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Article History

Received: 3 December 2024

Accepted: 29 July 2026

First Online: 1 August 2026

Declarations

Ethics approval and consent to participate: Ethical approval for the study was obtained from the Brighton and Sussex Medical School Research Governance and Ethics Committee in the UK (2nd August 2021, Ref Number ER/BSMS9E3G/9), the Institutional Review Board of the College of Arts and Social Sciences at University of Rwanda (29th June 2021) and to be able to conduct community outreach and household survey, we got an authorization permit from both the National Institute of Statistics of Rwanda (1st October 2021, Ref Number 0286/2021/10/NISR) and the study district mayors. Participants were informed of the goals of the research, and verbal or written informed consent was obtained. The participant information sheet (PIS) had been distributed by the CHW or HASA treatment centre a few days prior to the interview. Participants were also clearly informed of their right to withdraw from the study at any time without having to give a reason and without it having any adverse consequences for them. Participants were given the first author’s contact details, whom they could contact if they wished to withdraw their data after participation in the study. However, participants were told that they would not be able to withdraw their data from the particular component of the study once the data had been aggregated. We trained research assistants on how to identify signs of distress among participants. If a participant showed any signs of distress, the interview was discontinued immediately. If any participant seemed to be fatigued during an interview, they were invited to suspend the session and continue at a later time. We ensured that any participant needing follow-up, support, treatment or immediate assistance received this promptly according to local resources and capacities.

Consent for publication: Not applicable.

Competing interests: The authors declare no competing interests.