{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,12]],"date-time":"2026-05-12T18:09:48Z","timestamp":1778609388884,"version":"3.51.4"},"reference-count":55,"publisher":"Public Library of Science (PLoS)","issue":"5","license":[{"start":{"date-parts":[[2026,5,12]],"date-time":"2026-05-12T00:00:00Z","timestamp":1778544000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:sec id=\"sec001\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>HIV pre-exposure prophylaxis (PrEP) is an effective biomedical intervention for preventing HIV acquisition. Using nationally representative data from Ghana, this study examined the factors associated with awareness of and positive attitudes toward PrEP among women of reproductive age.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec002\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>The study utilised nationally representative data from the 2022 Ghana Demographic and Health Survey, with a weighted sample of 13,980 women. The outcome variable was awareness of and positive attitudes toward PrEP, assessed based on whether respondents had heard of PrEP and approved of people taking it to prevent acquiring HIV. Data analysis was conducted using Stata 18, employing a multilevel logistic regression model to examine factors associated with awareness of and positive attitudes toward PrEP. Results were reported as adjusted odds ratios (aOR) with 95% confidence intervals (CI).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec003\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Overall, 12.1% (95% CI: 11.1\u201313.3) of women were aware of PrEP and had positive attitudes toward it. The Ahafo region had the highest proportion of women with awareness of and positive attitudes toward PrEP (21.1% [95% CI: 15.7\u201327.7]), whereas the Savannah region had the lowest (7.2% [95% CI: 5.3\u20139.9]). Women with two or more sexual partners had lower odds of being aware of and having positive attitudes toward PrEP (aOR = 0.51, 95% CI: 0.28\u20130.96) than those with no partner. Women aged 25\u201329 (aOR = 1.75, 95% CI: 1.28\u20132.40), 30\u201334 (aOR = 1.61, 95% CI: 1.14\u20132.27), 35\u201339 (aOR = 1.69, 95% CI: 1.22\u20132.32), and 40\u201344 (aOR = 1.48, 95% CI: 1.03\u20132.12) had higher odds of awareness of and positive attitudes toward PrEP than women aged 15\u201319 years. Also, higher odds of awareness of and positive attitudes toward PrEP were observed among women who had heard about other sexually transmitted infections (STIs) (aOR = 1.79, 95% CI: 1.40\u20132.28), had secondary (aOR = 1.34, 95% CI: 1.06-1.70) and higher education (aOR = 3.27, 95% CI: 2.35\u20134.55), and listened to radio (aOR = 1.20, 95% CI: 1.01\u20131.43), compared with those who have not heard of STIs, those with no education, and those who did not listen to the radio, respectively. Additionally, women from Central (aOR = 3.28, 95% CI: 1.76\u20136.12), Volta (aOR = 3.28, 95% CI: 1.63\u20136.62), Western North (aOR = 2.59, 95% CI: 1.26\u20135.29), Ahafo (aOR = 5.02, 95% CI: 2.54\u20139.91), Bono (aOR = 2.87, 95% CI: 1.37\u20136.02), Bono East (aOR = 2.87, 95% CI: 1.56\u20135.26), Oti (aOR = 5.64, 95% CI: 3.06\u201310.39), Northern (aOR = 2.47, 95% CI: 1.10\u20135.51), Upper East (aOR = 4.17, 95% CI: 2.05\u20138.50), and Upper West (aOR = 3.62, 95% CI: 1.85\u20137.08) regions had higher odds of awareness of and positive attitudes toward PrEP than those in the Western region.