{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,29]],"date-time":"2026-05-29T12:07:40Z","timestamp":1780056460013,"version":"3.54.0"},"reference-count":74,"publisher":"Public Library of Science (PLoS)","issue":"12","license":[{"start":{"date-parts":[[2021,12,21]],"date-time":"2021-12-21T00:00:00Z","timestamp":1640044800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000308","name":"Carnegie Corporation of New York","doi-asserted-by":"publisher","award":["B 8606.R02"],"award-info":[{"award-number":["B 8606.R02"]}],"id":[{"id":"10.13039\/100000308","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100004441","name":"Swedish International Development Cooperation Agency","doi-asserted-by":"crossref","award":["54100113"],"award-info":[{"award-number":["54100113"]}],"id":[{"id":"10.13039\/100004441","id-type":"DOI","asserted-by":"crossref"}]},{"name":"Developing Excellence in Leadership, Training and Science","award":["107768\/Z\/15\/Z"],"award-info":[{"award-number":["107768\/Z\/15\/Z"]}]},{"DOI":"10.13039\/501100001829","name":"Utrecht University","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100001829","id-type":"DOI","asserted-by":"crossref"}]},{"name":"National Heart, Lung, And Blood Institute of the National Institutes of Health","award":["UG3HL156388"],"award-info":[{"award-number":["UG3HL156388"]}]},{"name":"National Heart, Lung, And Blood Institute of the National Institutes of Health","award":["UG3HL156388"],"award-info":[{"award-number":["UG3HL156388"]}]},{"name":"Deutscher Akademischer Austauschdienst"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:p>Multiple factors make adherence to antiretroviral therapy (ART) a complex process. This study aims to describe the barriers and facilitators to adherence for patients receiving first-line and second-line ART, identify different adherence strategies utilized and make recommendations for an improved adherence strategy. This mixed method parallel convergent study will be conducted in seven high volume public health facilities in Gauteng and one in Limpopo province in South Africa. The study consists of four phases; a retrospective secondary data analysis of a large cohort of patients on ART (using TIER.Net, an ART patient and data management system for recording and monitoring patients on ART and tuberculosis (TB)) from seven Johannesburg inner-city public health facilities (Gauteng province); a secondary data analysis of the Intensified Treatment Monitoring Accumulation (ITREMA) trial (a randomized control trial which ran from June 2015 to January 2019) conducted at the Ndlovu Medical Center (Limpopo province); in-depth interviews with people living with Human Immunodeficiency Virus (PLHIV) who are taking ART (in both urban and rural settings); and a systematic review of the impact of treatment adherence interventions for chronic conditions in sub-Saharan Africa. Data will be collected on demographics, socio-economic status, treatment support, retention in care status, disclosure, stigma, clinical markers (CD4 count and viral load (VL)), self-reported adherence information, intrapersonal, and interpersonal factors, community networks, and policy level factors. The systematic review will follow the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) reporting and Population, Interventions, Comparisons and Outcomes (PICO) criteria. Analyses will involve tests of association (Chi-square and t-test), thematic analysis (deductive and inductive approaches) and network meta-analysis. Using an integrated multilevel socio-ecological framework this study will describe the factors associated with adherence for PLHIV who are taking first-line or second-line ART. Implementing evidence-based adherence approaches, when taken up, will improve patient\u2019s overall health outcomes. Our study results will provide guidance regarding context-specific intervention strategies to improve ART adherence.