{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T21:59:47Z","timestamp":1790805587856,"version":"4.1.0"},"reference-count":35,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2020,5,25]],"date-time":"2020-05-25T00:00:00Z","timestamp":1590364800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2020,5,25]],"date-time":"2020-05-25T00:00:00Z","timestamp":1590364800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/100010269","name":"Wellcome Trust","doi-asserted-by":"publisher","award":["206575\/Z\/17\/Z"],"award-info":[{"award-number":["206575\/Z\/17\/Z"]}],"id":[{"id":"10.13039\/100010269","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100004440","name":"Wellcome Trust","doi-asserted-by":"publisher","award":["WT091769"],"award-info":[{"award-number":["WT091769"]}],"id":[{"id":"10.13039\/100004440","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Unitaid","award":["NCT02718274"],"award-info":[{"award-number":["NCT02718274"]}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["BMC Public Health"],"published-print":{"date-parts":[[2020,12]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Many southern African countries are nearing the global goal of diagnosing 90% of people with HIV by 2020. In 2016, 84 and 86% of people with HIV knew their status in Malawi and Zimbabwe, respectively. However, gaps remain, particularly among men. We investigated awareness and use of, and willingness to self-test for HIV and explored sociodemographic associations before large-scale implementation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We pooled responses from two of the first cross-sectional Demographic and Health Surveys to include HIV self-testing (HIVST) questions in Malawi and Zimbabwe in 2015\u201316. We investigated sociodemographic factors and sexual risk behaviours associated with previously testing for HIV, and past use, awareness of, and future willingness to self-test using univariable and multivariable logistic regression, adjusting for the sample design and limiting analysis to participants with a completed questionnaire and valid HIV test result. We restricted analysis of willingness to self-test to Zimbabwean men, as women and Malawians were not systematically asked this question.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Of 31,385 individuals, 31.2% of men had never tested compared with 16.5% of women (\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0&lt;\u20090.001). For men, the likelihood of having ever tested increased with age. Past use and awareness of HIVST was very low, 1.2 and 12.6%, respectively. Awareness was lower among women than men (9.1% vs 15.3%, adjusted odds ratio [aOR]\u2009=\u20091.55; 95% confidence interval [CI]: 1.37\u20131.75), and at younger ages, and lower education and literacy levels. Willingness to self-test among Zimbabwean men was high (84.5%), with greater willingness associated with having previously tested for HIV, being at high sexual risk (highest willingness [aOR\u2009=\u20093.74; 95%CI: 1.39\u201310.03,\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0&lt;\u20090.009]), and being \u226525\u2009years old. Wealthier men had greater awareness of HIVST than poorer men (\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0&lt;\u20090.001). The highest willingness to self-test (aOR\u2009=\u20093.74; 95%CI: 1.39\u201310.03,\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0&lt;\u20090.009) was among men at high HIV-related sexual risk.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>In 2015\u201316, many Malawian and Zimbabwean men had never tested for HIV. Despite low awareness and minimal HIVST experience, willingness to self-test was high among Zimbabwean men, especially older men with moderate-to-high HIV-related sexual risk. These data provide a valuable baseline against which to investigate population-level uptake of HIVST as programmes scale up. Programmes introducing, or planning to introduce, HIVST should consider including relevant questions in population-based surveys.