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec004\">\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>About 1 in 10 women in Ghana were aware of PrEP and held positive attitudes toward it. The factors associated with awareness of and positive attitudes toward PrEP\u00a0included women\u2019s age, educational level, number of sexual partners, listening to the radio, hearing about other STIs, and geographical regions. Policymakers and healthcare providers should focus on interventions that address regional inequalities and barriers to PrEP awareness and facilitate uptake to strengthen HIV prevention efforts in Ghana.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1371\/journal.pone.0347111","type":"journal-article","created":{"date-parts":[[2026,5,12]],"date-time":"2026-05-12T17:30:58Z","timestamp":1778607058000},"page":"e0347111","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":0,"title":["Awareness of and positive attitudes toward HIV pre-exposure prophylaxis among reproductive-aged women in Ghana: A multilevel analysis of the 2022 Demographic and Health Survey"],"prefix":"10.1371","volume":"21","author":[{"ORCID":"https:\/\/orcid.org\/0009-0002-7861-1365","authenticated-orcid":true,"given":"Florence Gyembuzie","family":"Wongnaah","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gilbert","family":"Eshun","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mainprice","family":"Akuoko Essuman","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Collins","family":"Adu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Richard Gyan","family":"Aboagye","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"340","published-online":{"date-parts":[[2026,5,12]]},"reference":[{"key":"pone.0347111.ref001","doi-asserted-by":"crossref","DOI":"10.1097\/QAI.0000000000003344","article-title":"Updated Data and Methods for the 2023 UNAIDS HIV Estimates","volume":"95","author":"C van Schalkwyk","year":"2024","journal-title":"J Acquir Immune Defic Syndr"},{"key":"pone.0347111.ref002","author":"World Health Organization","year":"2023"},{"key":"pone.0347111.ref003","article-title":"Overview of the epidemiological conditions of HIV among key populations in Africa","author":"H Jin","year":"2021","journal-title":"J Int AIDS Soc"},{"issue":"3","key":"pone.0347111.ref004","first-page":"46","article-title":"The global burden of HIV and progress toward the 2030 UNAIDS targets: a comprehensive review","volume":"3","author":"G Mwangi","year":"2024","journal-title":"J Glob Health"},{"key":"pone.0347111.ref005","article-title":"HIV estimates through 2018: data for decision-making","author":"M Mahy","year":"2019","journal-title":"AIDS"},{"key":"pone.0347111.ref006","doi-asserted-by":"crossref","DOI":"10.1016\/S2352-3018(24)00212-1","article-title":"Global, regional, and national burden of HIV\/AIDS, 1990\u20132021, and forecasts to 2050: the Global Burden of Disease Study 2021","volume":"11","author":"A Carter","year":"2024","journal-title":"Lancet HIV"},{"issue":"1","key":"pone.0347111.ref007","article-title":"What explains gender inequalities in HIV\/AIDS prevalence in sub-Saharan Africa? Evidence from the demographic and health surveys","volume":"16","author":"D Sia","year":"2016","journal-title":"BMC Public Health"},{"key":"pone.0347111.ref008","author":"World Health Organization","year":"2017"},{"issue":"6","key":"pone.0347111.ref009","doi-asserted-by":"crossref","first-page":"795","DOI":"10.1097\/QAD.0000000000001765","article-title":"HIV-positive women have higher risk of human papilloma virus infection, precancerous lesions, and cervical cancer","volume":"32","author":"G Liu","year":"2018","journal-title":"AIDS"},{"key":"pone.0347111.ref010","doi-asserted-by":"crossref","first-page":"191","DOI":"10.2147\/IDR.S91260","article-title":"Pelvic inflammatory disease: improving awareness, prevention, and treatment","volume":"9","author":"BB Das","year":"2016","journal-title":"Infect Drug