Effectiveness and cost effectiveness of oral pre-exposure prophylaxis in a portfolio of prevention programs for injection drug users in mixed HIV epidemics
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{"title"=>"Effectiveness and cost effectiveness of oral pre-exposure prophylaxis in a portfolio of prevention programs for injection drug users in mixed HIV epidemics", "type"=>"journal", "authors"=>[{"first_name"=>"Sabina S.", "last_name"=>"Alistar", "scopus_author_id"=>"36522253600"}, {"first_name"=>"Douglas K.", "last_name"=>"Owens", "scopus_author_id"=>"7401547451"}, {"first_name"=>"Margaret L.", "last_name"=>"Brandeau", "scopus_author_id"=>"57192112298"}], "year"=>2014, "source"=>"PLoS ONE", "identifiers"=>{"issn"=>"19326203", "scopus"=>"2-s2.0-84900330910", "pui"=>"373059335", "doi"=>"10.1371/journal.pone.0086584", "isbn"=>"10.1371/journal.pone.0086584", "sgr"=>"84900330910", "pmid"=>"24489747"}, "id"=>"c20f810e-5e63-3db0-9b86-80d665806b22", "abstract"=>"BACKGROUND: Pre-exposure prophylaxis with oral antiretroviral treatment (oral PrEP) for HIV-uninfected injection drug users (IDUs) is potentially useful in controlling HIV epidemics with a significant injection drug use component. We estimated the effectiveness and cost effectiveness of strategies for using oral PrEP in various combinations with methadone maintenance treatment (MMT) and antiretroviral treatment (ART) in Ukraine, a representative case for mixed HIV epidemics.\\n\\nMETHODS AND FINDINGS: We developed a dynamic compartmental model of the HIV epidemic in a population of non-IDUs, IDUs who inject opiates, and IDUs in MMT, adding an oral PrEP program (tenofovir/emtricitabine, 49% susceptibility reduction) for uninfected IDUs. We analyzed intervention portfolios consisting of oral PrEP (25% or 50% of uninfected IDUs), MMT (25% of IDUs), and ART (80% of all eligible patients). We measured health care costs, quality-adjusted life years (QALYs), HIV prevalence, HIV infections averted, and incremental cost effectiveness. A combination of PrEP for 50% of IDUs and MMT lowered HIV prevalence the most in both IDUs and the general population. ART combined with MMT and PrEP (50% access) averted the most infections (14,267). For a PrEP cost of $950, the most cost-effective strategy was MMT, at $520/QALY gained versus no intervention. The next most cost-effective strategy consisted of MMT and ART, costing $1,000/QALY gained compared to MMT alone. Further adding PrEP (25% access) was also cost effective by World Health Organization standards, at $1,700/QALY gained. PrEP alone became as cost effective as MMT at a cost of $650, and cost saving at $370 or less.\\n\\nCONCLUSIONS: Oral PrEP for IDUs can be part of an effective and cost-effective strategy to control HIV in regions where injection drug use is a significant driver of the epidemic. Where budgets are limited, focusing on MMT and ART access should be the priority, unless PrEP has low cost.", "link"=>"http://www.mendeley.com/research/effectiveness-cost-effectiveness-oral-preexposure-prophylaxis-portfolio-prevention-programs-injectio-4", "reader_count"=>53, "reader_count_by_academic_status"=>{"Unspecified"=>4, "Professor > Associate Professor"=>1, "Librarian"=>1, "Researcher"=>5, "Student > Doctoral Student"=>1, "Student > Ph. D. Student"=>8, "Student > Postgraduate"=>3, "Student > Master"=>19, "Other"=>2, "Student > Bachelor"=>7, "Professor"=>1, "Lecturer"=>1}, "reader_count_by_user_role"=>{"Unspecified"=>4, "Professor > Associate Professor"=>1, "Librarian"=>1, "Researcher"=>5, "Student > Doctoral Student"=>1, "Student > Ph. D. Student"=>8, "Student > Postgraduate"=>3, "Student > Master"=>19, "Other"=>2, "Student > Bachelor"=>7, "Professor"=>1, "Lecturer"=>1}, "reader_count_by_subject_area"=>{"Unspecified"=>4, "Nursing