<\/jats:p>","DOI":"10.1371\/journal.pone.0261107","type":"journal-article","created":{"date-parts":[[2021,12,21]],"date-time":"2021-12-21T13:38:40Z","timestamp":1640093920000},"page":"e0261107","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":4,"title":["Study protocol: Strengthening understanding of effective adherence strategies for first-line and second-line antiretroviral therapy (ART) in selected rural and urban communities in South Africa"],"prefix":"10.1371","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7870-1363","authenticated-orcid":true,"given":"Siphamandla Bonga","family":"Gumede","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John Benjamin Frank","family":"de Wit","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4157-732X","authenticated-orcid":true,"given":"Willem Daniel Francois","family":"Venter","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3597-1643","authenticated-orcid":true,"given":"Samanta Tresha","family":"Lalla-Edward","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2021,12,21]]},"reference":[{"key":"pone.0261107.ref001","article-title":"Optimizing ART Adherence: Update for HIV Treatment and Prevention","author":"RN Robbins","year":"2014","journal-title":"Current HIV\/AIDS Reports"},{"key":"pone.0261107.ref002","article-title":"The Consistency of Adherence to Antiretroviral Therapy Predicts Biologic Outcomes for Human Immunodeficiency Virus\u2013Infected Persons in Clinical Trials","author":"S Mannheimer","year":"2002","journal-title":"Clin Infect Dis"},{"key":"pone.0261107.ref003","article-title":"Modest nonadherence to antiretroviral therapy promotes residual HIV-1 replication in the absence of virological rebound in plasma","author":"AO Pasternak","year":"2012","journal-title":"J Infect Dis"},{"key":"pone.0261107.ref004","article-title":"Optimizing adherence to antiretroviral therapy","author":"S Sahay","year":"2011","journal-title":"Indian Journal of Medical Research"},{"key":"pone.0261107.ref005","unstructured":"World Health Organization. Section 1: Setting the scene [Internet]. 2003. https:\/\/www.who.int\/chp\/knowledge\/publications\/adherence_Section1.pdf (accessed 09 February 2020)."},{"key":"pone.0261107.ref006","unstructured":"World Health Organization. Consolidated guidelines on the use of antiretroviral drugs for treating and preventing HIV infection: recommendations for a public health approach [Internet]. WHO Guidelines. 2013. https:\/\/apps.who.int\/iris\/bitstream\/handle\/10665\/85321\/9789241505727_eng.pdf?sequence=1 (accessed 09 February 2020)."},{"key":"pone.0261107.ref007","article-title":"A novel human immunodeficiency virus type 1 reverse transcriptase mutational pattern confers phenotypic lamivudine resistance in the absence of mutation 184V","author":"K Hertogs","year":"2000","journal-title":"Antimicrob Agents Chemother"},{"key":"pone.0261107.ref008","article-title":"Antiretroviral resistance and high-risk transmission behavior among HIV-positive patients in clinical care","author":"MJ Kozal","year":"2004","journal-title":"AIDS"},{"key":"pone.0261107.ref009","article-title":"Adherence to antiretroviral therapy among people living with HIV","author":"B Achappa","year":"2013","journal-title":"N Am J Med Sci"},{"key":"pone.0261107.ref010","article-title":"Genetic barrier to resistance for dolutegravir","author":"JM Llibre","year":"2015","journal-title":"AIDS reviews"},{"key":"pone.0261107.ref011","article-title":"Clinical pharmacokinetic, pharmacodynamic and drug-interaction profile of the integrase inhibitor dolutegravir","author":"ML Cottrell","year":"2013","journal-title":"Clinical Pharmacokinetics"},{"key":"pone.0261107.ref012","unstructured":"World Health Organization. Update of recommendations on first-and second-line antiretroviral regimens [Internet]. 2019. https:\/\/apps.who.int\/iris\/bitstream\/handle\/10665\/325892\/WHO-CDS-HIV-19.15-eng.pdf (accessed 10 February 2020)."