Resist"},{"key":"pone.0347111.ref011","author":"Joint United Nations Programme on HIV\/AIDS UNAIDS","year":"2024"},{"issue":"1","key":"pone.0347111.ref012","doi-asserted-by":"crossref","first-page":"59","DOI":"10.4314\/gmj.v53i1.9","article-title":"Ghana\u2019s HIV epidemic and PEPFAR\u2019s contribution towards epidemic control","volume":"53","author":"H Ali","year":"2019","journal-title":"Ghana Med J"},{"key":"pone.0347111.ref013","author":"Ghana Health Service"},{"key":"pone.0347111.ref014","doi-asserted-by":"crossref","DOI":"10.1097\/QAI.0b013e3182986f69","article-title":"Preexposure prophylaxis for HIV prevention: where have we been and where are we going?","volume":"63","author":"JM Baeten","year":"2013","journal-title":"J Acquir Immune Defic Syndr"},{"key":"pone.0347111.ref015","first-page":"125","article-title":"Pre-exposure prophylaxis for sexually-acquired HIV risk management: a review","volume":"7","author":"J Wilton","year":"2015","journal-title":"HIV AIDS (Auckl)"},{"issue":"3","key":"pone.0347111.ref016","doi-asserted-by":"crossref","first-page":"363","DOI":"10.1007\/s40121-017-0159-9","article-title":"A Review of HIV Pre-Exposure Prophylaxis: The Female Perspective","volume":"6","author":"JL Bailey","year":"2017","journal-title":"Infect Dis Ther"},{"issue":"6","key":"pone.0347111.ref017","doi-asserted-by":"crossref","first-page":"579","DOI":"10.1007\/s11904-020-00533-y","article-title":"Understanding, Contextualizing, and Addressing PrEP Stigma to Enhance PrEP Implementation","volume":"17","author":"SK Calabrese","year":"2020","journal-title":"Curr HIV\/AIDS Rep"},{"issue":"4","key":"pone.0347111.ref018","doi-asserted-by":"crossref","first-page":"127","DOI":"10.1177\/10872914261424544","article-title":"Global Perspectives on Pre-Exposure Prophylaxis: A Systematic Review and Meta-Analysis of Health Care Providers\u2019 Awareness, Willingness, and Barriers","volume":"40","author":"TE Habtie","year":"2026","journal-title":"AIDS Patient Care STDS"},{"issue":"3","key":"pone.0347111.ref019","article-title":"Barriers to Pre-Exposure Prophylaxis (PrEP) use for HIV: an integrative review","volume":"76","author":"M Antonini","year":"2023","journal-title":"Rev Bras Enferm"},{"issue":"6","key":"pone.0347111.ref020","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pgph.0001956","article-title":"PrEP knowledge, acceptability, and implementation in Ghana: Perspectives of HIV service providers and MSM, trans women, and gender diverse individuals living with HIV","volume":"3","author":"AO Gyamerah","year":"2023","journal-title":"PLOS Glob Public Health"},{"issue":"1","key":"pone.0347111.ref021","doi-asserted-by":"crossref","first-page":"1253","DOI":"10.1186\/s12889-024-18717-1","article-title":"Knowledge and attitude to HIV pre exposure prophylaxis among women in five sub-Saharan African countries: a multilevel model analysis of population-based survey 2021-2022","volume":"24","author":"B Terefe","year":"2024","journal-title":"BMC Public Health"},{"issue":"1","key":"pone.0347111.ref022","doi-asserted-by":"crossref","first-page":"712","DOI":"10.1186\/s12879-023-08683-1","article-title":"Awareness of and willingness to use oral pre-exposure prophylaxis (PrEP) for HIV prevention among sexually active adults in Malawi: results from the 2020 Malawi population-based HIV impact assessment","volume":"23","author":"AN Kabaghe","year":"2023","journal-title":"BMC Infect Dis"},{"issue":"5","key":"pone.0347111.ref023","doi-asserted-by":"crossref","DOI":"10.1097\/MD.0000000000028798","article-title":"Willingness to take and ever use of pre-exposure prophylaxis among female sex workers in Ghana","volume":"101","author":"C Guure","year":"2022","journal-title":"Medicine (Baltimore)"},{"issue":"3","key":"pone.0347111.ref024","doi-asserted-by":"crossref","first-page":"330","DOI":"10.1080\/09540121.2019.1675858","article-title":"Knowledge and Acceptability of HIV pre-exposure prophylaxis (PrEP) among men who have sex with men (MSM) in Ghana","volume":"32","author":"A Ogunbajo","year":"2020","journal-title":"AIDS Care"},{"issue":"1","key":"pone.0347111.ref025","doi-asserted-by":"crossref","first-page":"1065","DOI":"10.1186\/s12889-023-15871-w","article-title":"Policymakers\u2019 and healthcare providers\u2019 perspectives on the introduction of oral pre-exposure prophylaxis for key populations in Ghana","volume":"23","author":"H Nagai","year":"2023","journal-title":"BMC Public Health"},{"key":"pone.0347111.ref026","doi-asserted-by":"crossref","first-page":"23259582231209649","DOI":"10.1177\/23259582231209649","article-title":"Awareness and Willingness to use Condoms and Preexposure Prophylaxis among Gay, Bisexual, and Other Cisgendered Men who Have sex with men in Slum Communities in Ghana. BSGH-004","volume":"22","author":"GR Abu-Ba\u2019are","year":"2023","journal-title":"J Int Assoc Provid AIDS Care"},{"issue":"1","key":"pone.0347111.ref027","doi-asserted-by":"crossref","first-page":"213","DOI":"10.1186\/s12879-025-10614-1","article-title":"Awareness, willingness, and uptake of pre-exposure prophylaxis (PrEP) among men who have sex with men in Ghana","volume":"25","author":"A Apreku","year":"2025","journal-title":"BMC Infect Dis"},{"key":"pone.0347111.ref028","article-title":"We have our reasons: exploring the acceptability of pre\u2011exposure prophylaxis among gay, bisexual, and other men who have sex with men in Ghana","volume":"2023","author":"G Aidoo\u2011Frimpong","year":"2023","journal-title":"medRxiv"},{"key":"pone.0347111.ref029","volume-title":"Ghana Demographic and Health Survey 2022","author":"Ghana Statistical Service, Ghana Health Service, ICF","year":"2023"},{"issue":"3","key":"pone.0347111.ref030","doi-asserted-by":"crossref","first-page":"218","DOI":"10.1071\/SH18081","article-title":"Drawing from the Theory of Planned Behaviour to examine pre-exposure prophylaxis uptake intentions among heterosexuals in high HIV prevalence neighbourhoods in Philadelphia, Pennsylvania, USA: an observational study","volume":"16","author":"A Roth","year":"2019","journal-title":"Sex Health"},{"issue":"4","key":"pone.0347111.ref031","doi-asserted-by":"crossref","first-page":"329","DOI":"10.5114\/hivar.2023.133168","article-title":"Awareness and willingness to use pre-exposure prophylaxis (PrEP) and post-exposure prophylaxis (PEP) among sexually active adults in Ghana","volume":"22","author":"SN Eshun","year":"2023","journal-title":"HIV & AIDS Review"},{"issue":"5","key":"pone.0347111.ref032","doi-asserted-by":"crossref","first-page":"454","DOI":"10.1177\/0956462420912141","article-title":"High pre-exposure prophylaxis awareness and willingness to pay for pre-exposure prophylaxis among young adults in Western Kenya: results from a population-based survey","volume":"31","author":"ER Begnel","year":"2020","journal-title":"Int J STD AIDS"},{"issue":"9","key":"pone.0347111.ref033","article-title":"Adoption of HIV pre-exposure prophylaxis among women at high risk of HIV infection in Kenya","volume":"17","author":"CH Bien-Gund","year":"2022","journal-title":"PLoS One"},{"key":"pone.0347111.ref034","volume-title":"National and Sub-National HIV and AIDS Estimates and Projections Report 2023 [Internet]","author":"Ghana AIDS Commission","year":"2023"},{"issue":"2","key":"pone.0347111.ref035","doi-asserted-by":"crossref","first-page":"151","DOI":"10.1080\/19317611.2016.1153560","article-title":"MSM\u2019s Versus