and Health Professions"=>6, "Mathematics"=>2, "Medicine and Dentistry"=>20, "Agricultural and Biological Sciences"=>2, "Philosophy"=>1, "Arts and Humanities"=>1, "Pharmacology, Toxicology and Pharmaceutical Science"=>2, "Business, Management and Accounting"=>1, "Social Sciences"=>10, "Computer Science"=>2, "Economics, Econometrics and Finance"=>1, "Environmental Science"=>1}, "reader_count_by_subdiscipline"=>{"Medicine and Dentistry"=>{"Medicine and Dentistry"=>20}, "Social Sciences"=>{"Social Sciences"=>10}, "Mathematics"=>{"Mathematics"=>2}, "Unspecified"=>{"Unspecified"=>4}, "Pharmacology, Toxicology and Pharmaceutical Science"=>{"Pharmacology, Toxicology and Pharmaceutical Science"=>2}, "Environmental Science"=>{"Environmental Science"=>1}, "Arts and Humanities"=>{"Arts and Humanities"=>1}, "Economics, Econometrics and Finance"=>{"Economics, Econometrics and Finance"=>1}, "Agricultural and Biological Sciences"=>{"Agricultural and Biological Sciences"=>2}, "Computer Science"=>{"Computer Science"=>2}, "Nursing and Health Professions"=>{"Nursing and Health Professions"=>6}, "Business, Management and Accounting"=>{"Business, Management and Accounting"=>1}, "Philosophy"=>{"Philosophy"=>1}}, "reader_count_by_country"=>{"United States"=>2}, "group_count"=>9}

Scopus | Further Information

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Figshare

  • {"files"=>["https://ndownloader.figshare.com/files/1364751"], "description"=>"<p>Prevalence is shown for the status quo and alternative strategies of scaling up antiretroviral therapy (ART) to 80% of all eligible individuals, methadone maintenance treatment (MMT) for 25% of injection drug users (IDUs), and introducing oral pre-exposure prophylaxis (PrEP) for 25% or 50% of uninfected IDUs.</p>", "links"=>[], "tags"=>["epidemiology", "Infectious disease epidemiology", "Global health", "Infectious diseases", "Sexually transmitted diseases", "aids", "Viral diseases", "hiv", "HIV epidemiology", "HIV prevention", "Infectious disease control", "Infectious disease modeling", "Non-clinical medicine", "Health care policy", "Comparative effectiveness research", "Drug policy", "Health economics", "Cost effectiveness", "Public health", "prevalence", "20", "years"], "article_id"=>916734, "categories"=>["Medicine"], "users"=>["Sabina S. Alistar", "Douglas K. Owens", "Margaret L. Brandeau"], "doi"=>["https://dx.doi.org/10.1371/journal.pone.0086584.g001"], "stats"=>{"downloads"=>0, "page_views"=>0, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_HIV_prevalence_over_20_years_for_alternative_strategies_/916734", "title"=>"HIV prevalence over 20 years for alternative strategies.", "pos_in_sequence"=>0, "defined_type"=>1, "published_date"=>"2014-01-28 03:50:39"}
  • {"files"=>["https://ndownloader.figshare.com/files/1364752"], "description"=>"<p>Infections averted are shown for alternative strategies of scaling up antiretroviral therapy (ART) to 80% of all eligible individuals, methadone maintenance treatment (MMT) to 25% of injection drug users (IDUs), and introducing oral pre-exposure prophylaxis (PrEP) for 25% or 50% of uninfected IDUs.</p>", "links"=>[], "tags"=>["epidemiology", "Infectious disease epidemiology", "Global health", "Infectious diseases", "Sexually transmitted diseases", "aids", "Viral diseases", "hiv", "HIV epidemiology", "HIV prevention", "Infectious disease control", "Infectious disease modeling", "Non-clinical medicine", "Health care policy", "Comparative effectiveness research", "Drug policy", "Health economics", "Cost effectiveness", "Public health", "infections", "averted", "20", "years"], "article_id"=>916735, "categories"=>["Medicine"], "users"=>["Sabina S. Alistar", "Douglas K. Owens", "Margaret L. Brandeau"], "doi"=>["https://dx.doi.org/10.1371/journal.pone.0086584.g002"], "stats"=>{"downloads"=>0, "page_views"=>0, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_HIV_infections_averted_over_20_years_for_alternative_strategies_/916735", "title"=>"HIV infections averted over 20 years for alternative strategies.", "pos_in_sequence"=>0, "defined_type"=>1, "published_date"=>"2014-01-28 03:50:39"}
