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Article History

Received: 15 January 2025

Accepted: 3 July 2025

First Online: 28 July 2025

Declarations

:

: The study protocol, the informed consent form, and study-related documents were reviewed and approved by the Malawi National Health Sciences Research Ethics Committee (NHSRC) (Approval number #21/08/2758) and the University of North Carolina Institutional Review Board (UNC IRB) (Approval number LC 2122). Before beginning the study, approval was also sought from local authorities and the Lilongwe District Director of Health and Social Services. Informed consent was also obtained from all participants prior to their participation in the study. This study did not involve any experiments on humans or the use of human tissue samples. It involved interviews using in-depth interviews (IDIs) only. All procedures were conducted following relevant guidelines and regulations, including the Declaration of Helsinki, and ethical principles were adhered to throughout the study. The main study on which this sub-study was built is registered under ClinicalTrials.gov ID NCT04286243.

: This manuscript includes the personal details of participants. Explicit written consent for publication has been obtained from all participants to ensure compliance with BioMed Central policies. In cases where identifying information such as age, gender, and profession is presented alongside other details, care has been taken to limit the risk of compromising participant anonymity. Copies of consent forms will be made available upon request to verify compliance.

: The authors declare no competing interests.