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Article History

Received: 22 March 2025

Accepted: 7 July 2025

First Online: 22 August 2025

Declarations

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: Secondary ethics approval for this study was obtained from the South African Medical Research Council (SAMRC) Human Research Ethics Committee (HREC) (protocol: EC001-01/2023) and Stellenbosch University HREC (project: 31003). The study uses secondary data collected by SAPRIN, which received ethics approval from the SAMRC HREC (protocol EC010-3/2021) before conducting surveillances. In addition, separate ethical approvals were obtained for each HDSS surveillance site. The Agincourt surveillance site was approved by the University of Witwatersrand HREC (protocol: M190305), AHRI surveillance site was approved by the University of Kwazulu-Natal Biomedical Research Ethics Committee (protocol: BE290/16), and DIMAMO surveillance site was approved by the University of Limpopo Turfloop Research Ethics Committee (protocol: TREC/116/2018).Written informed consent was obtained from all participants during the primary data collection for SAPRIN and its HDSS sites. Participants consented to their anonymised data being shared for scientific analysis through the SAPRIN data repository. For minors aged 15–17 years, informed consent was obtained from parents or legal guardians, while adolescents provided assent []. However, adolescents aged 15–17 years who were married, parents, or living in child-headed households were considered emancipated minors and provided independent consent, in accordance with ethical guidelines. Additionally, informed consent and signed confidentiality agreements were obtained from participants for engagement with LEEs to ensure the protection of personal information.This research was conducted in accordance with the Declaration of Helsinki.

: Not applicable.

: The authors declare no competing interests.