  • {"files"=>["https://ndownloader.figshare.com/files/1364754"], "description"=>"<p>Assumes annual PrEP cost of $950 (<a href=\"http://www.plosone.org/article/info:doi/10.1371/journal.pone.0086584#pone-0086584-g003\" target=\"_blank\">Figure 3a</a>) and $450 (<a href=\"http://www.plosone.org/article/info:doi/10.1371/journal.pone.0086584#pone-0086584-g003\" target=\"_blank\">Figure 3b</a>). PrEP = oral pre-exposure prophylaxis for injection drug users; ART = antiretroviral therapy for 80% of eligible individuals; MMT = methadone maintenance treatment for 25% of IDUs; 25% PrEP = PrEP for 25% of uninfected IDUs; 50% PrEP = PrEP for 50% of uninfected IDUs.</p>", "links"=>[], "tags"=>["epidemiology", "Infectious disease epidemiology", "Global health", "Infectious diseases", "Sexually transmitted diseases", "aids", "Viral diseases", "hiv", "HIV epidemiology", "HIV prevention", "Infectious disease control", "Infectious disease modeling", "Non-clinical medicine", "Health care policy", "Comparative effectiveness research", "Drug policy", "Health economics", "Cost effectiveness", "Public health"], "article_id"=>916737, "categories"=>["Medicine"], "users"=>["Sabina S. Alistar", "Douglas K. Owens", "Margaret L. Brandeau"], "doi"=>["https://dx.doi.org/10.1371/journal.pone.0086584.g003"], "stats"=>{"downloads"=>0, "page_views"=>0, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Cost_effectiveness_of_alternative_prevention_and_treatment_strategies_/916737", "title"=>"Cost effectiveness of alternative prevention and treatment strategies.", "pos_in_sequence"=>0, "defined_type"=>1, "published_date"=>"2014-01-28 03:50:39"}
  • {"files"=>["https://ndownloader.figshare.com/files/1364755"], "description"=>"<p>Effectiveness is measured as percentage reduction in chance of HIV infection acquisition. Assumes 25% of uninfected IDUs are enrolled in PrEP, in comparison to the status quo (no scale up of MMT or ART). Bottom line (triangles) shows minimum effectiveness for which PrEP would be considered highly cost effective (ICER = $7,400). Middle line (diamonds) shows minimum effectiveness for which PrEP would be as cost effective as MMT (ICER = $520). Top line (squares) shows minimum effectiveness for which PrEP would be cost saving (ICER = $0). PrEP = oral pre-exposure prophylaxis for injection drug users; ART = antiretroviral therapy; MMT = methadone maintenance therapy; ICER = incremental cost-effectiveness ratio.</p>", "links"=>[], "tags"=>["epidemiology", "Infectious disease epidemiology", "Global health", "Infectious diseases", "Sexually transmitted diseases", "aids", "Viral diseases", "hiv", "HIV epidemiology", "HIV prevention", "Infectious disease control", "Infectious disease modeling", "Non-clinical medicine", "Health care policy", "Comparative effectiveness research", "Drug policy", "Health economics", "Cost effectiveness", "Public health", "prep"], "article_id"=>916738, "categories"=>["Medicine"], "users"=>["Sabina S. Alistar", "Douglas K. Owens", "Margaret L. Brandeau"], "doi"=>["https://dx.doi.org/10.1371/journal.pone.0086584.g004"], "stats"=>{"downloads"=>0, "page_views"=>0, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Breakeven_effectiveness_for_PrEP_as_a_function_of_its_annual_cost_/916738", "title"=>"Breakeven effectiveness for PrEP as a function of its annual cost.", "pos_in_sequence"=>0, "defined_type"=>1, "published_date"=>"2014-01-28 03:50:39"}
