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All data included in our analysis were aggregated, deidentified data extracted from routine project performance reports. These reports were prepared and used for routine program monitoring and improvement and are publicly available. No additional data were collected from clients beyond those for the routine programming reporting. Per Dominican Republic government guidelines, all program clients signed consent forms which covered data collection and the use of programmatic data for analytical purposes; these forms remain in their client files. Also, per government regulations, is not necessary to obtain parental consent for individuals ages 15 and older. At no point did the authors have access to individual-level data or personally identifiable information.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare no competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"1325"}}