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Article History

Received: 4 June 2024

Accepted: 5 March 2026

First Online: 18 April 2026

Declarations

:

: This study utilized secondary data collected from the previous STEP project, which was implemented starting in 2018. The initial ethics approval for that project was obtained from the University of South Carolina, covering the period from May 2017 to May 2018, during which data collection took place. The project received approval from different institutions due to the Principal Investigator (PI) shifting institutions during the project. Specifically, the project was reviewed and approved by the institutional review boards of the University of South Carolina (approval period: 5/16/2017 to 5/15/2018), the National Institute of Medical Research of Tanzania (NIMR/HQ/R.8c/Vol.I/1170, approval period: 29th June 2017 to 28th June 2018), and George Washington University in 2021. All respondents provided written informed consent prior to participation in the original study. All study procedures were performed in accordance with the ethical standards of the institutional and/or national research committees and the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. For our current study, which involves secondary analysis of this already collected data, we did not seek an extension of the original ethics approval. According to the guidelines of our institutional review boards and standard ethical practices, secondary data analysis does not typically require new, or extended ethics approval provided the data was collected ethically and anonymized appropriately, with no new data collection involving human subjects being undertaken.

: All authors provided consent to publish this paper.

: The authors declare no competing interests.