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s12889-020-08855-7","type":"journal-article","created":{"date-parts":[[2020,5,25]],"date-time":"2020-05-25T10:02:58Z","timestamp":1590400978000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":37,"title":["Use and awareness of and willingness to self-test for HIV: an analysis of cross-sectional population-based surveys in Malawi and Zimbabwe"],"prefix":"10.1186","volume":"20","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5499-5523","authenticated-orcid":false,"given":"Cheryl","family":"Johnson","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Melissa","family":"Neuman","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter","family":"MacPherson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Augustine","family":"Choko","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Caitlin","family":"Quinn","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vincent J.","family":"Wong","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karin","family":"Hatzold","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rose","family":"Nyrienda","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Getrude","family":"Ncube","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rachel","family":"Baggaley","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fern","family":"Terris-Prestholt","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elizabeth L.","family":"Corbett","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2020,5,25]]},"reference":[{"key":"8855_CR1","volume-title":"Communities at the Centre","author":"UNAIDS","year":"2019","unstructured":"UNAIDS. Communities at the Centre. Geneva: Joint United Nations Programme on HIV\/AIDS; 2019."},{"key":"8855_CR2","volume-title":"Consolidated guidelines on HIV testing services","author":"WHO","year":"2019","unstructured":"WHO. Consolidated guidelines on HIV testing services. Geneva: World Health Organization; 2019."},{"issue":"7","key":"8855_CR3","doi-asserted-by":"publisher","first-page":"e25325","DOI":"10.1002\/jia2.25325","volume":"22","author":"AN Phillips","year":"2019","unstructured":"Phillips AN, Cambiano V, Nakagawa F, Bansi-Matharu L, Wilson D, Jani I, et al. Cost-per-diagnosis as a metric for monitoring cost-effectiveness of HIV testing programmes in low-income settings in southern Africa: health economic and modelling analysis. J Int AIDS Soc. 2019;22(7):e25325.","journal-title":"J Int AIDS Soc"},{"issue":"10","key":"8855_CR4","doi-asserted-by":"publisher","first-page":"e25398","DOI":"10.1002\/jia2.25398","volume":"22","author":"C Quinn","year":"2019","unstructured":"Quinn C, Kadengye DT, Johnson CC, Baggaley R, Dalal S. Who are the missing men? Characterising men who never tested for HIV from population-based surveys in six sub-Saharan African countries. J Int AIDS Soc. 2019;22(10):e25398.","journal-title":"J Int AIDS Soc"},{"issue":"1","key":"8855_CR5","doi-asserted-by":"publisher","first-page":"1679472","DOI":"10.1080\/16549716.2019.1679472","volume":"12","author":"ML Chihana","year":"2019","unstructured":"Chihana ML, Huerga H, Van Cutsem G, Ellman T, Goemaere E, Wanjala S, et al. Distribution of advanced HIV disease from three high HIV prevalence settings in sub-Saharan Africa: a secondary analysis data from three population-based cross-sectional surveys in Eshowe (South Africa), Ndhiwa (Kenya) and Chiradzulu (Malawi). Glob Health Action. 2019;12(1):1679472.","journal-title":"Glob Health Action"},{"issue":"9879","key":"8855_CR6","doi-asserted-by":"publisher","first-page":"1783","DOI":"10.1016\/S0140-6736(13)60253-6","volume":"381","author":"S Hawkes","year":"2013","unstructured":"Hawkes S, Buse K. Gender and global health: evidence, policy, and inconvenient truths. Lancet. 2013;381(9879):1783\u20137.","journal-title":"Lancet."},{"issue":"8","key":"8855_CR7","doi-asserted-by":"publisher","first-page":"618","DOI":"10.2471\/BLT.13.132795","volume":"92","author":"P Baker","year":"2014","unstructured":"Baker P, Dworkin SL, Tong S, Banks I, Shand T, Yamey G. The men's health gap: men must be included in the global health equity agenda. Bull World Health Organ. 2014;92(8):618\u201320.","journal-title":"Bull World Health Organ"},{"issue":"1","key":"8855_CR8","doi-asserted-by":"publisher","first-page":"21594","DOI":"10.7448\/IAS.20.1.21594","volume":"20","author":"CC Johnson","year":"2017","unstructured":"Johnson CC, Kennedy C, Fonner V, Siegfried N, Figueroa C, Dalal S, et al. Examining the effects of HIV self-testing compared to standard HIV testing services: a systematic review and meta-analysis. J Int AIDS Soc. 2017;20(1):21594.","journal-title":"J Int AIDS Soc"},{"key":"8855_CR9","unstructured":"Jamil M, Wilson I, Witzel C, Figueroa C, Barr-Dichiara M, Rodgers A, et al. Should HIV self-testing be offered as an HIV testing approach? ICASA; 2\u20137 December 2019; Kigali, Rwanda. Abstract: THPEC104, https:\/\/www.professionalabstracts.com\/icasa2019\/iplanner\/#\/presentation\/2504. Accessed 16 May 2020."