  • {"files"=>["https://ndownloader.figshare.com/files/1364756"], "description"=>"<p>IDU = injection drug user, ART = antiretroviral therapy, MMT = methadone maintenance treatment, PrEP = pre-exposure prophylaxi.</p>", "links"=>[], "tags"=>["epidemiology", "Infectious disease epidemiology", "Global health", "Infectious diseases", "Sexually transmitted diseases", "aids", "Viral diseases", "hiv", "HIV epidemiology", "HIV prevention", "Infectious disease control", "Infectious disease modeling", "Non-clinical medicine", "Health care policy", "Comparative effectiveness research", "Drug policy", "Health economics", "Cost effectiveness", "Public health", "parameter"], "article_id"=>916739, "categories"=>["Medicine"], "users"=>["Sabina S. Alistar", "Douglas K. Owens", "Margaret L. Brandeau"], "doi"=>["https://dx.doi.org/10.1371/journal.pone.0086584.t001"], "stats"=>{"downloads"=>0, "page_views"=>0, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Key_parameter_values_ranges_and_sources_/916739", "title"=>"Key parameter values, ranges, and sources.", "pos_in_sequence"=>0, "defined_type"=>3, "published_date"=>"2014-01-28 03:50:39"}
  • {"files"=>["https://ndownloader.figshare.com/files/1364757"], "description"=>"*<p>The table presents undiscounted HIV infections averted, and discounted QALYs and costs (discounted to the present at 3% annually). IDU = injection drug user; PrEP = oral pre-exposure prophylaxis for injection drug users; ART = antiretroviral therapy for 80% of eligible individuals; MMT = methadone maintenance treatment for 25% of IDUs; 25% PrEP = PrEP for 25% of uninfected IDUs; 50% PrEP = PrEP for 50% of uninfected IDUs.</p>**<p>The numbers for similar strategies vary because of dynamics. For example, for the strategy “25% PrEP,” 13,686 IDUs receive PrEP, whereas for the strategy “ART, 25% PrEP,” 14,506 IDUs receive PrEP; this is because with scaled up ART, IDUs live longer, so 25% of IDUs on PrEP with ART scale up is greater than 25% of IDUs on PrEP without ART scale up.</p>***<p>Incremental to the status quo.</p>", "links"=>[], "tags"=>["epidemiology", "Infectious disease epidemiology", "Global health", "Infectious diseases", "Sexually transmitted diseases", "aids", "Viral diseases", "hiv", "HIV epidemiology", "HIV prevention", "Infectious disease control", "Infectious disease modeling", "Non-clinical medicine", "Health care policy", "Comparative effectiveness research", "Drug policy", "Health economics", "Cost effectiveness", "Public health"], "article_id"=>916740, "categories"=>["Medicine"], "users"=>["Sabina S. Alistar", "Douglas K. Owens", "Margaret L. Brandeau"], "doi"=>["https://dx.doi.org/10.1371/journal.pone.0086584.t002"], "stats"=>{"downloads"=>0, "page_views"=>0, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Base_case_results_/916740", "title"=>"Base case results.<sup>*</sup>", "pos_in_sequence"=>0, "defined_type"=>3, "published_date"=>"2014-01-28 03:50:39"}
  • {"files"=>["https://ndownloader.figshare.com/files/1364764"], "description"=>"<div><p>Background</p><p>Pre-exposure prophylaxis with oral antiretroviral treatment (oral PrEP) for HIV-uninfected injection drug users (IDUs) is potentially useful in controlling HIV epidemics with a significant injection drug use component. We estimated the effectiveness and cost effectiveness of strategies for using oral PrEP in various combinations with methadone maintenance treatment (MMT) and antiretroviral treatment (ART) in Ukraine, a representative case for mixed HIV epidemics.