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Article History

Received: 21 December 2024

Accepted: 26 August 2025

First Online: 14 October 2025

Declarations

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: The original Population-based HIV Impact Assessment (PHIA) surveys from which data for this secondary analysis were derived received ethical approval from the Institutional Review Boards (IRB) of the United States Centers for Disease Control and Prevention (CDC) and Columbia University, as well as from the relevant national ethical review boards in each of the nine participating countries: Cameroon, Eswatini, Ethiopia, Malawi, Namibia, Rwanda, Tanzania, Zambia, and Zimbabwe. All methods performed in the original surveys and in this secondary analysis were in accordance with the ethical standards of the institutional and national research committees and with the 1964 Helsinki declaration and its later amendments.Informed consent was obtained from all participants, and from the parents or legal guardians of any participant under the age of 16, in the original PHIA surveys prior to any data or specimen collection. For this secondary analysis, the study population was restricted to adults aged 15 years and older. Therefore, while the original PHIA surveys obtained consent from parents or legal guardians for participants under the age of 16, this was not applicable to the specific dataset analyzed in our study. For this secondary analysis, the study population was restricted to adults aged 15 years and older. Therefore, while the original PHIA surveys obtained consent from parents or legal guardians for participants under the age of 16, this was not applicable to the specific dataset analyzed in our study.Permission to use the de-identified, anonymized datasets was granted by the International Center for AIDS Care and Treatment Programs (ICAP) at Columbia University. The datasets were accessed from the publicly available PHIA repository at . Additional ethical approval for the conduct of this specific study was obtained from the University of Zambia Research Ethics Committee (UNZABREC Ref. No. 4784–2023) and the Zambia National Health Research Authority (NHRA). As the study utilized pre-existing, anonymized secondary data, the requirement for additional informed consent was waived by these approving ethics committees.

: Not applicable. This manuscript does not contain any individual person’s data in any form (including any individual details, images, or videos). All data used in this secondary analysis were obtained from de-identified, anonymized datasets from the PHIA surveys. Therefore, no consent for publication from individuals was required for this study.

: The authors declare no competing interests.