},{"key":"pone.0261107.ref013","article-title":"HIV Treatment Adherence, Drug Resistance, Virologic Failure: Evolving Concepts","author":"J B. Nachega","year":"2011","journal-title":"Infect Disord\u2014Drug Targets"},{"key":"pone.0261107.ref014","article-title":"Factors influencing antiretroviral treatment suboptimal adherence among perinatally hivinfected adolescents in Thailand","author":"L Xu","year":"2017","journal-title":"PLoS One"},{"key":"pone.0261107.ref015","article-title":"Predicting the Need for Third-Line Antiretroviral Therapy by Identifying Patients at High Risk for Failing Second-Line Antiretroviral Therapy in South Africa","author":"D Onoya","year":"2017","journal-title":"AIDS Patient Care STDS"},{"issue":"3","key":"pone.0261107.ref016","doi-asserted-by":"crossref","first-page":"e146","DOI":"10.1016\/S2352-3018(17)30190-X","article-title":"Cost-effectiveness of public-health policy options in the presence of pretreatment NNRTI drug resistance in sub-Saharan Africa: a modelling study","volume":"5","author":"AN Phillips","year":"2018","journal-title":"Lancet HIV"},{"issue":"6","key":"pone.0261107.ref017","doi-asserted-by":"crossref","first-page":"915","DOI":"10.1097\/QAD.0b013e3283360976","article-title":"The high cost of second-line antiretroviral therapy for HIV\/AIDS in South Africa","volume":"24","author":"L Long","year":"2010","journal-title":"AIDS"},{"key":"pone.0261107.ref018","article-title":"Adherence to HAART: A systematic review of developed and developing nation patient-reported barriers and facilitators","author":"EJ Mills","year":"2006","journal-title":"PLoS Medicine"},{"key":"pone.0261107.ref019","article-title":"Adherence to antiretroviral therapy in sub-Saharan Africa and North America: A meta-analysis","author":"EJ Mills","year":"2006","journal-title":"Journal of the American Medical Association"},{"key":"pone.0261107.ref020","article-title":"Barriers to access to antiretroviral treatment in developing countries: A review","author":"M Posse","year":"2008","journal-title":"Tropical Medicine and International Health"},{"key":"pone.0261107.ref021","article-title":"Strategies for promoting adherence to antiretroviral therapy: A review of the literature","author":"JM Simoni","year":"2008","journal-title":"Current Infectious Disease Reports"},{"key":"pone.0261107.ref022","article-title":"An Ecological Perspective on Medication Adherence","author":"L Berben","year":"2012","journal-title":"West J Nurs Res"},{"key":"pone.0261107.ref023","article-title":"Development and Validation of the Physician-Patient Humor Rating Scale","author":"KB Haskard Zolnierek","year":"2009","journal-title":"J Health Psychol"},{"key":"pone.0261107.ref024","article-title":"Patient-reported barriers and drivers of adherence to antiretrovirals in sub-Saharan Africa: A meta-ethnography","author":"S Merten","year":"2010","journal-title":"Trop Med Int Heal"},{"key":"pone.0261107.ref025","article-title":"Elements of the HIV care continuum: Improving engagement and retention in care","author":"MJ Mugavero","year":"2016","journal-title":"Top Antivir Med"},{"key":"pone.0261107.ref026","article-title":"The right combination\u2014treatment outcomes among HIV-positive patients initiating first-line fixed-dose antiretroviral therapy in a public sector HIV clinic in johannesburg, South Africa","author":"K Hirasen","year":"2018","journal-title":"Clin Epidemiol"},{"issue":"12","key":"pone.0261107.ref027","doi-asserted-by":"crossref","first-page":"696","DOI":"10.1093\/trstmh\/trx003","article-title":"Markers of poor adherence among adults with HIV attending Themba Lethu HIV Clinic, Helen Joseph Hospital, Johannesburg, South Africa","volume":"110","author":"M Nnambalirwa","year":"2016","journal-title":"Trans R Soc Trop Med Hyg"},{"key":"pone.0261107.ref028","doi-asserted-by":"crossref","first-page":"495","DOI":"10.1097\/QAI.0000000000000770","article-title":"A randomized controlled trial of real-time electronic adherence monitoring with text message dosing reminders in people starting first-line antiretroviral therapy","author":"C Orrell","year":"2015","journal-title":"Journal of Acquired Immune Deficiency Syndromes"},{"key":"pone.0261107.ref029","first-page":"1","author":"Z Shubber","year":"2016","journal-title":"Patient-Reported Barriers to Adherence to Antiretroviral Therapy: A Systematic Review and Meta-Analysis"},{"key":"pone.0261107.ref030","article-title":"Using Anderson\u2019s model of health service utilization to examine use of services by adolescent girls in south-eastern Nigeria","author":"EC Azfredrick","year":"2016","journal-title":"Int J Adolesc Youth"},{"key":"pone.0261107.ref031","unstructured":"ESRC. The Dahlgren\u2013Whitehead rainbow model of health. Economic and Social Research Council. 