Omar, Suzan M Walters, Zachary K Collier, Marwan S Haddad, Frederick L Altice, Adeeba Kamarulzaman, Valerie A Earnshaw","doi":"10.1007/s10461-025-04829-1","DOIUrl":"https://doi.org/10.1007/s10461-025-04829-1","url":null,"abstract":"<p><p>HIV continues to disproportionately affect key populations in Malaysia, compared to the general population. Lessons learned from decades of research and programmatic experience suggest that HIV activism can be a driver for change. We pilot-tested a tele-training platform, Project ECHO^® for Stigma Reduction (PE-SR), in a randomised controlled trial from July 2022 to March 2023, alongside two comparator groups, i.e., Project ECHO^®-Standard (PE-S) and the conventional HIV training program for clinicians, HIV Connect (HC). We randomised 78 primary care physicians and general practitioners across Malaysia into the three study arms (n = 26 each). We evaluated changes in HIV activist identity and commitment, and orientation towards day-to-day HIV activism and structural HIV activism. Repeated measure analysis of covariance (ANCOVA), controlling for age, years of practice, and contact with key populations as covariates, compared changes in HIV activism constructs across time and groups. The randomised controlled trial yielded mixed results. We observed statistically significant changes in HIV activist identity and commitment, as well as changes in orientation towards structural activism in all groups. We also found statistically significant mean differences between PE-S and HC in terms of HIV activist identity and commitment, and between PE-SR and HC in terms of orientation towards structural activism. Results suggest that stigma reduction tools embedded in a tele-training platform had a preliminary impact on HIV activism and could be scaled up and tailored to train clinician-activists.Trial Registration NCT05597787.</p>","PeriodicalId":7543,"journal":{"name":"AIDS and Behavior","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144681806","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}