},{"issue":"Suppl 1","key":"8855_CR10","doi-asserted-by":"publisher","first-page":"e25244","DOI":"10.1002\/jia2.25244","volume":"22","author":"K Hatzold","year":"2019","unstructured":"Hatzold K, Gudukeya S, Mutseta M, Chilongosi R, Nalubamba M, Nkhoma C, et al. HIV self-testing: breaking the barriers to uptake of testing among men and adolescents in sub-Saharan Africa, experiences from STAR demonstration projects in Malawi, Zambia and Zimbabwe. J Int AIDS Soc. 2019;22(Suppl 1):e25244.","journal-title":"J Int AIDS Soc"},{"key":"8855_CR11","unstructured":"UNAIDS. UNAIDS laws and policies Geneva: Joint United Nations Programme on HIV\/AIDS and World Health Organization; 2019. Available from: http:\/\/lawsandpolicies.unaids.org\/. Accessed 2020 3 Jan."},{"key":"8855_CR12","volume-title":"WHO HIV self-testing need and demand forecast, 2019\u20132025","author":"WHO","year":"2019","unstructured":"WHO. WHO HIV self-testing need and demand forecast, 2019\u20132025. Geneva: World Health Organization; 2019."},{"issue":"10","key":"8855_CR13","doi-asserted-by":"publisher","first-page":"e1001102","DOI":"10.1371\/journal.pmed.1001102","volume":"8","author":"AT Choko","year":"2011","unstructured":"Choko AT, Desmond N, Webb EL, Chavula K, Napierala-Mavedzenge S, Gaydos CA, et al. The uptake and accuracy of oral kits for HIV self-testing in high HIV prevalence setting: a cross-sectional feasibility study in Blantyre, Malawi. PLoS Med. 2011;8(10):e1001102.","journal-title":"PLoS Med"},{"key":"8855_CR14","unstructured":"Mavengere Y, Sibanda E, Hatzold K, Cowan F, Mugurungi O, Mavedzenge S. Can \u2018late-read\u2019 of self-test devices be used as a quality assurance measure?: results of a pilot HIV self-test project in Zimbabwe. 21st International AIDS conference; 18\u201322 July 2016; Durban, South Africa. Abstract: TUPEE636; http:\/\/programme.aids2016.org\/Abstract\/Abstract\/4171. Accessed 16 May 2020."},{"issue":"1","key":"8855_CR15","doi-asserted-by":"publisher","first-page":"1234","DOI":"10.1186\/s12889-018-6120-3","volume":"18","author":"M Neuman","year":"2018","unstructured":"Neuman M, Indravudh P, Chilongosi R, d'Elb\u00e9e M, Desmond N, Fielding K, et al. The effectiveness and cost-effectiveness of community-based lay distribution of HIV self-tests in increasing uptake of HIV testing among adults in rural Malawi and rural and peri-urban Zambia: protocol for STAR (self-testing for Africa) cluster randomized evaluations. BMC Public Health. 2018;18(1):1234.","journal-title":"BMC Public Health"},{"issue":"1","key":"8855_CR16","doi-asserted-by":"publisher","first-page":"e1002719","DOI":"10.1371\/journal.pmed.1002719","volume":"2019","author":"AT Choko","year":"2019","unstructured":"Choko AT, Corbett EL, Stallard N, Maheswaran H, Lepine A, Johnson CC, et al. HIV self-testing alone or with additional interventions, including financial incentives, and linkage to care or prevention among male partners of antenatal care clinic attendees in Malawi: an adaptive multi-arm, multi-stage cluster randomised trial. PLoS Med. 2019;2019(1):e1002719.","journal-title":"PLoS Med"},{"issue":"9","key":"8855_CR17","doi-asserted-by":"publisher","first-page":"e1001873","DOI":"10.1371\/journal.pmed.1001873","volume":"12","author":"AT Choko","year":"2015","unstructured":"Choko AT, MacPherson P, Webb EL, Willey BA, Feasy H, Sambakunsi R, et al. Uptake, accuracy, safety, and linkage into care over two years of promoting annual self-testing for HIV in Blantyre, Malawi: a community-based prospective study. PLoS Med. 2015;12(9):e1001873.","journal-title":"PLoS Med"},{"key":"8855_CR18","unstructured":"Sibanda E, Neuman M, Tumushime M, Hatzold K, Watadzaushe C, Mutseta M, et al. Linkage to care after HIV self-testing in Zimbabwe: a cluster-randomised trial. Conference on opportunistic infections and retroviruses; 3\u20136 Mar 2018; Boston, USA."