2018."},{"issue":"5","key":"pone.0261107.ref032","doi-asserted-by":"crossref","first-page":"1246","DOI":"10.2337\/dc13-1828","article-title":"Empirical validation of the information-motivation-behavioral skills model of diabetes medication adherence: A framework for intervention","volume":"37","author":"LS Mayberry","year":"2014","journal-title":"Diabetes Care"},{"key":"pone.0261107.ref033","first-page":"979","article-title":"Information-motivation-behavioral skills barriers associated with intentional versus unintentional ARV non-adherence behavior among HIV+ patients in clinical care","author":"WE Norton","year":"2010","journal-title":"AIDS Care\u2014Psychological and Socio-Medical Aspects of AIDS\/HIV"},{"issue":"6","key":"pone.0261107.ref034","doi-asserted-by":"crossref","first-page":"828","DOI":"10.1177\/1359105309357092","article-title":"The effectiveness of the information-motivation-behavioral skills model in promoting adherence in CABG patients","volume":"15","author":"F Zarani","year":"2010","journal-title":"J Health Psychol"},{"key":"pone.0261107.ref035","article-title":"Social Ecological Approaches to Individuals and Their Contexts: Twenty Years of Health Education & Behavior Health Promotion Interventions","author":"SD Golden","year":"2012","journal-title":"Heal Educ Behav"},{"key":"pone.0261107.ref036","article-title":"The state of engagement in HIV care in the United States: From cascade to continuum to control","author":"KH Mayer","year":"2013","journal-title":"Clinical Infectious Diseases"},{"key":"pone.0261107.ref037","article-title":"Descriptive analysis of World Health Organization-recommended second-line antiretroviral treatment: A retrospective cohort data analysis","author":"SB Gumede","year":"2019","journal-title":"South African Med J"},{"key":"pone.0261107.ref038","article-title":"Understanding adherence in virally suppressed and unsuppressed human immunodeficiency virus-positive urban patients on second-line antiretroviral treatment","author":"SB Gumede","year":"2020","journal-title":"South Afr J HIV Med"},{"issue":"1","key":"pone.0261107.ref039","doi-asserted-by":"crossref","DOI":"10.1186\/s12879-014-0664-3","article-title":"Short term adherence tool predicts failure on second line protease inhibitor-based antiretroviral therapy: An observational cohort study","volume":"14","author":"R Court","year":"2014","journal-title":"BMC Infect Dis"},{"issue":"1","key":"pone.0261107.ref040","doi-asserted-by":"crossref","first-page":"e12","DOI":"10.1016\/S2352-3018(14)00007-1","article-title":"Partner-Focused Adherence Intervention for Second-line Antiretroviral Therapy: A Multinational Randomized Trial (ACTG A5234)","volume":"2","author":"R Gross","year":"2015","journal-title":"lancet HIV"},{"issue":"10","key":"pone.0261107.ref041","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1371\/journal.pone.0186557","article-title":"Changing the South African national antiretroviral therapy guidelines: The role of cost modelling","volume":"12","author":"G Meyer-Rath","year":"2017","journal-title":"PLoS One"},{"key":"pone.0261107.ref042","article-title":"Early Warning Indicators for First-Line Virologic Failure Independent of Adherence Measures in a South African Urban Clinic","author":"VC Marconi","year":"2013","journal-title":"AIDS Patient Care STDS"},{"issue":"4","key":"pone.0261107.ref043","first-page":"1","article-title":"Assessing the association between changing NRTIs when initiating second-line ART and treatment outcomes","volume":"77","author":"JK Rohr","year":"2017","journal-title":"JAIDS J Acquir Immune Defic Syndr"},{"issue":"8","key":"pone.0261107.ref044","doi-asserted-by":"crossref","first-page":"768","DOI":"10.1097\/INF.0000000000001547","article-title":"Transitioning to Second-line Antiretroviral Therapy among Adolescents