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Article History

Received: 2 June 2025

Accepted: 8 December 2025

First Online: 12 December 2025

Declarations

:

: The study obtained ethical approval from the Botswana Health Research and Development Division dated April 11, 2025 (reference number: HPDME 6/14/1) before the study was conducted. Permission was obtained from each study site. The was conducted in compliance with the principles of the declaration of Helsinki (last updated; October 2013) which is as a statement of ethical principles for medical research involving human participants, including research using identifiable human material or data.

: A waiver of informed consent was granted by the IRB for this study due to the retrospective nature of the analysis, which used de-identified patient data collected as part of routine clinical practice. The IRB determined that this research posed no more than minimal risk to patients and that the waiver would not adversely affect their rights or welfare. The research could not have been practically conducted without this waiver.

: All patient data were fully anonymized and aggregated before analysis to protect patient confidentiality. No personally identifiable information is included in this manuscript. The authors affirm that all steps were taken to ensure patient privacy and confidentiality throughout the study.

: The authors declare no competing interests.