</p><p>Methods and Findings</p><p>We developed a dynamic compartmental model of the HIV epidemic in a population of non-IDUs, IDUs who inject opiates, and IDUs in MMT, adding an oral PrEP program (tenofovir/emtricitabine, 49% susceptibility reduction) for uninfected IDUs. We analyzed intervention portfolios consisting of oral PrEP (25% or 50% of uninfected IDUs), MMT (25% of IDUs), and ART (80% of all eligible patients). We measured health care costs, quality-adjusted life years (QALYs), HIV prevalence, HIV infections averted, and incremental cost effectiveness. A combination of PrEP for 50% of IDUs and MMT lowered HIV prevalence the most in both IDUs and the general population. ART combined with MMT and PrEP (50% access) averted the most infections (14,267). For a PrEP cost of $950, the most cost-effective strategy was MMT, at $520/QALY gained versus no intervention. The next most cost-effective strategy consisted of MMT and ART, costing $1,000/QALY gained compared to MMT alone. Further adding PrEP (25% access) was also cost effective by World Health Organization standards, at $1,700/QALY gained. PrEP alone became as cost effective as MMT at a cost of $650, and cost saving at $370 or less.</p><p>Conclusions</p><p>Oral PrEP for IDUs can be part of an effective and cost-effective strategy to control HIV in regions where injection drug use is a significant driver of the epidemic. Where budgets are limited, focusing on MMT and ART access should be the priority, unless PrEP has low cost.</p></div>", "links"=>[], "tags"=>["epidemiology", "Infectious disease epidemiology", "Global health", "Infectious diseases", "Sexually transmitted diseases", "aids", "Viral diseases", "hiv", "HIV epidemiology", "HIV prevention", "Infectious disease control", "Infectious disease modeling", "Non-clinical medicine", "Health care policy", "Comparative effectiveness research", "Drug policy", "Health economics", "Cost effectiveness", "Public health", "pre-exposure", "prophylaxis", "programs", "injection", "users"], "article_id"=>916742, "categories"=>["Medicine"], "users"=>["Sabina S. Alistar", "Douglas K. Owens", "Margaret L. Brandeau"], "doi"=>["https://dx.doi.org/10.1371/journal.pone.0086584"], "stats"=>{"downloads"=>0, "page_views"=>0, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Effectiveness_and_Cost_Effectiveness_of_Oral_Pre_Exposure_Prophylaxis_in_a_Portfolio_of_Prevention_Programs_for_Injection_Drug_Users_in_Mixed_HIV_Epidemics_/916742", "title"=>"Effectiveness and Cost Effectiveness of Oral Pre-Exposure Prophylaxis in a Portfolio of Prevention Programs for Injection Drug Users in Mixed HIV Epidemics", "pos_in_sequence"=>0, "defined_type"=>3, "published_date"=>"2014-01-28 03:50:39"}

PMC Usage Stats | Further Information

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  • {"unique-ip"=>"14", "full-text"=>"10", "pdf"=>"9", "abstract"=>"0", "scanned-summary"=>"0", "scanned-page-browse"=>"0", "figure"=>"0", "supp-data"=>"1", "cited-by"=>"0", "year"=>"2016", "month"=>"10"}
  • {"unique-ip"=>"9", "full-text"=>"9", "pdf"=>"4", "abstract"=>"0", "scanned-summary"=>"0", "scanned-page-browse"=>"0", "figure"=>"2", "supp-data"=>"0", "cited-by"=>"0", "year"=>"2016", "month"=>"11"}
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  • {"unique-ip"=>"12", "full-text"=>"29", "pdf"=>"1", "abstract"=>"0", "scanned-summary"=>"0", "scanned-page-browse"=>"0", "figure"=>"2", "supp-data"=>"0", "cited-by"=>"0", "year"=>"2017", "month"=>"2"}
  • {"unique-ip"=>"15", "full-text"=>"37", "pdf"=>"3", "abstract"=>"0", "scanned-summary"=>"0", "scanned-page-browse"=>"0", "figure"=>"0", "supp-data"=>"0", "cited-by"=>"0", "year"=>"2017", "month"=>"3"}
  • {"unique-ip"=>"13", "full-text"=>"36", "pdf"=>"4", "abstract"=>"0", "scanned-summary"=>"0", "scanned-page-browse"=>"0", "figure"=>"2", "supp-data"=>"0", "cited-by"=>"0", "year"=>"2017", "month"=>"4"}
  • {"unique-ip"=>"16", "full-text"=>"41", "pdf"=>"2", "abstract"=>"0", "scanned-summary"=>"0", "scanned-page-browse"=>"0", "figure"=>"3", "supp-data"=>"0", "cited-by"=>"0", "year"=>"2017", "month"=>"5"}