},{"key":"8855_CR19","unstructured":"Indravudh P, Fielding K, Kumwenda M, Nzawa R, Chilongosi R, Desmond N, et al. Community-led delivery of HIV self-testing targeting adolescents and men in rural Malawi: a cluster-randomised trial. 10th International AIDS society conference; 21\u201324 July 2019; Mexico City, Mexico. Abstract: MOSY0105LB; http:\/\/programme.ias2019.org\/Abstract\/Abstract\/4874. Accessed 16 May 2020."},{"issue":"Suppl 1","key":"8855_CR20","doi-asserted-by":"publisher","first-page":"e25243","DOI":"10.1002\/jia2.25243","volume":"22","author":"V Cambiano","year":"2019","unstructured":"Cambiano V, Johnson CC, Hatzold K, Terris-Prestholt F, Maheswaran H, Thirumurthy H, et al. The impact and cost-effectiveness of community-based HIV self-testing in sub-Saharan Africa: a health economic and modelling analysis. J Int AIDS Soc. 2019;22(Suppl 1):e25243.","journal-title":"J Int AIDS Soc"},{"issue":"1","key":"8855_CR21","doi-asserted-by":"publisher","first-page":"12621","DOI":"10.1038\/s41598-019-49109-w","volume":"9","author":"LF Johnson","year":"2019","unstructured":"Johnson LF, van Rensburg C, Govathson C, Meyer-Rath G. Optimal HIV testing strategies for South Africa: a model-based evaluation of population-level impact and cost-effectiveness. Sci Rep. 2019;9(1):12621.","journal-title":"Sci Rep"},{"key":"8855_CR22","volume-title":"Malawi Demographic and Health Survey 2015\u201316","author":"NOS and ICF","year":"2017","unstructured":"NOS and ICF. Malawi Demographic and Health Survey 2015\u201316. Zomba, Malawi: National Statistical Office and ICF; 2017."},{"key":"8855_CR23","unstructured":"Zimbabwe National Statistics Agency and ICF International. Zimbabwe Demographic and Health Survey 2015. Final report. Zimbabwe National Statistics Agency and ICF International: Rockville, Maryland, USA; 2016."},{"key":"8855_CR24","doi-asserted-by":"publisher","first-page":"331","DOI":"10.2147\/CLEP.S129728","volume":"9","author":"P Corrani","year":"2017","unstructured":"Corrani P, Olsen M, Pedersen L, Dekkers O, Vandenbroucke J. Effect modification, interaction and mediation: an overview of theoretical insights of clinical investigators. Clin Epidemiol. 2017;9:331\u20138.","journal-title":"Clin Epidemiol"},{"key":"8855_CR25","unstructured":"Gigu\u00e8re K, Eaton J, Marsh K, Stannah J, Maheu-Giroux M. \u201cFirst 90\u201d estimates: where are the gaps? ICASA; 2\u20137 Dec 2019; Kigali, Rwanda."},{"key":"8855_CR26","volume-title":"UNAIDS estimates, average age of people living with HIV","author":"UNAIDS","year":"2019","unstructured":"UNAIDS. UNAIDS estimates, average age of people living with HIV. Geneva: Joint United Nations Programme on HIV\/AIDS; 2019."},{"key":"8855_CR27","unstructured":"Offorjebe O, Shaba F, Balakasi K, Nyrienda M, Hoffman R, Dovel K, et al. Partner-delivered HIV self-testing increases the perceived acceptability of index partner testing among HIV-positive clients in Malawi. 22nd International AIDS Conference; 23\u201327 July 2018; Amsterdam, Netherlands. Abstract: WEPEE683; http:\/\/programme.aids2018.org\/Abstract\/Abstract\/5275. Accessed 16 May 2020."},{"issue":"2","key":"8855_CR28","doi-asserted-by":"publisher","first-page":"e276","DOI":"10.1016\/S2214-109X(19)30534-0","volume":"8","author":"K Dovel","year":"2020","unstructured":"Dovel K, Shaba F, Offorjebe OA, Balakasi K, Nyirenda M, Phiri K, et al. Effect of facility-based HIV self-testing on uptake of testing among outpatients in Malawi: a cluster-randomised trial. Lancet Glob Health. 2020;8(2):e276\u2013e87.","journal-title":"Lancet Glob Health"},{"key":"8855_CR29","volume-title":"HIV self-testing at the workplace","author":"WHO and ILO","year":"2018","unstructured":"WHO and ILO. HIV self-testing at the workplace. Geneva: International Labour Organization; World Health Organization; 2018."},{"issue":"Suppl 1","key":"8855_CR30","doi-asserted-by":"publisher","DOI":"10.1002\/jia2.25256","volume":"22","author":"V Wong","year":"2019","unstructured":"Wong V, Jenkins E, Ford N, Ingold H. To thine own test be true: HIV self-testing and the global reach for the undiagnosed. J Int AIDS Soc. 2019;22(Suppl 1):e25256.","journal-title":"J Int AIDS Soc"},{"key":"8855_CR31","unstructured":"Indravudh P, Fielding K, Neuman M, Chilongosi R, Mkandawire P, Nyondo E, et al. Increasing knowledge of HIV status and demand for antiretroviral therapy using community-based HIV self-testing in rural communities: a cluster randomised trial in Malawi. 