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Article History

Received: 29 January 2020

Accepted: 5 May 2020

First Online: 25 May 2020

Ethics approval and consent to participate

: All DHS and data collection procedures were approved by the ICF Institutional Review Board (IRB), as well as in the country of research. In Zimbabwe, the survey protocol and biomarker collection including HIV testing procedures were reviewed and approved by the Medical Research Council of Zimbabwe (MRCZ), the Institutional Review Board of ICF International, and the Centers for Disease Control and Prevention (CDC) in Atlanta. In Malawi, the survey protocol, including biomarker collection and HIV testing procedures were reviewed and approved by the National Health Sciences Research Committee in Malawi and the ICF Institutional Review Board. Participation was voluntary, and all individuals provided verbal informed consent according to approved survey protocols. This article features a secondary analysis of publicly available DHS data which does not require further ethics approval. Details on ethical procedures are provided in the annexes to DHS reports and on the DHS website: .

: Individual-level data not presented. Not applicable.

: The authors have no competing interests. The contents in this article are those of the authors and do not necessarily reflect the view of the World Health Organization or the U.S. President’s Emergency Plan for AIDS Relief, the U.S. Agency for International Development or the U.S. Government.