  • {"unique-ip"=>"6", "full-text"=>"36", "pdf"=>"3", "abstract"=>"0", "scanned-summary"=>"0", "scanned-page-browse"=>"0", "figure"=>"0", "supp-data"=>"0", "cited-by"=>"0", "year"=>"2017", "month"=>"6"}
  • {"unique-ip"=>"19", "full-text"=>"35", "pdf"=>"9", "abstract"=>"0", "scanned-summary"=>"0", "scanned-page-browse"=>"0", "figure"=>"1", "supp-data"=>"0", "cited-by"=>"0", "year"=>"2017", "month"=>"7"}
  • {"unique-ip"=>"18", "full-text"=>"21", "pdf"=>"8", "abstract"=>"0", "scanned-summary"=>"0", "scanned-page-browse"=>"0", "figure"=>"0", "supp-data"=>"0", "cited-by"=>"0", "year"=>"2017", "month"=>"8"}
  • {"unique-ip"=>"11", "full-text"=>"11", "pdf"=>"4", "abstract"=>"0", "scanned-summary"=>"0", "scanned-page-browse"=>"0", "figure"=>"5", "supp-data"=>"0", "cited-by"=>"0", "year"=>"2017", "month"=>"9"}
  • {"unique-ip"=>"7", "full-text"=>"8", "pdf"=>"3", "abstract"=>"0", "scanned-summary"=>"0", "scanned-page-browse"=>"0", "figure"=>"0", "supp-data"=>"0", "cited-by"=>"0", "year"=>"2017", "month"=>"10"}
  • {"unique-ip"=>"11", "full-text"=>"9", "pdf"=>"5", "abstract"=>"0", "scanned-summary"=>"0", "scanned-page-browse"=>"0", "figure"=>"0", "supp-data"=>"0", "cited-by"=>"0", "year"=>"2017", "month"=>"11"}
  • {"unique-ip"=>"6", "full-text"=>"8", "pdf"=>"3", "abstract"=>"0", "scanned-summary"=>"0", "scanned-page-browse"=>"0", "figure"=>"0", "supp-data"=>"0", "cited-by"=>"0", "year"=>"2017", "month"=>"12"}
  • {"unique-ip"=>"10", "full-text"=>"10", "pdf"=>"5", "abstract"=>"0", "scanned-summary"=>"0", "scanned-page-browse"=>"0", "figure"=>"0", "supp-data"=>"0", "cited-by"=>"1", "year"=>"2018", "month"=>"1"}
  • {"unique-ip"=>"19", "full-text"=>"15", "pdf"=>"10", "abstract"=>"0", "scanned-summary"=>"0", "scanned-page-browse"=>"0", "figure"=>"3", "supp-data"=>"0", "cited-by"=>"0", "year"=>"2018", "month"=>"3"}
  • {"unique-ip"=>"7", "full-text"=>"10", "pdf"=>"2", "scanned-summary"=>"0", "scanned-page-browse"=>"0", "figure"=>"0", "supp-data"=>"0", "cited-by"=>"0", "year"=>"2019", "month"=>"1"}
  • {"unique-ip"=>"10", "full-text"=>"9", "pdf"=>"5", "scanned-summary"=>"0", "scanned-page-browse"=>"0", "figure"=>"0", "supp-data"=>"0", "cited-by"=>"0", "year"=>"2018", "month"=>"12"}
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  • {"unique-ip"=>"7", "full-text"=>"7", "pdf"=>"2", "scanned-summary"=>"0", "scanned-page-browse"=>"0", "figure"=>"0", "supp-data"=>"2", "cited-by"=>"1", "year"=>"2018", "month"=>"7"}
  • {"unique-ip"=>"8", "full-text"=>"6", "pdf"=>"2", "scanned-summary"=>"0", "scanned-page-browse"=>"0", "figure"=>"0", "supp-data"=>"1", "cited-by"=>"0", "year"=>"2018", "month"=>"8"}
  • {"unique-ip"=>"7", "full-text"=>"9", "pdf"=>"2", "scanned-summary"=>"0", "scanned-page-browse"=>"0", "figure"=>"0", "supp-data"=>"0", "cited-by"=>"0", "year"=>"2018", "month"=>"10"}
  • {"unique-ip"=>"5", "full-text"=>"5", "pdf"=>"2", "scanned-summary"=>"0", "scanned-page-browse"=>"0", "figure"=>"0", "supp-data"=>"2", "cited-by"=>"0", "year"=>"2018", "month"=>"11"}
  • {"unique-ip"=>"6", "full-text"=>"5", "pdf"=>"3", "scanned-summary"=>"0", "scanned-page-browse"=>"0", "figure"=>"0", "supp-data"=>"0", "cited-by"=>"0", "year"=>"2018", "month"=>"9"}
  • {"unique-ip"=>"8", "full-text"=>"9", "pdf"=>"2", "scanned-summary"=>"0", "scanned-page-browse"=>"0", "figure"=>"0", "supp-data"=>"0", "cited-by"=>"0", "year"=>"2019", "month"=>"2"}
  • {"unique-ip"=>"19", "full-text"=>"19", "pdf"=>"12", "scanned-summary"=>"0", "scanned-page-browse"=>"0", "figure"=>"0", "supp-data"=>"2", "cited-by"=>"0", "year"=>"2019", "month"=>"3"}
  • {"unique-ip"=>"5", "full-text"=>"6", "pdf"=>"1", "scanned-summary"=>"0", "scanned-page-browse"=>"0", "figure"=>"0", "supp-data"=>"0", "cited-by"=>"0", "year"=>"2019", "month"=>"4"}
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Relative Metric

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