22nd International AIDS conference; 25\u201327 July 2018; Amsterdam, Netherlands. Abstract: THPDC0103; http:\/\/programme.aids2018.org\/Abstract\/Abstract\/7310. Accessed 16 May 2020."},{"key":"8855_CR32","volume-title":"Landscape for HIV rapid diagnostic tests for HIV self-testing","author":"WHO and Unitaid","year":"2015","unstructured":"WHO and Unitaid. Landscape for HIV rapid diagnostic tests for HIV self-testing. Geneva: Unitaid and World Health Organization; 2015."},{"issue":"2","key":"8855_CR33","doi-asserted-by":"publisher","first-page":"303","DOI":"10.1086\/209351","volume":"20","author":"R Fisher","year":"1993","unstructured":"Fisher R. Social desirability bias and the validity of indirect questioning. J Consum Res. 1993;20(2):303\u201315.","journal-title":"J Consum Res"},{"issue":"1","key":"8855_CR34","doi-asserted-by":"publisher","first-page":"1553470","DOI":"10.1080\/16549716.2018.1553470","volume":"11","author":"CT Rentsch","year":"2018","unstructured":"Rentsch CT, Reniers G, Machemba R, Slaymaker E, Marston M, Wringe A, et al. Non-disclosure of HIV testing history in population-based surveys: implications for estimating a UNAIDS 90-90-90 target. Glob Health Action. 2018;11(1):1553470.","journal-title":"Glob Health Action"},{"issue":"Suppl 2","key":"8855_CR35","first-page":"ii13","volume":"80","author":"E Slaymaker","year":"2004","unstructured":"Slaymaker E. A critique of international indicators of sexual risk behaviour. Sex Transm Infect. 2004;80(Suppl 2):ii13\u201321.","journal-title":"Sex Transm Infect"}],"container-title":["BMC Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12889-020-08855-7.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s12889-020-08855-7\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12889-020-08855-7.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,5,24]],"date-time":"2021-05-24T19:08:12Z","timestamp":1621883292000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmcpublichealth.biomedcentral.com\/articles\/10.1186\/s12889-020-08855-7"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,5,25]]},"references-count":35,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2020,12]]}},"alternative-id":["8855"],"URL":"https:\/\/doi.org\/10.1186\/s12889-020-08855-7","relation":{"has-preprint":[{"id-type":"doi","id":"10.21203\/rs.3.rs-15570\/v1","asserted-by":"object"},{"id-type":"doi","id":"10.21203\/rs.3.rs-15570\/v2","asserted-by":"object"}]},"ISSN":["1471-2458"],"issn-type":[{"value":"1471-2458","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,5,25]]},"assertion":[{"value":"29 January 2020","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"5 May 2020","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"25 May 2020","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"All DHS and data collection procedures were approved by the ICF Institutional Review Board (IRB), as well as in the country of research. In Zimbabwe, the survey protocol and biomarker collection including HIV testing procedures were reviewed and approved by the Medical Research Council of Zimbabwe (MRCZ), the Institutional Review Board of ICF International, and the Centers for Disease Control and Prevention (CDC) in Atlanta. In Malawi, the survey protocol, including biomarker collection and HIV testing procedures were reviewed and approved by the National Health Sciences Research Committee in Malawi and the ICF Institutional Review Board. Participation was voluntary, and all individuals provided verbal informed consent according to approved survey protocols. This article features a secondary analysis of publicly available DHS data which does not require further ethics approval. Details on ethical procedures are provided in the annexes to DHS reports and on the DHS website:\n                      \n                      .","order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Individual-level data not presented. Not applicable.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors have no competing interests. The contents in this article are those of the authors and do not necessarily reflect the view of the World Health Organization or the U.S. President\u2019s Emergency Plan for AIDS Relief, the U.S. Agency for International Development or the U.S. Government.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"779"}}