in Copperbelt Province, Zambia: Predictors of Treatment Switching and Adherence to Second-line Regimens","volume":"36","author":"RM Stalter","year":"2017","journal-title":"Pediatr Infect Dis J"},{"issue":"1","key":"pone.0261107.ref045","doi-asserted-by":"crossref","DOI":"10.1186\/1748-5908-8-19","article-title":"Developing a measure of provider adherence to improve the implementation of behavioral health services in primary care: A Delphi study","volume":"8","author":"GP Beehler","year":"2013","journal-title":"Implement Sci"},{"issue":"8","key":"pone.0261107.ref046","doi-asserted-by":"crossref","first-page":"510","DOI":"10.1111\/j.1468-1293.2010.00825.x","article-title":"Second-line treatment in the Malawi antiretroviral programme: high early mortality, but good outcomes in survivors, despite extensive drug resistance at baseline","volume":"11","author":"MC Hosseinipour","year":"2010","journal-title":"HIV Med"},{"key":"pone.0261107.ref047","article-title":"Risk of viral failure declines with duration of suppression on highly active antiretroviral therapy irrespective of adherence level","author":"VD Lima","year":"2010","journal-title":"J Acquir Immune Defic Syndr"},{"key":"pone.0261107.ref048","unstructured":"South African Antiretroviral Treatment Guidelines (Adult) 2015. 2015;(June):6782 (accessed 16 January 2021)."},{"issue":"April","key":"pone.0261107.ref049","first-page":"1","article-title":"National Consolidated Guidelines for the Prevention of Mother-To-Child Transmission of HIV (PMTCT) and the Managment of HIV in Children, Adolescents and Adults","author":"South African National Department of Health","year":"2015","journal-title":"Dep Heal Repub South Africa"},{"key":"pone.0261107.ref050","unstructured":"South African National Department of Health. Health indicators update: antiretroviral indicators [Internet]. Pretoria; 2013. https:\/\/www.uio.no\/studier\/emner\/matnat\/ifi\/INF5761\/v14\/timeplan\/artprogramme-overview-from-2004-to-2013_ndoh-2013.pdf (accessed 16 January 2021)."},{"key":"pone.0261107.ref051","unstructured":"Wensing AMJ. The Intensified Treatment Monitoring Strategy to Prevent Accumulation of Drug Resistance (ITREMA) Trial. https:\/\/clinicaltrials.gov\/show\/NCT03357588. 2017."},{"key":"pone.0261107.ref052","article-title":"Optimizing measurement of self-reported adherence with the ACTG adherence questionnaire: A cross-protocol analysis","author":"NR Reynolds","year":"2007","journal-title":"J Acquir Immune Defic Syndr"},{"key":"pone.0261107.ref053","unstructured":"World Health Organization. Consolidated guidelines on the use of antiretroviral drugs for treating and preventing HIV infection: recommendations for a public health approach. WHO Guidel. 2013; https:\/\/doi.org\/9789241505727 (accessed 16 January 2021)."},{"key":"pone.0261107.ref054","article-title":"Thematic Analysis Revised\u2014Final","author":"V Braun","year":"2006","journal-title":"Qualitative Research in Psychology"},{"key":"pone.0261107.ref055","article-title":"Using thematic analysis in psychology","author":"V Braun","year":"2006","journal-title":"Qual Res Psychol"},{"key":"pone.0261107.ref056","article-title":"Preferred reporting items for systematic reviews and meta-analyses: The PRISMA statement","author":"D Moher","year":"2009","journal-title":"PLoS Medicine"},{"key":"pone.0261107.ref057","author":"S Gumede","year":"2020","journal-title":"Adherence strategies and interventions for selected chronic conditions in sub-Saharan Africa: a systematic review and meta-analysis"},{"key":"pone.0261107.ref058","article-title":"Estimating the prevalence and awareness rates of hypertension in Africa: A systematic analysis","author":"D Adeloye","year":"2014","journal-title":"PLoS One"},{"key":"pone.0261107.ref059","article-title":"Diabetes in sub-Saharan Africa: from clinical care to health policy","author":"R Atun","year":"2017","journal-title":"The Lancet Diabetes and Endocrinology"},{"key":"pone.0261107.ref060","article-title":"Convergence of non-communicable and infectious diseases in low- and middle-income countries","author":"J