Health Care Providers\u2019 Perceptions of Barriers to Uptake of HIV\/AIDS-Related Interventions: Systematic Review and Meta-Synthesis of Qualitative and Quantitative Evidence","volume":"28","author":"H Wao","year":"2016","journal-title":"International Journal of Sexual Health"},{"issue":"5","key":"pone.0347111.ref036","doi-asserted-by":"crossref","first-page":"15579883231201729","DOI":"10.1177\/15579883231201729","article-title":"Oral Pre-exposure Prophylaxis Uptake and Acceptability Among Men Who Have Sex With Men: A Scoping Review of the Literature","volume":"17","author":"PL Moyo","year":"2023","journal-title":"Am J Mens Health"},{"issue":"1","key":"pone.0347111.ref037","doi-asserted-by":"crossref","first-page":"619","DOI":"10.1186\/s12889-024-18105-9","article-title":"Comprehensive knowledge about HIV\/AIDS and associated factors among reproductive age women in Liberia","volume":"24","author":"BL Seifu","year":"2024","journal-title":"BMC Public Health"},{"key":"pone.0347111.ref038","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1155\/2018\/5784902","article-title":"Parents\u2019 Experiences and Sexual Topics Discussed with Adolescents in the Accra Metropolis, Ghana: A Qualitative Study","volume":"2018","author":"EAk Baku","year":"2018","journal-title":"Advances in Public Health"},{"issue":"1","key":"pone.0347111.ref039","doi-asserted-by":"crossref","first-page":"1456","DOI":"10.1186\/s12913-023-10447-1","article-title":"Adolescent perception of sexual and reproductive health rights and access to reproductive health information and services in Adaklu District of the Volta Region, Ghana","volume":"23","author":"D Klu","year":"2023","journal-title":"BMC Health Serv Res"},{"issue":"3","key":"pone.0347111.ref040","doi-asserted-by":"crossref","first-page":"197","DOI":"10.1108\/JHR-10-2018-0119","article-title":"Barriers on access to and use of adolescent health services in Ghana","volume":"33","author":"AA Abuosi","year":"2019","journal-title":"JHR"},{"key":"pone.0347111.ref041","author":"UNAIDS","year":"2023"},{"issue":"1","key":"pone.0347111.ref042","doi-asserted-by":"crossref","DOI":"10.2196\/publichealth.8089","article-title":"Functional Knowledge of Pre-Exposure Prophylaxis for HIV Prevention Among Participants in a Web-Based Survey of Sexually Active Gay, Bisexual, and Other Men Who Have Sex With Men: Cross-Sectional Study","volume":"4","author":"EM Kahle","year":"2018","journal-title":"JMIR Public Health Surveill"},{"issue":"1","key":"pone.0347111.ref043","doi-asserted-by":"crossref","DOI":"10.4102\/phcfm.v15i1.4086","article-title":"Knowledge and attitudes of HIV pre-exposure prophylaxis among nurses in South Africa","volume":"15","author":"VC Bailey","year":"2023","journal-title":"Afr J Prim Health Care Fam Med"},{"key":"pone.0347111.ref044","first-page":"7313497","article-title":"Comprehensive Knowledge of HIV and AIDS among Ghanaian Adults from 1998 to 2014: A Multilevel Logistic Regression Model Approach","volume":"2020","author":"C Guure","year":"2020","journal-title":"Scientifica (Cairo)"},{"issue":"1","key":"pone.0347111.ref045","doi-asserted-by":"crossref","first-page":"45","DOI":"10.1186\/s12961-024-01128-4","article-title":"Comprehensive HIV knowledge and associated factors among reproductive-age women: analysis of the Gambia Demographic and Health Survey 2019\/2020","volume":"22","author":"M Tsegaw","year":"2024","journal-title":"Health Res Policy Syst"},{"issue":"8","key":"pone.0347111.ref046","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0273475","article-title":"Measuring socioeconomic inequalities in prenatal HIV test service uptake for prevention of mother to child transmission of HIV in East Africa: A decomposition analysis","volume":"17","author":"FH Astawesegn","year":"2022","journal-title":"PLoS One"},{"issue":"1","key":"pone.0347111.ref047","doi-asserted-by":"crossref","first-page":"1331538","DOI":"10.1080\/16549716.2017.1331538","article-title":"A generation at risk: a cross-sectional study on HIV\/AIDS knowledge, exposure to mass media, and stigmatizing behaviors among young women aged 15-24 years in Ghana","volume":"10","author":"CK Asamoah","year":"2017","journal-title":"Glob Health Action"},{"issue":"2","key":"pone.0347111.ref048","doi-asserted-by":"crossref","first-page":"59","DOI":"10.3390\/socsci6020066","article-title":"Challenges confronting rural dwellers in accessing health information in Ghana: Shai Osudoku District in perspective","volume":"6","author":"PP Sokey","year":"2017","journal-title":"Soc Sci"},{"key":"pone.0347111.ref049","doi-asserted-by":"crossref","DOI":"10.1017\/S1049023X19001626","article-title":"Public Information, Education, and Communication (IEC) of Health: Active Participation of Health Practitioners in Urban Radio in a Low Resource Setting","volume":"34","author":"J Bonney","year":"2019","journal-title":"Prehosp Disaster med"},{"issue":"8","key":"pone.0347111.ref050","doi-asserted-by":"crossref","first-page":"1119","DOI":"10.1080\/09540121.2023.2297739","article-title":"Evaluation of a community-informed multimedia intervention to increase PrEP awareness and intention among African American young adults","volume":"36","author":"J Kerr","year":"2024","journal-title":"AIDS Care"},{"issue":"10","key":"pone.0347111.ref051","doi-asserted-by":"crossref","first-page":"1211","DOI":"10.1080\/09540120902730047","article-title":"Multiple sex partners and perceived risk of HIV infection in Zambia: attitudinal determinants and gender differences","volume":"21","author":"M Do","year":"2009","journal-title":"AIDS Care"},{"issue":"9","key":"pone.0347111.ref052","doi-asserted-by":"crossref","first-page":"2881","DOI":"10.1007\/s10461-022-03632-6","article-title":"Women\u2019s Perceptions of HIV- and Sexuality-Related Stigma in Relation to PrEP: Qualitative Findings from the Masibambane Study, Durban, South Africa","volume":"26","author":"S Bergam","year":"2022","journal-title":"AIDS Behav"},{"issue":"9","key":"pone.0347111.ref053","doi-asserted-by":"crossref","first-page":"730","DOI":"10.4172\/2155-6113.1000730","article-title":"Stigma, Partners, Providers and Costs: Potential Barriers to PrEP Uptake among US Women","volume":"8","author":"L Goparaju","year":"2017","journal-title":"J AIDS Clin Res"},{"key":"pone.0347111.ref054","doi-asserted-by":"crossref","first-page":"305","DOI":"10.1186\/s12913-025-12226-6","article-title":"Barriers to healthcare services utilisation among women in Ghana: evidence from the 2022 Ghana Demographic and Health Survey","volume":"25","author":"FG Wongnaah","year":"2025","journal-title":"BMC Health Serv Res"},{"key":"pone.0347111.ref055","author":"MIHOSO International Foundation","year":"2023"}],"container-title":["PLOS One"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0347111","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,12]],"date-time":"2026-05-12T17:31:08Z","timestamp":1778607068000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0347111"}},"subtitle":[],"editor":[{"given":"Anthony Mwinilanaa","family":"Tampah-Naah","sequence":"first","affiliation":[],"role":[{"role":"editor","vocabulary":"crossref"}]}],"short-title":[],"issued":{"date-parts":[[2026,5,12]]},"references-count":55,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2026,5,12]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0347111","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,5,12]]}}}