V. Remais","year":"2013","journal-title":"Int J Epidemiol"},{"key":"pone.0261107.ref061","article-title":"Grading quality of evidence and strength of recommendations in clinical practice guidelines Part 3 of 3. the GRADE approach to developing recommendations","author":"JL Broazek","year":"2011","journal-title":"Allergy: European Journal of Allergy and Clinical Immunology"},{"key":"pone.0261107.ref062","article-title":"GRADE guidelines: 1. Introduction\u2014GRADE evidence profiles and summary of findings tables","author":"G Guyatt","year":"2011","journal-title":"J Clin Epidemiol"},{"key":"pone.0261107.ref063","article-title":"Interventions to improve adherence to antiretroviral therapy: a systematic review and network meta-analysis","author":"S Kanters","year":"2017","journal-title":"Lancet HIV"},{"key":"pone.0261107.ref064","article-title":"Violence a global public health problem","author":"LL Dahlberg","year":"2006","journal-title":"Ciencia e Saude Coletiva"},{"key":"pone.0261107.ref065","article-title":"Facility-level factors influencing retention of patients in HIV care in East Africa","author":"B Rachlis","year":"2016","journal-title":"PLoS One"},{"key":"pone.0261107.ref066","article-title":"Gender-related differences in outcomes and attrition on antiretroviral treatment among an HIV-infected patient cohort in Zimbabwe: 2007\u20132010","author":"KC Takarinda","year":"2015","journal-title":"Int J Infect Dis"},{"key":"pone.0261107.ref067","article-title":"Masculinity as a barrier to men\u2019s use of HIV services in Zimbabwe","author":"M Skovdal","year":"2011","journal-title":"Global Health"},{"key":"pone.0261107.ref068","article-title":"Intensive adherence counselling for HIV-infected individuals failing second-line antiretroviral therapy in Johannesburg, South Africa","author":"MP Fox","year":"2016","journal-title":"Trop Med Int Heal"},{"key":"pone.0261107.ref069","article-title":"Interventions for enhancing medication adherence","author":"R Nieuwlaat","year":"2014","journal-title":"Cochrane Database of Systematic Reviews"},{"key":"pone.0261107.ref070","article-title":"Partner-based adherence intervention for second-line antiretroviral therapy (ACTG A5234): A multinational randomised trial","author":"R Gross","year":"2015","journal-title":"Lancet HIV"},{"key":"pone.0261107.ref071","article-title":"HIV\/AIDS stigma-associated attitudes in a rural Ethiopian community: Characteristics, correlation with HIV knowledge and other factors, and implications for community intervention","author":"AR Lifson","year":"2012","journal-title":"BMC Int Health Hum Rights"},{"key":"pone.0261107.ref072","article-title":"Barriers to antiretroviral therapy adherence in developed countries: a qualitative synthesis to develop a conceptual framework for a new patient-reported outcome measure","author":"K Engler","year":"2018","journal-title":"AIDS Care\u2014Psychol Socio-Medical Asp AIDS\/HIV"},{"key":"pone.0261107.ref073","article-title":"Vulnerability of socio\u2014ecological systems: A conceptual Framework","author":"LM Berrouet","year":"2018","journal-title":"Ecol Indic"},{"issue":"1","key":"pone.0261107.ref074","doi-asserted-by":"crossref","first-page":"1","DOI":"10.4102\/sajhivmed.v18i1.776","article-title":"Adult antiretroviral therapy guidelines 2017","volume":"18","author":"G Meintjes","year":"2017","journal-title":"South Afr J HIV Med"}],"container-title":["PLOS ONE"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0261107","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,11,14]],"date-time":"2023-11-14T13:46:14Z","timestamp":1699969574000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0261107"}},"subtitle":[],"editor":[{"given":"Obinna Ikechukwu","family":"Ekwunife","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2021,12,21]]},"references-count":74,"journal-issue":{"issue":"12","published-online":{"date-parts":[[2021,12,21]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0261107","relation":{"has-preprint":[{"id-type":"doi","id":"10.1101\/2021.05.04.21256648","asserted-by":"object"}]},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,12,21]]}}}